Acceptability of universal screening for intimate partner violence in voluntary HIV testing and counseling services in South Africa and service implications.

Women who experience intimate partner violence (IPV) are more likely to be HIV positive. Many of these women never receive any relevant services, and those who do often access them only after events have escalated to a crisis requiring the police or emergency medical care. Evidence from other settings suggests that routinely asking women about experiences of partner violence is received positively. Voluntary counseling and testing (VCT) services would seem an ideal opportunity to screen for IPV in South Africa. However, in low resource settings, VCT is carried out by lay counselors with few skills. We therefore conducted a qualitative study that explored women's experience of IPV screening in VCT services, and explored implications for VCT counseling. The study was conducted in a clinic in Johannesburg where we trained the lay counselors to do IPV screening. In-depth interviews were conducted with 35 women attending VCT services. Participants were recruited before they attended VCT, and 12 women participated in a follow-up interview. A focus group was held with lay counselors a year after the intervention was implemented. Findings suggest that women were supportive of being asked about their experiences of IPV during VCT sessions. Reasons for supporting IPV screening at VCT services include the limited access of many women to health services. Many women who were aware of their HIV risk felt powerless to discuss condom use, HIV testing, and infidelity with their male partners. Women directly related such experience of gender power inequality to HIV risk. One year after training, there was no evidence of screening continuing. Our findings suggest that the focus should shift from asking about violence to equipping counselors to discuss gender inequality in relationships more broadly. This needs to be part of basic counselor training as it is integral to approaching HIV risk reduction.