How to improve the quality of VCT in existing services? Client perspective Christiana Nöstlinger, HIV-SAM Project

Working group 1

Aim of Voluntary Counseling and HIV Testing

1) Diagnosis - Reduce number of late diagnoses - Reduce number of undiagnosed HIV infections2) Prevention - Discuss risk reduction strategies - Stigma reduction: opening conversation about HIV can contribute to normalizing HIV in the community

Focus is mainly on diagnosis

Aim of this workshop:

How can we improve the quality of VCT in a way that it is cultural sensitive and contributes to prevention?

Guidelines for VCT Confidentiality must be guaranteed during the entire procedure 1. Pretest counseling - Informing about test process and implications of testing - Risk assessment and risk prevention - Coping strategies - Individual decision to test: informed consent 2. HIV Testing3. Posttest counseling HIV positive HIV negative - news given - news given - risk reduction plan - risk reduction plan - support to cope with the diagnosis - discussion about disclosure

- discussion about disclosure 4. Follow- up counseling and support Further differentiation between HIV- and HIV+ clients/patients.

Questions: Pretest Counseling

1. How should we address fears about confidentiality?

Many fear that the counselor will tell other people in the community and this will lead to discrimination and exclusion

HIV-related stigma*

* HIV/AIDS Alliance, 2006, Facilitators’ guide. Let’s talk about VCT

Questions: Pretest counseling

2. How should we discuss the implications of an HIV test?

- Fear of death “This retroviral-something is just prolonging your live, eventually you will die (FG 6)” - Fear of social rejection / exclusion - “You will be stigmatized, people will run away from you, you will be an outcast (FG 1)” - Women with HIV are more likely to face domestic violence or divorce* - Fear of living with HIV (how to cope?)

* Anderson & Doyal, 2004, AIDS Care

Questions: Posttest Counseling

3. How should we address the barriers of health professionals to do posttest counseling with persons with an HIV negative diagnosis?

- “She said, if I don’t call you, you are ok. I called her almost every day to see if the results were there (FG 7)”

- Evidence shows that increased sexual risk following receipt of a negative VCT result may be a serious unintended effect of VCT*

* Sherr et al., 2007, AIDS

Questions: Posttest Counseling

4. How should we discuss a risk reduction plan with SAM who are diagnosed negative?

Sex is rarely directly spoken about, even between couples*

They make sexual decisions primarily on the grounds of emotion, rather than on health. They would rather ignore health risk than jeopardize a partner’s trust *

Importance of reproduction*

* Heald, 1995 * Rosenthal et al., 1998, Peart et al., 1996 * Caldwell, 1989 All in Kesby et al., 2003, Social Science & Medicine

Questions: Posttest Counseling

5. How should we discuss “disclosure” of HIV-testing with SAM who have been diagnosed HIV-negative?

Talking about having performed an HIV test Testing itself carries the connotation of blame*

* Burns et al, 2007, AIDS care