Voluntary Counseling and Testing (VCT) for HIV

1. Voluntary Counseling and Testing (VCT) for HIV

2. Presentation Objectives By the end of this session, you should be able to: Describe the basic facts about voluntary counseling and testing (VCT). Explain the importance of VCT. Describe the goals and outcomes of VCT. Describe the link from VCT to HIV prevention, care and treatment.

3. HIV Counseling and Testing HIV Counseling • Confidential dialogue between a client and a care provider aimed at enabling the client to cope with stress and make personal decisions related to HIV and AIDS. • Voluntary Counseling and Testing (VCT) • A combination of two activities– counseling and testing –into a service that amplifies the benefits of both.

4. Why is VCT So Important? • 90% of those infected in Eastern and Southern Africa do not know that they are infected. • Knowing one’s serostatus allows people to alter their behavior. • VCT provides an opportunity for prevention counseling and referral to care and support services. VCT is an entry point and not the end point.

5. Why is VCT So Important? • Effective prevention and care activities require people to know their HIV status. • VCT promotes and sustains behavior change (prevention). • VCT facilitates early referral to care and support services- including access to antiretroviral therapy. • VCT links with PMTCT, STI, and OI services. • VCT assists in stigma reduction.

6. Acceptance of Serostatus and coping Early management of OIs and STDs Planning for future orphan care; Will preparation Voluntary Counseling Testing Reduces mother-to-child transmission Referral to social and peer support Normalizes HIV/AIDS Facilitates behavioral change Preventive therapy (TB and bacteraemia) and contraceptive advice

7. Goals of VCT (1) • Prevention of HIV transmission • From +ve tested people to -ve or untested partner/s • From +ve tested mother to child • From +ve or untested partner/s to -ve tested people • Early uptake of services • Counseling for positive living • Social support • Legal advice • Future planning • Medical care • Family planning • Emotional care

8. Societal benefits Normalisation of HIV Reduction of stigma Promote awareness Support human rights Increase adherence to: ARV therapy Preventive therapies ARV regimens for PMTCT Infant feeding choices Goals of VCT (2)

9. Determining clients knowledge Giving accurate information Conducting personalized risk assessment Developing a personalized risk reduction plan Demonstrating appropriate condom use Explaining the test and obtaining informed consent Discussing implications of HIV result Assessing coping ability Result notification Providing psychological and emotional support and referral as appropriate Components of VCT

10. Rationale for VCT as an Intervention Strategy • Effective in promoting behavioural change and providing psychosocial support. • Cost effective especially when it is targeted to couples and “high risk groups”. • Feasible as a component of comprehensive HIV prevention and care strategies in developing countries. • Facilitates the linkage to other HIV prevention and care activities.

11. Outcome Tanzania Kenya HIV Infections Averted Per 10,000 Persons 895 1104 Cost/HIV Infection Averted $ 346 $ 249 Cost /DALY Saved $ 17.78 $ 12.77 Cost Effectiveness of VCTVCT is cost effective (Sweat et al).

12. Review of VCT Outcomes • Prevention of HIV transmission • Prevention of HIV transmission in special populations • Care: Improving access to medical, emotional, and social support

13. Barriers to VCT (1) • Fear • No cure or treatment • Stigma • No need: I’m faithful • Partner with a negative HIV result • Gender inequalities • Lack of perceived benefit • Lack of access to care and support services

14. Barriers to VCT (2) Fear “I feel if I tested positive it would just devastate me. You know that, while I know I might be positive - I had herpes zoster - there are times I tell myself that its my father-in-law doing some black magic on me. If I went and had a test and they said ‘you have it’ then I know I would be dead in a week.” • Woman 28 years, Kara Counseling and Training Trust, Lusaka, Zambia

15. Barriers to VCT (3) No cure or effective treatment “I do not even want a test. What are you going to do about it if I come out positive? Are you going to give me medicines? If you tell me that you can give me medicines or that you will cure the disease then I can go for a test tomorrow.” • Man 30 years, Kara Counseling and Training Trust, Lusaka, Zambia

16. Barriers to VCT (4) Stigma “ If you go for a test and the result comes out positive your family will not take care of you because you will be an outcast.” • Woman 22 years, Kara Counseling and Training Trust, Lusaka, Zambia

17. Barriers to VCT (5) No need “Its not necessary since a test is only for those young ones who have not followed their parents’ advice of not indulging in things like careless sex.” • Woman 56 years, Kara Counseling and Training Trust, Lusaka, Zambia

18. Barriers to Changing Sexual Behavior Following VCT • Partner communication difficulties • Gender imbalances in sexual decision making • Difficulties in changing sexual behaviour • Desire to have children • Stigma • Economic deprivation