HIV counseling and testing of pregnant women was assessed for acceptability in Tanzania. From June 1996 to May 1998, HIV testing was offered to a total of 10,010 pregnant women. Approximately 74 percent agreed to be tested but only 68 percent of these returned for their test results. Kilewo et al (2001 :458) indicate that several similar studies have not been able to establish exact reasons why people agree to pre- test counseling, but then refuse testing or do not return for their test results once they have been tested. Other studies (CartouxI999; Ladner 1996; and Temmerman; 1995 quoted in Kilewo et al. 2001) have suggested the counseling techniques, suspicion of already being infected and fear of having to cope with a positive result are reasons for
differences in levels of acceptance of HIV test results. Group pre-test counseling has also been reported as yielding higher compliance to being tested and returning for results. The reason that this method is often used is due to the shortage of trained counselors in many districts. In the Petra trial, of the 27 percent of respondents who agreed and qualified to take part in the study, it was found that only 16 percent revealed their HIV status to their sexual partners. Reasons for this were attributed to the fear of violence, stigma and divorce (Kilewo et al. 2001 :458).
Provincial health departments, in order to promote the fight against AIDS, provide VCT guidelines. VCT starts by counseling to help individuals to make an informed choice to be tested for HIV. The objectives of VCT programmes are for VCT to become the accepted thing to do and therefore help reduce the stigma. Other secondary functions are to learn more about the virus and its effects on the body.
Healthy living is also promoted to ensure longevity. Information and counseling for positive people would mean acceptance, access to emotional support, development of healthy eating habits, controlling stress, controlling the possibility of re-infection and gaining knowledge of opportunistic diseases. Other advantages are to network with other HIV positive people as a support and to find out about resources to manage the disease. Information for medication for the control of opportunistic infections and for preventing MTCT can also be obtained. Most importantly is to be able to contain the disease and not to spread it to significant others (VCT guidelines KwaZulu-Natal department of Health 2000).
Sangiwa et al (2000:25-35) conducted a study of client's perspectives on the role of VCT in Tanzania. VCT as an important HIV prevention tool is used to reduce risk behaviours, is also cost-effective and provides support and care for people living with HIV. Results of this first ever efficacy study revealed that this client-centered model was positively received and could play a significant role in the future of VCT.
Comments from participants showed that VCT helped them to assess their own risk, helped them to engage in risk reduction strategies, change lifestyles and adjust their relationships in line with their own capacity.
Chapter Two Literature review 44
The cost-effectiveness was placed in the context of poverty and this freely available service empowered HIV positive individuals to have control of their own lives where ownership meant self-management in many cases. This study was unique in that it reports that participants were keen to learn their status and therefore made a greater effort to have access to blood results. Survey data and qualitative interviews showed that there were very few negative responses to receiving VCT.
Balmer et al. (2000) discussed the effectiveness of VCT in a study in Kenya where individuals and couples seeking HIV prevention services were monitored. Between June 1995 and March 1996 a total sample of 1,515 participants were recruited for the study. Ninetyfive percent of the participants agreed to be tested for HIV. It was ascertained that 32 percent of the sample had at least one STI. Most of the candidates were recruited through community outreach and were supported by friends and relatives who were made aware through presentations, schools and community leaders. This success should prove that community outreach programmes carry a highly effective response rate. Conclusions made from the study found that condom use was low, birth control use was low and the only low risk strategy employed was predominantly one partner sex. Over all findings suggested that in a low income area such as this, where condoms, contraceptives and treatment for STIs is in short supply, there is a high demand for VCT services (Balmer 2000:15-23). Kalichman (cited in Galloway, 2001 :28-30) discussed 3 effective HIV risk reduction interventions. He said that education which provides information, tries to get people to recognise their own risk and includes the provision of skills building which people could use in their daily lives to reduce their risk ofHIV.
It is also important to distinguish counseling from advice and instruction, which is discussed by Stein (1994:12-3). In HIV counseling, the client's concern is to make decisions concerning their own HIV testing, safer sex practice, disclosure etc. and in this case the counselor is only a facilitator who cannot make those decisions. If the client cannot make a decision the counselor may be able to point out various options and could advise on a course of action. Advice and instruction differs from counseling
(which is always non-judgmental and values-free), the latter enables ownership and autonomy.