An exploration of HIV testing policy and services through a social justice lens

Abstract

The objective of this study was to evaluate the congruence between HIV testing policies and everyday testing practices in a small urban centre in Newfoundland and Labrador (NL). Social justice principles were used to explore the challenges associated with anonymous testing in a small urban centre and how current service delivery practices may be affecting "at-risk" populations and other test seekers who require a higher degree of confidentiality. Framed within a constructivist epistemology, qualitative description was used to determine data collection and analysis strategies. The findings are presented within an expanded social determinants of health framework, which emphasizes health inequalities as a driver of poor health outcomes. Data were collected from four testing sites using individual interviews and a document review of policy-related documents. A reflexive journal was logged throughout data collection and used for verification during analysis, which included thematizing, diagramming and coding. -- The applicable legislation was the Communicable Diseases Act, which requires name based reporting. Participants interpreted anonymous testing as being illegal according to this legislation. Findings demonstrated a history of offering anonymous testing at all testing sites and present-day practices that fit the definition of anonymous testing, but were referred to in official policy and understood by participants as being non-nominal. An alternate definition of anonymous testing is proposed where contact information is not requested or recorded and pre- and post-test counseling is delivered face-to-face. Redefining the provision of HIV testing services in this way supports the call to increase the visibility of social justice in Canadian public health policy. Eighteen recommendations are offered to guide this legislative and policy change.