Análisis de resultados

All the health care providers who participated in this study made statements that regarded the PMTCT programme as ‘decisive’, ‘fundamental’, ‘very important’, ‘beneficial’ for the prevention of HIV transmission in paediatric AIDS. However, the pre-test counselling (pre-test information to use the terminology of the 2007 Ethiopian PMTCT guideline) was not perceived as a process of empowering pregnant women to make an autonomous decision but rather as a process of convincing or persuading them to take the HIV antibody testing. The quote below captures the above dimension well:

175

‘Our government wants us to convince women to take HIV testing during their

pregnancies. The government believes that here in Ethiopia we do not have a deaf [who

do not accept advices] mother.... there is no deaf woman in our country. There is no mother who does not want to be benefited and avoid harm on herself and her family ... as long as we educated her, we showed her the right way, and we make her understand. I personally believe that this is true. What mothers need is that you need to teach them to

the last [until they are convinced] and they will agree with the testing.’ (HEW1, Ofla)

This firm stand of health workers that if women are properly told they do accept medical advice was reflected throughout the interviews with all health workers who participated in this study. The following quotations from participants appear to support this:

‘... Those women who refused HIV testing are counselled up to the last... and eventually

agree for the testing [HIV]...’ (HEW1) [Emphasis added]

‘ .. a woman who refused HIV testing will repeatedly be told on the benefit of testing ... if

she persist refusing that is an indicator for us [ health workers] that the woman might

already know that she is HIV positive ... so we advice and make her understand to the last

point until she agree to take the testing ...’( midwife , Mekelle) [ Emphasis added]

5.6 Conclusion

Pre- test counselling has long been recognized vital in cases of testing women for HIV during their pregnancy to ensure that they understand the implications of a negative or positive test result, for

176 themselves, their partners and any future children.6 Nevertheless, the ‘opt-out’ HIV testing approach recommends ‘simplified pre-test information’ instead of pre-test counselling without necessarily imposing an obligation for extensive disclosure of information regarding the benefits and risks of HIV testing.

In this chapter I have explored the content of the pre-test information and the manner in which it was given to women in my sample as well as the perception of the pre-test counselling process by the health care providers who participated in this study. Accordingly, these data suggested that the pre-test information sessions are dominated by discussions of the ‘good for the baby message’ designed to make women feel some sort of moral obligation to take the test. In addition, the right to opt out of the offered HIV testing without affecting the care pregnant women receive from the health facilities was not clearly communicated and in some scenarios data gathered in this study suggested that pregnant women were actually told that they have no right to refuse the HIV testing . In cases of refusal of the HIV test during the pre-test information sessions, women were subjected to serious questioning and are required to give repeated explanations to the health care workers as to why they said ‘No’ to the testing offered to them.

Furthermore, in rural settings the HIV pre-test counselling of pregnant women does not necessarily stop within the clinical setting but other people, such as the WDAs, leaders of the women association in the village and local administrators often become involved in convincing her to take the HIV test. Moreover, the data suggested that the health care providers did not perceive the pre- test information

6 _{S Gruskin et al., ‘ Provider-Initiated HIV Testing and Counselling in Health Facilities–What does this Mean for the Health} and Human Rights of Pregnant Women?’(2008) 8(1) Developing World Bioethics 27.

177 session as a process of empowering pregnant women to make an autonomous decision but rather as a process of convincing or persuading them to take the HIV antibody testing.

The findings presented in this chapter, provides an analytical account for understanding the practices of ‘simplified information’ during HIV screening programs and its impact on limiting women’s rights to access to information necessary to make the best possible choices. The following chapter explore how the pre-test counselling process discussed in this chapter frame the process of the decision making for HIV testing offered at the antenatal clinic or in labour ward to women who participated in this study.

CHAPTER –SIX

FINDINGS - HIV TESTING OF PREGNANT WOMEN AND THE DECISION MAKING PROCESS

6.1 Introduction

The previous chapter presented the findings related to the pre-test counselling/ information process women in this study experienced before they had the HIV testing at the maternal health care services. These findings illustrated the availability, content and adequacy of the information provided to women before they were asked for their consent to HIV testing during their pregnancies or child birth. The current chapter picks up from that point and presents findings related to how these women experienced the process of decision making for the HIV testing offered at the ANC or labour wards in order to have a better understanding of how and why these decisions are made and if they meet the informed consent criteria.

The findings of this chapter therefore address the third and fourth objective of this study:

 To determine if and how pregnant women visiting maternal health care settings are

enabled to make their own informed decision in connection to HIV testing under the routine provider initiated ‘opt-out’ HIV testing approach.

 To determine the influence of peer pressure on pregnant women’s decision making in

relation to HIV testing in the rural setting.;

The first section of this chapter explores respondents’ experiences of HIV testing during their visit to health facilities for antenatal care. The section presents the findings of how and why the decision of women to take or not take an HIV test is made and also explores the situation of women in rural settings

179 and their exposure to peer pressure. The second section examines the experience of the women who underwent HIV testing during child delivery. The third section presents the stories shared by participants to reveal the patient practitioner relationship in the context of HIV testing and its impact on the informed decision-making of the women while the fourth section deals with reports of clinic avoidance by respondents for fear of being tested for HIV. The last section provides a conclusion.