What Works for Women and Girls

Women’s Barriers to Testing Go Beyond AccessFor women, access to testing is not necessarily the key constraint to testing, although womencertainly face a number of barriers to accessing testing. Barriers for women include lack ofinformation, time, childcare, resources, and transportation. In a study of serological anddemographic survey data collected between 1994 and 2004 for 8,790 men and women livingin rural Tanzania, “knowledge of VCT emerged as one of the strongest predictors of VCT useamong both sexes” (Wringe et al., 2008: 326). Women who had no prior knowledge of VCThad a much lower rate of completing VCT. Only 4 percent of women who had no prior exposureto VCT and indicated a desire to get tested actually completed the program. In comparison,17 percent of women who had heard of VCT completed the program” (Wringe et al.,2008: 326). A comparative study in four Asian countries (India, Indonesia, the Philippinesand Thailand) found that men were more likely to be tested if they had HIV-related symptoms,whereas women were more likely if their partner tested positive. Additionally, women whotested HIV-positive were more likely than men to be excluded from social interactions andevents, forced to change residences or be physically assaulted (Paxton et al., 2005).Many women, especially rural women, are unable to afford the time or money requiredto travel to a facility providing HIV testing. High rates of illiteracy mean that many womencannot access information about the benefits or availability of HIV testing. Women withoutaccess to treatment may not see any advantage in learning their HIV status. Stigma, genderinequalities, and fear of negative outcomes following disclosure are significant barriers. Fear ofstigma and discrimination from health care providers is also a concern, especially for womenfrom marginalized groups. [See Chapter 11. Strengthening the Enabling Environment and Chapter13. Structuring Health Services to Meet Women’s Needs]Expanded Testing Must Not Put Womenat Risk for ViolenceWhile continuing to expand HIV testing and counseling options and opportunities is beneficial,it is important to ensure that testing is undertaken in ways that support women and girls.“Efforts to increase access to HIV testing must be accompanied by vastly scaled up efforts toconfront the stigma and human rights abuses that deter people from seeking HIV tests inthe first place….” (Jurgens and Cohen, 2007: 7). Rapid expansion of testing without ensuringinformed consent and confidentiality could increase the risk of women being rejected by theirfamilies, losing their property, and suffering violence and abuse. A study of 245 women whowere enrolled after pre-test counseling and prior to the collection of test results in Tanzaniafound that many women lack autonomy to make decisions about HIV testing. Fifty-twopercent of the women, regardless of HIV serostatus, feared their partners’ reaction; principallyfear of abuse or abandonment. Only a small percentage of women’s male partners said146 CHAPTER 6 HIV TESTING AND COUNSELING FOR WOMEN