"We... urge the inclusion of a strong human rights component into this ambitious testing programme," the New York-based Human Rights Watch (HRW) said in a recent letter http://www.hrw.org/en/news/2009/12/14/letter-kenyan-minister-public-health-and-sanitation-concerning-home-based-hiv-testin to Kenya's minister for public health. "In particular, we are calling for clear attention to principles of counselling, consent and confidentiality."
The programme aims to have 80 percent of eligible Kenyans tested by the end of 2010. A recent mini-drive which started in November 2009 to boost the initiative saw more than 1.5 million people tested in three weeks.
HRW noted that large-scale home-based testing would likely result in better access to testing and treatment and give a chance to those who could not afford the transport costs to health facilities or lacked information or the willingness to seek a test. But testing also reached into the family, where many abuses occurred, posing challenges for human rights protection, it said.
"Our research on access to testing and treatment in Kenya has shown that HIV-positive mothers and HIV-positive children frequently suffer stigma and abuse when their status becomes known," the letter said. "HIV-positive mothers - among them girls under the age of 18 - sometimes suffer violence, mistreatment, disinheritance, and discrimination from their husbands, families-in-law, or their own families."
According to Evelyn Amunga, a community health worker who has been involved in home-based counselling and testing programmes in Nairobi, many women agree to be tested at home in the presence of their husbands for fear of being accused of infidelity.
"If they decline, their husbands will accuse them of infidelity and say that is the reason they do not want to be tested," she told IRIN/PlusNews. "As much as we ensure confidentiality, we also counsel married people to reveal their status to each other, but it is a dilemma because the next day a woman you counselled with the husband calls to tell you she has been thrown out together with the children."
Damned if they do.
"The reality is, in home-based counselling and testing, many women are damned if they do and damned if they don't, especially in families where the man is present," she added.
Veronica Mwari, 34, lives with her husband in Gomongo, a Nairobi slum. They were recently visited by one of the government's home-based counselling and testing teams. After testing, her husband insisted on seeing her results.
"They just talked to us together but they told us they cannot show us our results together, so they sent my husband out and gave me mine and did the same for me when they wanted to show my husband his," she said.
"When they left us, he said he must know my status. It was negative so I just told him," she added. "He didn't tell me his results, but he warned me that if I had given him the HIV he would have killed me."
Nicholas Muraguri, the director of the National AIDS and Sexually Transmitted Infection Control Programme, says the government has put measures in place to ensure that those tested receive adequate medical and psychosocial support.
"Confidentiality and consent are the pillars of our counselling and testing programmes," he said. "Violence, discrimination and neglect are issues the government has been addressing together with partners and stakeholders but we can't say they do not happen."
"During testing, there is adequate counselling and those found to be positive are linked to health facilities through which they can receive medicine and further care," he added.
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