Background: HIV self-testing (HIVST) offers great potential to increase knowledge of HIV status since it uniquely addresses tensions between convenience and confidentiality. However, the high rate of gender based violence (GBV) in Sub-Saharan Africa generates concerns over the possibility that HIVST may trigger coercive testing at household level. This paper is drawn from a study exploring the social impacts of introducing HIVST in resource-poor settings. This presentation will explore the concept of coercion in the context of HIVST in Malawi and argues that coercion is a culturally relative concept, interpreted differently in different contexts.
Methods: Data on coercion was collected using mixed methods but the focus in this paper is on 60 serial biographical interviews (15 men, 15 women and 15 couples) collected at two time points with individuals aged 16-49 years who collected the HIVST kit in Blantyre. Data was organised, coded and themes developed using Nvivo 10.
Results: HIVST kit was an empowering tool especially for women by bringing test kits into the household. Coercive testing was considered acceptable in some contexts where people were in a stable relationship or had a history of infidelity and had never disclosed HIV status. Coercive testing was often considered as a beneficent act that helped people to control their future. In other cases, coercion was viewed as an infringement of human rights but actual impacts of coercive testing did not reflect perceived impacts of coercive testing.
Conclusions: Underlying social contexts such as power and gender imbalances informed male and female responses to coercion. In cases where coercion was considered acceptable actual realities of coercion were not considered unethical. The impact of methodological approaches needs to be understood in researching complex concepts such as coercion.