title: "It is not easy": challenges for provider-initiated HIV testing and counseling in Flanders, Belgium.
abstract: This study identified physicians' HIV testing practices and their barriers toward implementing provider-initiated HIV testing and counseling (PITC) for Sub-Saharan African migrants (SAM) in Flanders, Belgium. In-depth interviews were conducted on a purposive sample of 20 physicians (ten GPs and ten internists). GPs performed mainly patient-initiated tests, while internists carried out tests based on disease indicators and risk behavior. For the most part, World Health Organization (WHO) guidelines were not followed. Study participants were not in favor of implementing PITC. Reasons included lack of information on the HIV epidemic among SAM, fear of stigmatizing patients, perceiving testing as unethical for undocumented patients, questionable relevance of pre-test counseling, lack of expertise in discussing sexuality, language barriers, lack of time, and the absence of a national or regional HIV testing policy. Implementing PITC will require appropriate training of service providers. Also, supporting policies should be developed with the participation of stakeholders encouraging "normalization" of HIV testing.
authors.affiliation: Institute of Tropical Medicine in Antwerp, Belgium. Lmaniran@itg.be
authors.forename: Lazare
authors.initials: L
authors.lastname: Manirankunda
authors.forename: Jasna
authors.initials: J
authors.lastname: Loos
authors.forename: Pieterjan
authors.initials: P
authors.lastname: Debackaere
authors.forename: Christiana
authors.initials: C
authors.lastname: Nöstlinger
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000208:ethnology; D001291:Attitude of Health Personnel; D001530:Belgium / Q000453:epidemiology; D003376:Counseling; D054521:Cultural Competency; D054242:Emigrants and Immigrants / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000208:ethnology / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000523:psychology; D008875:Middle Aged; D010465:Perception; D010819:Physician's Role; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D013240:Stereotyping