perceived barriers to HIV voluntary counseling

"It's better not to know": perceived barriers to HIV voluntary counseling and testing among sub-Saharan African migrants in Belgium.

This study explored perceptions, needs, and barriers of sub-Saharan African migrants in relation to HIV voluntary counselling and testing. Using an inductive qualitative methodological approach, data were obtained from focus group discussions. Results showed that participants were in principle in favour of voluntary counselling and testing. However, they indicated that barriers outweighed advantages. Such barriers included fear of positive test results and its related personal and social consequences, lack of information, lack of preventive health behaviour, denial of HIV risk, and missed opportunities. Limited financial resources were only a concern for some subgroups like young people, asylum seekers, and recent migrants. This study identified multiple and intertwined barriers to voluntary counselling and testing from a community perspective. In order to promote voluntary counselling and testing, interventions such as raising awareness through culturally sensitive education should be adopted at community level. At level of service provision, provider initiated HIV testing including target group tailored counselling should be promoted.

This first qualitative community-based study of the barriers to uptake of voluntary counselling and testing among sub-Saharan migrants in Belgium found that previously acquired experiences in their countries of origin negatively influenced testing uptake. The images of relatives or friends, who had been ill and died of AIDS, shaped attitudes toward knowledge of serostatus, as did the considerable responsibilities that many recent migrants have toward family and community members back home. Focus group participants indicated that provider-initiated discussions of HIV testing, combined with the testimonies of people living with HIV and in good health on how to live with HIV, would help reduce fears of HIV testing and counselling. Efforts to reduce stigma, increase social support, and increase testing uptake in a culturally sensitive manner will increase the proportion of migrants wanting to learn their HIV status.