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Voluntary Counselling & Testing.

What is VCT?
VCT is a public health strategy that aims at reducing preventing) HIV transmission by: 1. Increasing peoples access to knowledge and understanding of HIV status on a voluntary basis 2. Facilitating early uptake of services for HIV-positive and -negative people (medical, psychological, legal, social) 3. Providing tools for the adoption of safe behaviour

What is VCT? (contd)

4. Increasing awareness and information in communities 5. Reducing and removing stigmatization and discrimination associated with the epidemic

United Nations Policy

VCT is based on the requirement that testing for HIV be based on the informed consent of the person being tested. HIV Testing must always be the individuals informed decision.

What is Counselling in VCT ?

A confidential dialogue between a person and a care provider aimed at enabling the person to cope with stress and make personal decisions related to HIV/AIDS.

The counselling process includes an evaluation of personal risk of HIV transmission & facilitation of preventive behaviour.

*Voluntary Counselling and Testing Technical Update, UNAIDS, 2000

Goals of VCT {1}

1. Prevention of HIV Transmission:

From +ve tested people to -ve or untested partner/s.

From +ve tested mother to child.

To -ve tested people from +ve or untested partner/s.

Goals of VCT {2}

2. Promote Early Uptake Of Services:

Medical care.
ARV therapy Treatment & prevention of OIs PMTCT

Family planning. Emotional care. Counselling for positive living. Social support. Legal advice and future planning.

Goals of VCT {3}


Normalisation of HIV. Challenging stigma. Promoting awareness. Supporting human rights.

Guiding principle of VCT


Accompanied by Counselling
Only be conducted with Consent, i.e. both informed and voluntary

What is confidentiality?
Confidentiality arises when:

There is a confidential relationship, the nature of which may be dependent on factors of trust, knowledge and skill Information which otherwise would not be disclose to other without the clients consent .
For example, doctorpatient and counsellorclient relationship

Informed consent for HIV testing

Pre-test counselling should include:

engagement and assessment

risk reduction and planning assistance review and signing the consent form Post-test counselling should include: presentation and encouragement

priorities and follow-up

Symptoms or worries leading to a decision to know HIV status

Counselling before testing, including assessment of risk behaviour and psychosocial condition, and provision or oral and written factual information.

Providing time to consider

Blood test declined

Blood sample taken

HIV Positive Breaking the news sensitively; assessing capacity to manage news; providing time for discussion; helping to adjust to situation and making appropriate and reasonable plans.

HIV Negative
Reinforcing appropriate behaviour and encouraging change of in-appropriate behaviour.

Providing on-going counselling that involves family, friends & others; mobilising family and community support; identifying other sources of support; encouraging responsible behaviour.

Explaining that even in a low-risk situation, care needs to be taken to avoid infection and possible transmission.

Providing continuing counselling, including stimulating motivation to reduce risks of transmission; where appropriate, identifying other sources of support, including medical, hospital and possibly hospice care.

Essential elements of VCT services

Determining the clients knowledge Providing information Conduct risk assessment Develop risk reduction plan Demonstrating correct condom use Counselling about the test result Assessing the clients capacity and ability to cope Counselling on how to inform partner how to refer partner for testing Providing psychological and emotional support and referrals, as appropriate

VCT sites should have at least the following

An appropriate private room for counselling A room for HIV testing A comfortable waiting area Appropriate equipment, test kits and other supplies . A trained counsellor A health worker/laboratory worker certified in HIV testing Appropriate record keeping, monitoring and evaluation system IEC materials, condoms and other supplies.

Voluntary Versus Mandatory Testing as a Public Health Strategy


is no evidence to support the use of mandatory HIV testing.


is evidence to suggest that promoting and offering VCT is an effective public health strategy.

What are the Documented Benefits of VCT ?

VCT reduces risk behaviour, especially in those tested positive. VCT assists in test-making decision-making and coping. VCT assists HIV status disclosure to family members & loved-ones. VCT facilitates access to community support, material support & psychosocial care.

Who benefits from accessing HIV counseling and testing?

Populations most at risk such as FSW,MSW, MSM, IDU, migrants, Pregnant women People who perceive themselves at risk of HIV infection through unsafe practices
frequent or unprotected sex injecting drug use

People who had a potential exposure:

through unsafe blood supplies or contaminated equipment victims of rape Children of HIV positive mothers Adolescents and young people

Couples planning to commence a sexual relationship or marry and/or have children Sexual or needle sharing partners of PLHA People with sign symptom of STI