Enhancing HIV Control: Voluntary Counseling & Testing Overview

1. Overview of Voluntary Counseling and Testing (VCT) Patrick Osewe, MD, MPH

2. Presentation Outline • Introduction • Rationale for VCT • VCT Experience in Sub Saharan Africa • Challenges to scaling up VCT services • Operations research questions • Closing remarks

3. Introduction • HIV is spreading rapidly across Africa and Caribbean region • Urgent measures are need to control the epidemic • Requirement for epidemic control • Identification of a causative agent • Identification of the mode of spread • Case detection • Case management to prevent further transmission

4. Rationale for VCT • Prevention • HIV-infected • PMTCT • HIV negative • Care and Support • Societal Benefits

5. Rationale for VCT (1) • Prevention • HIV-infected • Behavior change • Partner notification • Discussion of family size • Care of children • PMTCT

6. Rationale for VCT (2) • Prevention • HIV negative • Re-enforcing negative status • Delayed sexual onset amongst youth • Everybody is positive except you! • Safer sex negotiation – important for youth • Promote use of female condoms

7. Rationale for VCT (3) • Care and Support • Prevention and management of HIV related infections • Discussion on ART – when to initiate, benefits, dangers • Access to ongoing emotional and psychosocial support • Access to post test services (nutritional, material, spiritual, legal services)

8. Rationale for VCT (4) • Societal benefits • Normalization of HIV • Challenges stigma – break cycle of fear • Making VCT as an entry point – but not a final destination to prevention, care and support

9. Impact of Knowing HIV Status

10. VCT Experience in Zimbabwe • Initiated in 1999 with funding from USAID • Branded New Start based on research • Limited experience with in the region except Uganda • Designed different VCT for different settings: • Public Sector • NGO Sector • Private companies • Free Standing • Outreach (mobile) service

11. Women Ever Tested for HIV and Learned Test Results, Zimbabwe YAS 2001 n=534

12. Men Ever Tested for HIV and Learned Test Results, Zimbabwe YAS 2001

13. Reinforcement Activities: Objectives Availability of services & a supportive environment Overcome barrier to change Assess own risk Apply info to own situation Accurate Information

14. Community Mobilization VCT Uptake Community leaders Pastors Teachers PLWHA Health workers Youth

15. Challenges for VCT • Largely “latent” disease • Highly stigmatized • Frightening revelations if infected • Benefits of testing not tangible or clear • No treatment for majority

16. Challenges to Scaling Up • Attitude of health care workers towards HIV testing – Training and sensitization • Shortage of staff (nurses, social workers) Alternative counseling staff • Regulation e.g HIV testing done by lab tech – Trained nurses to perform HIV test • Fear of HIV testing – Get real campaign

17. Operations Research Questions • What are the long term prevention benefits of VCT? • Does support groups/post test services membership promote disclosure? • Does VCT reduce stigma in a community? • Does ART increase uptake for VCT services? • What are the staffing requirements for an effective delivery of a VCT service

18. STAGES OF BEHAVIOUR CHANGE Precontemplation Contemplation Maintenance Preparation Action