VCT provides the opportunity for people to know their HIV status with quality counselling support to help them cope with a positive or a negative test result.
The majority of adult populations are HIV negative, even in high HIV prevalence settings. Knowing one is HIV negative can serve as a strong motivating factor to remain negative, particularly for those who may otherwise assume it is too late to adopt safer sexual practices.
For people who test positive, while VCT services can link them to options for treatment if and where they exist, and to care and support, just as important, it allows for adoption of preventive measures.
For some, self-protection is a stronger motivator for safer sex than the need to protect others; for others, the responsibility to avoid spreading the virus is itself the critical motivator. Both contribute to HIV prevention.
By knowing one’s positive status, HIV positive individuals may become more motivated to adopt a more healthy lifestyle that improves their health status and slows the progression from HIV infection to symptomatic HIV disease and full blown AIDS – for example, avoiding further risks of infection with other viral strains and STIs, seeking early treatment for opportunistic and HIV/AIDS related infections, eating healthy food, avoiding tobacco and reducing stress.
Knowing one is HIV positive also provides an opportunity to protect sexual partners and to plan for the future from an informed position – deciding on marriage and on child bearing, and preparing children and family for the progression of disease and death.
Today, there are many HIV positive people who are living healthy and positive lives. They serve as strong and effective HIV/AIDS advocates and also provide valuable support and motivation for others infected with HIV and affected by the epidemic.
What are the Guiding Principles for VCT?
VCT presupposes the right to: know one’s HIV status; link with further and ongoing information, supportive counselling, treatment, care and support systems; and efforts to raise public awareness about HIV/AIDS and reduce stigma and discrimination.
Critical to the provision of VCT services are the principles of voluntary attendance, informed consent and confidentiality, and of high quality, reliable and affordable counselling services. These are basic essentials and should be adhered to. If there is any doubt about their implementation in a given situation, VCT should not be supported.
Linkage to support systems
VCT should not be provided as an end in itself, but as part of a continuum of services and support, ranging from advocacy and community mobilization to reduce stigma and discrimination around HIV/AIDS, behaviour change strategies to prevent HIV/STI infections and re-infections, and psychosocial support, care and medical treatment including treatment for opportunistic infections and anti-retroviral (ARV) therapy where it exists.
When introducing VCT services in a community, concerted effort must be made to ensure the range of services and support systems either through direct provision or by referral and linkage with other programmes providing these aspects.
While couple counselling has many benefits, not everyone is part of ‘a couple’. Providers of VCT services must not insist on partner consent or presence as a prerequisite to providing HIV counselling and testing. Couple counselling must uphold voluntary, consensual practice. Coercion by one partner and/or organization (for example in the case of pre-marital mandatory testing) may result in adverse consequences for either party, but particularly for women that test positive.
In some countries mandatory testing has been introduced for certain categories of individuals – prospective students applying to enter University (Ecuador), new military recruits (China), first time antenatal attendants, refugees, those in institutionalized care like orphanages, detention centres, prisons, etc.
A common feature of mandatory testing is the lack of counselling and supportive services offered after testing.