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An exploratory study into the factors that constrain or enable voluntary HIV testing among young adults in Cape Town, South Africa

Includes bibliographical references (leaves 73-81). / Despite exceptionally high HIV prevalence rates, South Africa experiences prohibitively low levels of HIV testing. Considered to be a key element in the prevention of HIV transmission and a necessary gateway for providing care and treatment for those who are infected, widespread ignorance of HIV status has become a mounting concern in countries with high prevalence rates. Strategies for increasing testing rates have most commonly focused on testing and treatment services, such as the availability and accessibility of clinics offering voluntary counselling and testing (VCT), the number of trained nurses and health practitioners able to administer HIV tests, the possibility of instituting routine HIV testing to increase coverage, and the provision of highly active antiretroviral treatment (HAART) in the event of a positive diagnosis. These efforts seek to either increase access to testing through infrastructural improvements or encourage testing by highlighting its function as a gateway to accessing medical services to manage HIV infection and future transmission. In a departure from these strategies, this thesis considers the physical, social, and psychological ramifications of living with HIV - and not simply issues of access, treatment, and prevention - in order to understand HIV testing practices. Qualitative in-depth interviews were conducted with 15 young adults (6 mole and 9 female) living in Cape Town, South Africa. Semi-structured in-depth interviews collected information about: 1) knowledge and sources of knowledge about HIV/AIDS, as well as how this knowledge changes over time; 2) beliefs and attitudes towards HIV and HIV testing, including corresponding health-seeking behaviours; 3) personal stories about HIV testing, including reasons for and reactions to testing; and 4) possible strategies to encourage HIV testing in the future. Study participants identified three broad threats that were perceived to be experienced by HIV positive people and explained how the HIV test served to either mitigate or expose an individual to these threats. Physical threats posed by HIV, such as opportunistic infections or death, encouraged HIV testing as it was only through testing that these potential threats could be mitigated. Conversely, an HIV test exposed an individual to social and psychological threats. The social threats of living with HIV included exclusion, rejection by family and friends, and social shame. Psychological threats included mental destruction, depression, and stress, among others. Where social and psychological threats were perceived to be strong, testing was actively avoided. The findings of this study are that the decision to voluntarily test for HIV can be explained through a balance of the physical, social, and psychological threats that may be managed or catalysed through an HIV test. When study participants perceived physical threats to outweigh perceived social and psychological threats of living with HIV, they were biased towards testing. When they viewed social and psychological threats to outweigh physical threats, they were biased against testing. This focus on the perceived threats of living with HIV highlights the need to have a comprehensive approach to AIDS and HIV, rather than merely focusing on the clinical diagnosis and treatment of symptoms; enhanced infrastructural resources and the opportunity for mitigation of the physical threats alone do not encourage HIV testing.
Date January 2008
CreatorsLane, Hannah
PublisherUniversity of Cape Town, Faculty of Humanities, Aids and Society Research Unit
Source SetsSouth African National ETD Portal
Detected LanguageEnglish
TypeMaster Thesis, Masters, MPhil

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