Perceptions of couple HIV counseling and testing in Botswana: a stakeholder analysis.

Objective: To explore stakeholder's perceptions of Couples HIV Counseling and Testing (CHCT) as opposed to individual testing and potential couples' preferences for CHCT promotion and service provision.

Methods: Study was conducted as formative research for a phase III clinical trial of Herpes (HSV-2) suppression to prevent HIV transmission among HIV discordant couples. We used non-probability purposive sampling and snowballing techniques to identify study participants. Data were collected using key informant interviews and focus group discussions. Systematic textual data analysis was used. Two independent coders coded and compared their codes for agreement. Data was categorized by emerging themes.

Results: The general themes from both key informant interviews and focus group discussions were a preference for CHCT as opposed to individual counseling in HIV prevention and the need for a client-centered approach to promotion and provision of couple HIV testing services.

Conclusion: CHCT is important in HIV prevention and should be integrated in existing HIV testing programs. The study also demonstrates the challenges of HIV status disclosure and discordance among sexual partners who test as individuals.

Practice Implications: Current low HIV status disclosure rates imply that reducing HIV incidence rates will require integrating CHCT into current testing programs. Increasing CHCT uptake however, requires improving access, training providers and addressing social, cultural, political and logistical barriers.