Voluntary counselling and testing for HIV in a Zambian mining community: serial interviews with people testing negative
- 1Konkola Copper Mines, Medical Department, Community Medicine Section, Chingola, Zambia
- 2Primary Palliative Care Research Group, Centre for Population Health Sciences: General Practice Section, The University of Edinburgh Medical School, Teviot Place, Edinburgh, UK
- 3Research and Development Resource Centre, Lynebank Hospital, Dunfermline, Fife, UK
- 4Institute of Economic and Social Research, University of Zambia, Lusaka, Zambia
- Correspondence to Professor Scott A Murray, Primary Palliative Care Research Group, Centre for Population Health Sciences: General Practice Section, The University of Edinburgh Medical School, Teviot Place, Edinburgh, EH8 9AG, UK;
Contributors JS conducted the field work and primary analysis. All the authors designed the study, wrote this paper and agreed the final submission. JS the guarantor.
- Accepted 25 February 2011
- Published Online First 22 March 2011
Objective To understand the influence of voluntary counselling and testing (VCT) and an HIV-negative result on subsequent sexual behaviour; and to identify the specific felt needs of those testing negative.
Design Serial interviews, 6 months apart, with people who had tested negative, and three one-off focus group discussions with counsellors. Interviews were transcribed verbatim and analysed thematically. Paired transcripts were analysed longitudinally.
Participants Purposively sampled from first attenders for VCT who had tested negative.
Setting Four health-facility affiliated VCT centres in two mining towns in the Copperbelt Province of Zambia.
Results Participants in the 42 initial and 31 follow-up interviews understood VCT as ‘testing for HIV’. Most participants reported having adopted safer sexual behaviour months before attending VCT. They had already recognised personal susceptibility to HIV infection and reported engaging both emotionally and cognitively with the issues of testing. Ultimately attendance at testing was to know their status in order to regain control of their lives. Unmet post-test support needs were common and included additional information, supportive networks, life-skills training and access to recreational activities.
Conclusions In this population who tested HIV negative the majority said they had made life changes months before attending VCT. Counselling served to consolidate pre-test decisions about risk behaviour. Those testing HIV negative are underserved compared with those testing positive. We recommend that counselling for HIV should be de-linked from testing to encourage earlier attendance for counselling and that clients testing negative should receive more post-test support to help them remain HIV negative.
Funding British Commonwealth, Scholarships and Fellowships Plan.
Competing interests None.
Patient consent Obtained.
Ethics approval This study was conducted with the approval of the University of Edinburgh and the University of Zambia.
Provenance and peer review Not commissioned; externally peer reviewed.