Research Report: Antenatal HIV testing from the perspective of pregnant women and health clinic staff in South Africa—implications for pre- and post-test counselling

HIV testing is not routinely available at present in health clinics in Umtata, South Africa. However current statistics indicate that up to 25% of the population may be infected. Such findings imply that HIV testing and counselling should be introduced in health clinics as a means of promoting HIV prevention and reducing the risk of vertical transmission. However this would only be beneficial if staff are prepared to implement it and patients are willing to test. The issues are couched in a background of political activity surrounding HIV that may question approaches to HIV testing and a lack of availability of interventions to prevent mother to infant transmission. Furthermore the infrastructures of counselling training and provision may not be universally available, especially in pressured rural clinics. Therefore, a group of clinic staff and pregnant women, in rural and urban health centres in Umtata, were asked to participate in focus group discussions to elicit attitudes to HIV testing and counselling. In principal the majority of women, particularly in the rural clinic, were willing to have an HIV test, and strongly articulated the desire to test with their partners. Women who were reluctant to test emphasized their fear of receiving the result. The rural women appeared to be far more willing to disclose their HIV status to clinic staff, than urban women. Nevertheless, the discussions illustrated the impact of the stigma surrounding HIV, with clinic staff reporting cases where patients who were suspected to be positive were avoided by health workers. However staff in both clinics were willing to make the effort to implement HIV tests if they were to be made available. Despite the non-availability of rapid testing and interventions to reduce mother to child transmission most women saw advantages to HIV test provision. Pessimism and fear were underlying emotions associated with HIV for both staff and women. The implications for pre- and post-test counselling are discussed.