![]() ![]() Consequently, unlike the traditional public health strategies for controlling the spread of other infectious diseases (e.g., compulsory testing, contact tracing, involuntary quarantine), the response to HIV was unique. In the West, AIDS disproportionately affected highly stigmatised groups –gay men and injecting drug users – and concerns abounded about the prevention measures that might drive the epidemic underground ( DeCock, Mbori-Ngacha, and Marum 2002). Particularly important for the development of the global approach to HIV testing was the early history of the AIDS epidemic in Western democracies. This paper aims to show why a (global) model of HIV testing – one rooted in Western notions of individualism and human rights-resonates very differently in a setting far removed from its context of origin. The above encounter presents several themes of this paper: a woman's worries about how best to care for her sick husband and about having been unknowingly exposed to HIV a husband's fear of abandonment by his primary caretaker in a time of great need the situations in which health workers are often placed, ones which force them to make difficult decisions and underlying it all, the clash between a public health norm for HIV testing that privileges individual rights, and local concerns for the health and wellbeing of the communities experiencing the AIDS epidemic first-hand. Seeing how determined the wife was to leave her husband behind at the hospital, the clinician told her that her husband is HIV positive and suffering from HIV-related illnesses. The woman told them that she wants to know exactly what her husband is suffering from and the results of his blood tests. As she was about to leave the hospital ward, the nurse on duty called her into a separate room to discuss the matter further with the clinician. The wife, unmoved by his tears, insisted on being told the truth. The husband began to cry, pleading with his wife not to leave. She immediately collected her things and approached the door, threatening to leave her husband behind in their care. ![]() The woman, growing more frustrated, told the clinician that she does not tolerate nonsense. Furious, the wife inquired of the clinician, who explained to her that the patient has a right to privacy and that he could not disclose the husband's test results to her. The husband had had his blood drawn twice since arriving, but was unwilling to share the results of the tests with his wife. The woman tells the counsellor that she is the caretaker for her husband, who had been admitted to the hospital two weeks ago with diarrhoea and a persistent fever in Malawi, much of the care of a patient in the hospital is delegated to a family member. The counsellor, prepared to assist her, first inquires about the nature of the urgency. The woman tells the counsellor that she wants to be tested for HIV, immediately. It just so happens that it was a counsellor she had approached. The woman who interrupts them asks for urgent assistance locating an HIV Counsellor. Two health workers at a health facility in rural Malawi are in the midst of a conversation when they are interrupted. The case study of Malawi illustrates a tension between Western, individual rights-oriented public health norms and local concerns for the health and wellbeing of the imagined communities that they are meant to benefit. And the intended beneficiaries, the rural Malawians whose rights are meant to be protected by the 3Cs perceive the norms as protecting themselves as individuals, but as harming rather than benefitting their communities. For them, knowledge of the 3Cs as Western biomedical jargon distinguishes them from villagers, but places them in situations where the ethics of testing conflict with their moral concerns for those whom they were trained to help thus they adapt them in practice. ![]() The proponents are members of the “Counseling and Testing Establishment.” For them, the 3Cs are human rights imports that are worth defending formally, but not always worth prioritising in practice. ![]() It considers the differential perspectives of three categories of stakeholders: proponents, implementers and intended beneficiaries. This paper examines the implementation of Western HIV testing norms– counselling, consent and confidentiality (“3Cs”) – in Malawi, a high prevalence, rural African setting. ![]()
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