Working Outside of the Box: The Adaptation of Testing Practices by HIV Counselors in Sub-Saharan Africa

Nicole Angotti, University of Texas at Austin

The delivery of HIV testing programs, particularly throughout Sub-Saharan Africa where health infrastructures are weak and prevalence is disproportionately high, relies on the work performed by trained HIV counselors. HIV counselors occupy a unique position in their role as intermediaries between international and national policy-makers and the members of the communities in which they live. This paper attempts to explain when, why and how HIV counselors adapt testing guidelines in the course of doing their jobs. Preliminary findings suggest that counselors seek creative ways to maintain the fidelity of testing principles while reducing the harm they perceive may arise as a consequence of strict adherence to them. Data for this study come from 25 semi-structured interviews with HIV counselors in Malawi: a poor, largely rural country of Sub-Saharan Africa. A rigorous inquiry into health processes offers new insights into local concerns about HIV testing.