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How to improve the quality of VCT in existing services?

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How to improve the quality of VCT in existing services?
Working group 1
How to improve the quality of
VCT in existing services?
 Client perspective
Christiana Nöstlinger, HIV-SAM Project
Aim of Voluntary Counseling
and HIV Testing
1) Diagnosis
- Reduce number of late diagnoses
- Reduce number of undiagnosed HIV infections
2) 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 Testing
3. 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 HIVtesting 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
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