Private practitioners' communications with patients around HIV Tesing in Pune

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Private practitioners' communications with patients around HIV

testing in Pune, India

Vinita Datye, Karina Kielmann, Kabir Sheikh, Deepali Deshmukh,

Sucheta Deshpande, Porter and Sheela Rangan

Maharashtra Association of Anthropological Sciences, Pune, India and

London School of Hygiene and Tropical Medicine, UK

Health Policy and Planning 2006 21(5):343-352. (Abstract)

Unlike any other disease so far, the `exceptional' nature of

HIV/AIDS has prompted debate about the necessity, but also the

challenges, of regulating practitioner–patient communication around

HIV testing. In India, the National AIDS Control Organization (NACO)

has adopted the guidelines of the World Health Organization with

regard to HIV testing and counselling, yet the extent to which these

guidelines are fully understood or followed by the vast private

medical sector is unknown.

This paper examines the gaps between policy and practice in communications

around HIV testing in the private sector and aims to inform a bottom-up approach

to policy development that is grounded in actual processes of health care

provision.

Drawing on 27 in-depth interviews conducted with private

medical practitioners managing HIV patients in the city of Pune, we

looked specifically at practitioners' reported communications with

patients prior to an HIV test, during and following disclosure of

the test result.

Among these practitioners, informed consent is rare

and pre-test communication is prescriptive rather than shared.

Confidentiality of the patient is often breached during disclosure,

as family members are drawn into the process without consulting the

patient. While non-adherence to guidelines is a matter of concern,

practitioners' communication practices in this setting must be

understood in the given social and legal context of the patient–

practitioner relationship in India.

Communication with their patients is strongly influenced by practitioners'

perceptions of their own roles and relationships with patients, perceived

characteristics of the patient population, limitations in knowledge and skills,

moral values as well as perceptions of legal guidelines and patient rights.

We suggest that policy guidelines around patient–practitioner communication need

to take sufficient cognizance of existing practices, cultures and the realities

of care provision in the private sector. Patients themselves need to be

empowered in

order to grasp the importance and implications of HIV testing and

counselling.

Key Words: communication, private practitioner, guidelines, HIV

testing, informed consent, counselling, confidentiality, HIV/AIDS

policy, India

Correspondence: Vinita Datye, Maharashtra Association of

Anthropological Sciences, Centre for Health Research and

Development, 64/5 Anand Park, Aundh, Pune 411 007, India. Tel: 91 20

2588 4150; Fax: 91 20 2588 9919; E-mail: maaschrd@... or

vinitadatye@....

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