Is the policy of expansion of HIV testing getting to ensure equity and the right to autonomy? A study on the Brazilian seacoast
L. Rivero Pupo, P.H. Nico Monteiro, R. Barboza
Instituto de Saúde (Health Institute), Praticas de Saúde (Health Practices), São Paulo, Brazil
Background: In Brazil, although it was found lower levels than in countries like USA, Canada and Switzerland, the percentage of persons tested for HIV has grown considerably, from 20% in 1998 to 32.9% in 2005. Nevertheless, national studies also indicate the existence of inequalities of gender, race, economic level and generation into early diagnosis of HIV. This study examines inequities in access to testing related to sex, age and capacity of autonomous decision.
Methods: In 2007, a household survey-based population was executed in a metropolitan area with a high prevalence of aids on the seacoast of Sao Paulo state. It was applied a structured questionnaire to residents of selected households.
Results: 56.9% of respondents had been tested for HIV in life, with a higher percentage of tests in women (63.8%) compared to men (49%). The age group most tested for both sexes was adults between 25 to 39 years old, with a percentage significantly higher in women (79.6%) than men (55.5%) probably due to incorporation of HIV testing as a prenatal routine in health services. However, while for men there is a visible expansion in HIV testing with increasing age, for women otherwise, there is a significant increase in testing after 24 years old, and a significant decline in testing after 40 years old. The study also indicates a important flaw in counseling, because 51.5% of respondents received no guidance about testing either before or after the testing.
Conclusions: Despite the expansion of testing, the forced connection between sexuality and reproduction contributes for a significant gap in the provision of the test for women over 40 years. Moreover, the testing process has not given the due attention to the voluntary decision, affecting the right to personal autonomy.
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