An offer you can’t refuse? Provider-initiated HIV testing in antenatal clinics in rural Malawi
My paper with Lauren Gaydosh and Nicole Angotti is coming out in the next issue of Health Policy and Planning. It was mentioned on Berk Özler’s World Bank blog in a post about informed consent. Özler was one of the authors of the somewhat famous cash transfers to school girls in Malawi project (at least, if you consider making it to the Wikipedia page on CCTs as being famous). Here is the abstract:
International organizations promote provider-initiated, `routine’ HIV testing of pregnant women seeking antenatal care as an effort to curb mother-to-child transmission. We offer an account of the perceptions of HIV testing at antenatal clinics in rural Malawi. Although it is both international and Government of Malawi policy that women must be explicitly informed of their right to refuse testing, analysis of in-depth interviews, focus group discussions and evidence from observational field journals show that rural Malawians do not perceive HIV testing as a choice, but rather as compulsory in order to receive antenatal care. This study illustrates dissonance between global expectations and local realities of the delivery of HIV-testing interventions.
For copyright reasons, I cannot post a PDF here. However, if you cannot gain access to the article, you are welcome to email me and I will send you a copy.