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Health Policy and Planning Advance Access originally published online on August 13, 2008
Health Policy and Planning 2008 23(6):390-396; doi:10.1093/heapol/czn029
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Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2008; all rights reserved.

Potential for abuse in the VCT counselling room: service provider's perceptions in Kenya

C Hamilton1,*, D Okoko2, R Tolhurst1, N Kilonzo2, S Theobald1,3 and M Taegtmeyer1,2

1Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
2Liverpool VCT & Care, PO Box 43640, Nairobi, Kenya.
3The REACH Trust, PO Box 1597, Lilongwe, Malawi.

*Corresponding author. PO Box 1414, Mwanza, Tanzania. Tel: +11-255–754–755537/+11-254–733–587024. Fax: +11-255–282–502968. E-mail: Dale-Chris.Hamilton{at}aimint.net

The rapid scale-up of HIV counselling and testing programmes in Kenya has led to quality concerns, including the potential for abuse within the private, confidential setting of client-initiated voluntary counselling and testing (VCT).

A qualitative study was conducted in three provinces of Kenya, involving 26 VCT service providers and 13 key informants. First and second hand accounts of emotional, physical and sexual abuse emerged in all three study sites in spite of measures to mitigate such occurrences. Whilst uncommon, abuse was perceived by service providers to be serious and sufficiently widespread to raise significant concerns. Abuse occurred client to counsellor, from counsellor to client and from counsellor to counsellor. In all cases the person suffering the abuse was female.

While the potential for abuse was demonstrated in VCT sites, we argue that experiences of abuse are not confined to VCT and are largely shaped by gender and power relations within the Kenyan cultural context. The international impetus for scale-up of HIV services provides an urgent rationale for the need to address and highlight these difficult issues at multiple levels. International guidelines, policy and methods need adapting in recognition of the potential for abuse. Systems for investigating and deregistering counsellors have been developed in Kenya but require formalizing. Institutions providing VCT should consider unlocked doors, semi-opaque windows and the use of ‘mystery clients’ as a quality assurance measure.

Key Words: HIV, VCT, abuse, gender violence, ethics, Kenya

Accepted for publication 3 June 2008.


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