Open AccessCould you have said no? A mixed‐methods investigation of consent to HIV tests in four African countries
Author(s) -
Obermeyer Carla Makhlouf,
Verhulst Cairn,
Asmar Khalil
Publication year - 2014
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.17.1.18898
Subject(s) - medicine , informed consent , coercion (linguistics) , agency (philosophy) , test (biology) , family medicine , human immunodeficiency virus (hiv) , meaning (existential) , hiv test , qualitative research , alternative medicine , population , psychology , environmental health , health services , social science , pathology , paleontology , philosophy , linguistics , health facility , sociology , psychotherapist , biology
Although most studies report high frequencies of consent to HIV tests, critics argue that clients are subject to pressure, that acceptors later indicate they could not have refused, and that provider‐initiated HIV testing raises serious ethical issues. We examine the meaning of consent and why clients think they could not have refused. Methods Clients in Burkina Faso, Kenya, Malawi and Uganda were asked about consenting to HIV tests, whether they thought they could have refused and why. Textual responses were analyzed using qualitative and statistical methods. Results Among 926 respondents, 77% reported they could not have said no, but in fact, 60% actively consented to test, 24% had no objection and only 7% tested without consent. There were few significant associations between categories of consent and their covariates. Conclusions Retrospectively asking clients if they could have refused to test for HIV overestimates coercion. Triangulating qualitative and quantitative data suggests a considerable degree of agency.