Private practitioners' communications with patients around HIV testing in Pune, India. Health Policy Plan

Unlike any other disease so far, the ‘exceptional’ nature of HIV/AIDS has prompted debate about the necessity, but also the challenges, of regulating practitioner–patient communication around HIV testing. In India, the National AIDS Control Organization (NACO) has adopted the guidelines of the World Health Organization with regard to HIV testing and counselling, yet the extent to which these guidelines are fully understood or followed by the vast private medical sector is unknown. This paper examines the gaps between policy and practice in communications around HIV testing in the private sector and aims to inform a bottom-up approach to policy development that is grounded in actual processes of health care provision. While non-adherence to guidelines is a matter of concern, practitioners’ communication practices in this setting must be understood in the given social and legal context of the patient–practitioner relationship in India. Communication with their patients is strongly influenced by practitioners’ perceptions of their own with patients, roles and relationships perceived characteristics of the patient population, limitations in knowledge and skills, moral values as well as perceptions of legal guidelines and patient rights. We suggest that policy guidelines around patient–practitioner communication need to take sufficient cognizance of existing practices, cultures and the realities of care provision in the private sector. Patients themselves need to be empowered in order to grasp the importance and implications of HIV testing and counselling.
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