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Counseling and Testing for HIV |
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The global demand for HIV counseling and testing (CT) services is growing dramatically due to the intensified effort to expand access to antiretroviral therapy (ART). Donors and international public health organizations accordingly regard CT as a critical component of comprehensive HIV/AIDS programs. "HIV counseling and testing" has multiple definitions. For purposes of this brief, we define it in the following manner: HIV counseling is a confidential process that enables a person to assess his or her relative risk of acquiring or transmitting HIV. Counseling also helps a person determine whether to be tested and provides support when a person receives the test results. HIV testing involves analysis of blood or body fluids for the presence of antigens or antibodies produced in response to HIV. There are many technologies available today, including a proliferation of high-quality rapid tests. CT services serve two principal purposes: • They determine who requires care and treatment. A person must know his or her HIV status to access these services. This includes both ART and interventions to prevent mother-to-child HIV transmission (PMTCT). CT services may also promote a positive community response to the disease. Knowledge about HIV might stimulate discussion and reduce stigma and discrimination. It could also result in community action to address the issue, including adoption of HIV/AIDS-sensitive policies. Several types of CT have emerged in the last decade. They meet different objectives and provide services to different groups, but they are all voluntary and require client consent. The following approaches are increasingly used internationally: Client-initiated CT: Provider-initiated CT: Several service delivery models support these three approaches, including stand-alone (such as walk-in and anonymous VCT centers), integrated (antenatal care sites, tuberculosis clinics and hospitals), quasi-integrated (such as community-based VCT), private sector, mobile and home-based. A client's rights should be respected in each of these settings. International public health organizations suggest providers: • Ensure an ethical testing process where the purpose of the test and its benefits are explained to the client. The process should also include counseling, and guarantee the confidentiality of all medical information. The following should be present for high-quality, comprehensive CT: • Political will and government policies: Political commitment to provide adequate funding for CT must be present. This should be accompanied by government policies that protect people affected by HIV, including those using CT services. Stigma and discrimination are common, limiting access to key services for people either known or believed to be HIV-positive, such as health care, employment and housing. Sometimes there is also violence against those whose HIV status is disclosed. Therefore anti-discrimination laws need to be enacted and enforced. • Personnel: Counselors and lab staff need to be trained in CT. Increasingly these roles are performed by the same people. This helps to improve client flow, provide results to clients and facilitate immediate client enrollment in appropriate treatment, care and support services. The staff members must be trained in HIV/AIDS awareness, pre- and post-test counseling, rapid HIV testing, ways to address difficult issues (such as death and dying), HIV prevention and ongoing referral mechanisms. High-quality CT service delivery also requires proper personnel management. This includes skillfully supervising staff and identifying capacity-building needs. • Infrastructure: The minimal physical requirements for CT include a counseling space that ensures auditory and visual privacy, and a space that can accommodate HIV testing and waste disposal. The need for an elaborate laboratory infrastructure is declining because of rapid HIV tests. • Commodities and supplies: CT services require adequate supplies of tests and reagents, prevention materials (including condoms) and other medical products. Systems and procedures must be in place for the forecasting, procurement and management of these medical supplies. • Quality assurance: Mechanisms should be established to ensure that ethical and technical medical standards are upheld for both counseling and testing services. • Linkages and referrals: Relationships should be established among CT points of service, health facilities and community organizations so that clients receive comprehensive prevention, care, treatment and support services. This will also help ensure that all CT clients (both infected and uninfected) have access to ongoing services, such as psychosocial and legal services. Resources 1. World Health Organization. The Right to Know: New Approaches to HIV Testing and Counseling. Geneva: WHO, 2003. http://www.who.int/hiv/pub/vct/en/Right_know_a4E.pdf April 2006 * See FHI technical summary, "Service Delivery Models of HIV Counseling and Testing" |
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