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Working outside of the box: How HIV counselors in Sub-Saharan Africa adapt Western HIV testing norms

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  • Angotti, Nicole

Abstract

The delivery of HIV counseling and testing programs throughout Sub-Saharan Africa relies on the work performed by trained HIV counselors. These individuals occupy a critical position: they are intermediaries between the rule-making of international and national policymakers, and the norms of the communities in which they live and work. This paper explains when, how and why HIV counselors adapt Western testing guidelines (the "3Cs" - consent, confidentiality and counseling) to local concerns, attempting to maintain the fidelity of testing principles, while reducing the harm they perceive may arise as a consequence of strict adherence to them. Data for this study come from Malawi: a poor, largely rural African country, where HIV prevalence is ranked 9th highest in the world. The analysis is based on 25 interviews with HIV counselors and a unique set of field journals, and captures local experiences and the moral quandaries that counselors in rural Sub-Saharan Africa face. The findings of this inquiry provide new insights into the implementation of HIV testing in rural African settings, insights that may guide HIV prevention policy.

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  • Angotti, Nicole, 2010. "Working outside of the box: How HIV counselors in Sub-Saharan Africa adapt Western HIV testing norms," Social Science & Medicine, Elsevier, vol. 71(5), pages 986-993, September.
    • Handle: RePEc:eee:socmed:v:71:y:2010:i:5:p:986-993
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    1. Sikstrom, Laura, 2018. "“There was no love there”: Intergenerational HIV disclosure, and late presentation for antiretroviral therapy in Northern Malawi," Social Science & Medicine, Elsevier, vol. 211(C), pages 175-182.
    2. Zhou, Amy, 2016. "The uncertainty of treatment: Women's use of HIV treatment as prevention in Malawi," Social Science & Medicine, Elsevier, vol. 158(C), pages 52-60.
    3. Heimer, Carol A., 2013. "‘Wicked’ ethics: Compliance work and the practice of ethics in HIV research," Social Science & Medicine, Elsevier, vol. 98(C), pages 371-378.
    4. Nicole Angotti & Amy Kaler, 2013. "The more you learn the less you know? Interpretive ambiguity across three modes of qualitative data," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 28(33), pages 951-980.

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