IDEAS home Printed from
   My bibliography  Save this article

Increasing the acceptability of HIV counseling and testing with three C's: Convenience, confidentiality and credibility


  • Angotti, Nicole
  • Bula, Agatha
  • Gaydosh, Lauren
  • Kimchi, Eitan Zeev
  • Thornton, Rebecca L.
  • Yeatman, Sara E.


Agencies engaged in humanitarian efforts to prevent the further spread of HIV have emphasized the importance of voluntary counseling and testing (VCT), and most high-prevalence countries now have facilities that offer testing free of charge. The utilization of these services is disappointingly low, however, despite high numbers reporting that they would like to be tested. Explanations of this discrepancy typically rely on responses to hypothetical questions posed in terms of psychological or social barriers; often, the explanation is that people fear learning that they are infected with a disease that they understand to be fatal and stigmatizing. Yet when we offered door-to-door rapid blood testing for HIV as part of a longitudinal study in rural Malawi, the overwhelming majority agreed to be tested and to receive their results immediately. Thus, in this paper, we ask: why are more people not getting tested? Using an explanatory research design, we find that rural Malawians are responsive to door-to-door HIV testing for the following reasons: it is convenient, confidential, and the rapid blood test is credible. Our study suggests that attention to these factors in VCT strategies may mitigate the fear of HIV testing, and ultimately increase uptake in rural African settings.

Suggested Citation

  • Angotti, Nicole & Bula, Agatha & Gaydosh, Lauren & Kimchi, Eitan Zeev & Thornton, Rebecca L. & Yeatman, Sara E., 2009. "Increasing the acceptability of HIV counseling and testing with three C's: Convenience, confidentiality and credibility," Social Science & Medicine, Elsevier, vol. 68(12), pages 2263-2270, June.
  • Handle: RePEc:eee:socmed:v:68:y:2009:i:12:p:2263-2270

    Download full text from publisher

    File URL:
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    1. repec:aph:ajpbhl:10.2105/ajph.2006.096263_7 is not listed on IDEAS
    2. Beardsell, Susan & Coyle, Adrian, 1996. "A review of research on the nature and quality of HIV testing services: A proposal for process-based studies," Social Science & Medicine, Elsevier, vol. 42(5), pages 733-743, March.
    3. Kakoko, Deodatus Conatus & Åstrøm, A.N. & Lugoe, Wycliffe L. & Lie, Gro T., 2006. "Predicting intended use of voluntary HIV counselling and testing services among Tanzanian teachers using the theory of planned behaviour," Social Science & Medicine, Elsevier, vol. 63(4), pages 991-999, August.
    4. Rebecca L. Thornton, 2008. "The Demand for, and Impact of, Learning HIV Status," American Economic Review, American Economic Association, vol. 98(5), pages 1829-1863, December.
    5. Susan Cotts Watkins, 2004. "Navigating the AIDS Epidemic in Rural Malawi," Population and Development Review, The Population Council, Inc., vol. 30(4), pages 673-705.
    Full references (including those not matched with items on IDEAS)


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. Horwood, Christiane & Voce, Anna & Vermaak, Kerry & Rollins, Nigel & Qazi, Shamim, 2010. "Routine checks for HIV in children attending primary health care facilities in South Africa: Attitudes of nurses and child caregivers," Social Science & Medicine, Elsevier, vol. 70(2), pages 313-320, January.
    2. Jan Ostermann & Derek Brown & Axel Mühlbacher & Bernard Njau & Nathan Thielman, 2015. "Would you test for 5000 Shillings? HIV risk and willingness to accept HIV testing in Tanzania," Health Economics Review, Springer, vol. 5(1), pages 1-11, December.
    3. Arimoto, Yutaka & Ito, Seiro & Kudo, Yuya & Tsukada, Kazunari, 2013. "Stigma, Social Relationship and HIV Testing in the Workplace: Evidence from South Africa," CEI Working Paper Series 2012-06, Center for Economic Institutions, Institute of Economic Research, Hitotsubashi University.
    4. Kaler, Amy & Angotti, Nicole & Ramaiya, Astha, 2016. "“They are looking just the same”: Antiretroviral treatment as social danger in rural Malawi," Social Science & Medicine, Elsevier, vol. 167(C), pages 71-78.
    5. Angotti, Nicole, 2010. "Working outside of the box: How HIV counselors in Sub-Saharan Africa adapt Western HIV testing norms," Social Science & Medicine, Elsevier, vol. 71(5), pages 986-993, September.
    6. Jürgensen, Marte & Sandøy, Ingvild F. & Michelo, Charles & Fylkesnes, Knut & Mwangala, Sheila & Blystad, Astrid, 2013. "The seven Cs of the high acceptability of home-based VCT: Results from a mixed methods approach in Zambia," Social Science & Medicine, Elsevier, vol. 97(C), pages 210-219.
    7. Thornton, Rebecca L., 2012. "HIV testing, subjective beliefs and economic behavior," Journal of Development Economics, Elsevier, vol. 99(2), pages 300-313.
    8. Godlonton, Susan & Thornton, Rebecca, 2012. "Peer effects in learning HIV results," Journal of Development Economics, Elsevier, vol. 97(1), pages 118-129.
    9. Olivier STERCK, 2011. "Why only one individual tests for HIV/AIDS among Sub-Saharan African Couples?," Discussion Papers (IRES - Institut de Recherches Economiques et Sociales) 2011024, Université catholique de Louvain, Institut de Recherches Economiques et Sociales (IRES).
    10. Fylkesnes, Knut & Sandøy, Ingvild Fossgard & Jürgensen, Marte & Chipimo, Peter J. & Mwangala, Sheila & Michelo, Charles, 2013. "Strong effects of home-based voluntary HIV counselling and testing on acceptance and equity: A cluster randomised trial in Zambia," Social Science & Medicine, Elsevier, vol. 86(C), pages 9-16.
    11. Wachira, Catherine & Ruger, Jennifer Prah, 2011. "National poverty reduction strategies and HIV/AIDS governance in Malawi: A preliminary study of shared health governance," Social Science & Medicine, Elsevier, vol. 72(12), pages 1956-1964, June.


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:68:y:2009:i:12:p:2263-2270. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dana Niculescu). General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.