| HIV counselling has both prevention
and care as its objectives. It concentrates on emotional,
behavioral, and social issues related to possible or actual
infection with HIV. In essence, counselling is a confidential
dialogue between a client (in counselling, the word "client"
is preferred to "patient") and a counselor,
aimed at enabling the client to cope with stress and take
personal decisions related to HIV/AIDS. With the consent
of the client, counselling can be extended to spouses,
sex partners, and other persons considered important by
the client. While a counselor might be a doctor, nurse,
or social worker, she or he can also be a member of the
community such as a teacher, village leader, or religious
leader (e.g., imam, minister, or priest.) |
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| Voluntary counselling and testing
(VCT) is a combination of two activities - counselling
and testing - into a service that amplifies the benefits
of both. It is an approach that is useful in all settings
- resource-rich and resource-poor, urban and rural. Because
VCT is adaptable to clients' needs, it can be done for
individuals and couples, for people of all ages and of
all backgrounds. And, with proper training, members of
the clients' local community, regardless of their educational
level, can do the counselling component. |
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| New inclusions |
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| Voluntary counseling and testing has a two-pronged approach. Firstly it helps to determine who requires care and treatment. This includes both ART and interventions to prevent mother-to-child HIV transmission (PMTCT). Secondly it helps prevention and transmission of HIV infection to others. |
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| Additionally, voluntary counseling and testing can also stimulate discussion about HIV and AIDS and in turn reduce stigma and discrimination. |
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VCCTC as an entry point for HIV prevention and care |
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| Adapted from “Voluntary Counselling and Testing for HIV Infection in Antenatal Care: Practical Considerations for Implementation.” World Health Organisation, September 1999. |
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RIGHTS BASED APPROACH
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| Voluntary counseling and testing should follow a rights-based approach which means that: |
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- people have a right to know their HIV status;
- HIV testing must be voluntary, the decision to test or not to test being based on
an understanding of accurate, objective and relevant information;
- post-test counselling & services are crucial;
- confidentiality must be protected;
- non-discrimination in service delivery is critical; and
- testing and counselling must be scaled up, eventually leading to universal
access.
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| VCCT includes specialized counseling on the following issues: |
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| HIV and AIDS information |
| Pre-test or decision counseling |
| Post-test Counseling |
| Plans for reducing risk behaviour |
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| GOALS OF VCCT |
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1. Prevention of HIV transmission
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- From +ve tested people to untested or –ve partners
- From +ve tested mother to child
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| 2. Prevention of HIV acquisition |
- By –ve tested people from +ve or untested partners
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| 3. Early and appropriate uptake of service |
| +ve-tested people |
- Medical care (including ARV therapy, treatment of OIs, prevention of OIs and
HIV-associated infections and screening for HIV-associated infections and tumours
- Family planning (including counselling about reproductive choices)
- Emotional care (including individual, couple and family support)
- Counselling for positive living (nutrition, ongoing counselling, disclosure issues and
identification of safety network)
- Social support
- Improved coping and planning for the future
- Legal advice
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| The impact of Voluntary Counselling and Testing |
| -ve-tested people |
- Emotional care
- Family planning (including counselling about reproductive choices)
- Improved coping and planning for the future
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| 4. Societal benefits |
- Normalization of HIV
- Challenging stigma
- Promoting awareness
- Supporting human rights
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| 5. Counselling for adherence |
- Adherence to ARVs and preventive therapies
- Coping with adverse effects
- Counselling about adherence in MTCT interventions
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| GUIDING PRINCIPLES OF HIV COUNSELING AND TESTING |
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| WHO recommends that the following guiding principles be observed in the provision of all HIV testing and counselling services: |
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| a. Testing and Counselling must now be scaled up |
| Offering HIV testing and counselling should become standard practice wherever they are likely to enhance the health and well-being of the individual. The objective is to enable the greatest possible number of people to benefit from the ever-improving treatment, care and prevention options and realise their right to the highest attainable standard of health care. |
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| b. HIV testing should be voluntary |
| Mandatory HIV testing is neither effective for public health purposes nor ethical, because it denies individuals choice and violates principles such as the right to health, including the right to privacy and the ethical duties to obtain informed consent and maintain confidentiality.
Although the process of obtaining informed consent will vary according to different settings, all those offered the test should receive sufficient information and should be helped to an adequate understanding of the testing process and possible consequences of being tested. The three crucial elements in obtaining truly informed consent in HIV testing are:
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· Providing pre-test information on the purpose of testing, and on the
treatment and support available once the result is known
· Ensuring understanding
· Respecting the individual’s right to decide if they want to be tested
or not.
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| Only when these elements are in place will individuals be able to make a fully informed decision on whether or not to be tested in light of their own circumstances and values. Once this is assured, the actual process of obtaining informed consent can be adapted to suit the different settings under which expanded HIV testing and counselling services will be implemented. |
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| c. Post-test support and services are crucial |
| The result of HIV testing should always be offered to the person being tested. It is the person’s decision to share this result with others. Along with the result, appropriate post-test information, counselling or referral should be offered according to the result. People who receive positive test results should receive counselling and referral to care, support and treatment. |
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| d. Confidentiality must be protected |
| All medical records, whether or not they involve HIV-related information, should be managed in accordance with appropriate standards of confidentiality. Only health-care professionals with a direct role in the management of patients or clients should have access to such records or the information they contain, and only on a “need to know” basis.
In rare circumstances, confi dentiality may be breached where there is a clear indication that a third party may be harmed by the actions of the patient3. Steps that apply to such a process include:
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. The HIV-positive person (source client) has been thoroughly counseled on the need for partner notification/counselling.
· The counselling has failed to achieve the appropriate behavioural changes, including the practising of safer sex.
· The source client has refused to notify or consent to the counseling of his/her partner(s).
· There is a real risk of HIV transmission to the identifi able partner(s).
· The health worker gives the source client reasonable advance notice of the intention to counsel.
· The identity of the source client is concealed from the partner(s) if this is possible in practice.
· Follow-up is provided to ensure support to those involved as necessary and to prevent violence, family disruption, etc.
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| VCCT SITES |
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| VCT is being carried out in various settings in developing and industrialized countries, depending on demands and resources. |
• Free-standing VCT sites
• Hospital services
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- NGO within the hospital
- integrated into general medical outpatient services in public hospitals
- as part of specialist medical care, e.g. sexually transmitted infections (STI) clinic,
dermatology clinic, chest clinic, antenatal and family planning services
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• VCT as entry into the continuum of care/home-based care (including palliative care
services)
• Health centre – urban or rural
• Private sector (clinics and hospitals)
• Workplace clinics
• Referral sites for legal requirements, pre-employment, pre-travel, pre-marital
• Youth health services and school health services
• Health services for vulnerable groups
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- sex workers
- prison populations
- refugees
- IDUs
- men who have sex with men (MSM)
- children, orphans and street kids
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| Examples of best practices
in the provision of counselling and VCT services include
the following: |
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- The location and opening hours of the service should
reflect the needs of the particular community. Voluntary
counselling and testing is usually carried out in
STD clinics, hospital outpatient departments, and
hospital wards, but can also occur in centres dedicated
to this specific purpose (such as the Anonymous Clinics
of the Thai Red Cross). VCT services as well as condom
supplies for sex workers are sometimes offered in
the vicinity of night clubs, and operate at night.
- VCT needs to be well planned so that informed consent
is always sought and counselling offered before a
client takes an HIV test.
- Counselling should be integrated into other services,
including STD, antenatal, and family-planning clinics.
In particular, community-based counselling services
can be initiated and expanded quickly, and at little
expense.
- A referral system for provision of comprehensive
HIV/AIDS prevention, care, and support should be developed
in consultation with NGOs, community-based organizations,
hospital directors, and other service managers, as
well as with networks of people living with HIV and
AIDS. Regular meetings should be held among service
providers to review and improve the referral system.
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| Counselling services, with or without testing,
can and should be tailored to the needs of particular
client groups, some of which have very different needs.
These groups include: |
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- Women (regardless of their HIV status) who are or
who want to become pregnant.
- Couples who agree to attend sessions together before
and after testing.
- Children, including those living with HIV/AIDS,
or who are part of a family in which one or both of
the parents are either infected with the virus or
have died of AIDS.
- Young people, both in and out of school.
- Injecting drug users (including those who are young
people)
- Sex workers (including those who are young people)
- Other socially marginalized or vulnerable groups
such as gay, lesbian, or transgender individuals,
and migrants and refugees.
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