Access Denied?: Consent for HIV Testing at Antenatal Clinics in Rural Malawi

Nicole Angotti, University of Texas at Austin
Kim Dionne, University of California, Los Angeles
Lauren Gaydosh, Invest in Knowledge Initiative (IKI)

HIV Testing has been touted as an important step toward the prevention and treatment of HIV/AIDS. Central to the standards of practice for HIV testing programs are two Western social norms: that testing be voluntary and that the results be confidential. During the last decade, HIV testing has been exported by international organizations to settings quite different from the West in terms of health infrastructure and social and cultural practices. The literature on technology transfer suggests new technologies not only diffuse, but are also adapted by their users to local circumstances. This paper examines one aspect of the way that HIV testing has been implemented in antenatal clinics in rural Malawi: the extent to which testing is voluntary. We consider the perceptions of those who have been tested, and those who have not but may nonetheless share these perceptions. Our results indicate that HIV testing is perceived as compulsory and necessary to receive antenatal care.