In Mozambique, as in many countries, patients who receive a HIV test are informed of their results during a one-on-one post-test counseling session. For those who test positive, it is a critical first step in their treatment as it offers them a space to ask questions about their diagnosis, the anti-retroviral therapy (ART), and how they can care for their health and continue to live a full life. For those who test negative, it is an opportunity to discuss safe sexual practices and other preventative measures.
In the process of gathering feedback from the community regarding the challenges they face in accessing care at Chamanculo Health Centre in Maputo, the village health committee heard numerous complaints about breaches of confidentiality and privacy during these vital post-test HIV counseling sessions. The sessions were being conducted collectively — with multiple patients receiving their results together — and in the presence of other staff who were regularly coming into the room to file patient records.
The lack of privacy undermined the patients’ willingness to share personal information and ask questions. “They didn’t feel comfortable when they came in for care as they were ashamed to talk about their lives in an environment where strangers were present,” explains Hermenegilda Naftal, a member of the Chamanculo health committee. “At one of the health committee meetings here in the community, patients went so far as to say that they are afraid to return to the hospital to continue their HIV treatment because of lack of sensitivity on the part of counselors who do not respect confidentiality.”
To address this problem, the health committee members, along with a Namati health advocate, met with the head of the HIV department and the director of the health center. Both of them acknowledged the problem and pledged to take action. The health facility director called a meeting with the counselors involved to discuss the importance of providing humanized services during counseling sessions. She also convened the health facility management and together they identified an unused room in the maternity ward that could be used to accommodate counseling services and address the privacy concerns.
“[N]ow you can see that the environment in which care is provided is healthy and complies with the standards recommended by the national health system,” says Dr. Regina Macovela, director of Chamanculo Health Centre. “There’s also a sense that the providers are now more comfortable asking questions and talking with their patients. What I mean is that this problem was not only concerning for the health committee and the patients in terms of negatively impacting the demand for HIV testing; it was also negatively affecting health providers’ ability to do their work.”
The village health committee and health advocate have monitored the situation since the changes have been made and are happy to confirm that post-testing counseling sessions are conducted on an individual basis, in a room offering privacy and separated from the center’s filing cabinets.