Transcript Voluntary Counseling and Testing (VCT) for HIV

Voluntary Counseling and
Testing (VCT) for HIV
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.
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.
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.
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.
Acceptance of
Serostatus and coping
Planning for
future orphan
care; Will
preparation
Referral to
social and
peer support
Normalizes
HIV/AIDS
Early
management of
OIs and STDs
Voluntary
Counseling
Testing
Reduces
mother-tochild
transmission
Facilitates
behavioral
change
Preventive therapy
(TB and bacteraemia)
and contraceptive advice
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
Goals of VCT (2)
• 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
Components of VCT
• 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
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
Cost Effectiveness of VCT
VCT is cost effective
Outcome
Tanzania
Kenya
HIV Infections Averted Per
10,000 Persons
895
1104
Cost/HIV Infection Averted
$ 346
$ 249
$ 17.78
$ 12.77
Cost /DALY Saved
(Sweat
et al).
Review of VCT Outcomes
• Prevention of HIV transmission
• Prevention of HIV transmission in
special populations
• Care: Improving access to
medical, emotional, and social
support
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
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
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
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
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
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