24.2  Modes of delivering HIV counselling and testing

HIV counselling and testing is central to preventing the spread of HIV infection and identifying those individuals at risk. As discussed in Study Session 20, we can only say that a person has HIV in their blood when they are tested and found to be HIV-positive. In this section, you will learn that there are three different modes of delivering the counselling and testing service: voluntary counselling and testing (VCT), provider-initiated HIV testing and counselling (PITC), and mandatory HIV testing.

Voluntary counselling and testing (VCT) is initiated by the clients themselves. In other words, individuals request HIV testing without the health worker offering or recommending testing. VCT often takes more time than PITC because clients expect, and have allowed time for, additional counselling both before and after a test result. Note that you are not expected to perform VCT yourself. If individuals ask you for HIV testing voluntarily, you should refer them to a health centre that offers VCT.

The World Health Organization (WHO) and health services in many countries, including Ethiopia, promote a policy of provider-initiated HIV testing and counselling (PITC). This means that when trained to do so, you should offer and provide HIV testing and counselling yourself. PITC enables specific clinical decisions to be made and medical services to be offered that would not be possible without the knowledge of a person’s HIV status. A period of pre-test counselling and education should always accompany testing, and people should never be forced to undergo testing against their will.

Remember that under most conditions, an HIV test should only be done after obtaining the informed consent of the individual concerned.

PITC is further divided into diagnostic testing and routine offer. Diagnostic testing is part of the clinical process of determining the HIV status of a sick person, such as someone with TB or other symptoms that suggest possible HIV infection. On the other hand, a routine offer of testing and counselling means offering an HIV test to all sexually active people who seek medical care for other health issues.

Unlike VCT, PITC needs only a brief period of pre-test information/education before performing the test, and can be done in a few minutes. PITC is recommended for countries like Ethiopia where HIV is endemic (always present in the population). PITC is not a replacement for VCT. Instead, it provides an entry point to HIV services, it helps to prevent HIV transmission in the community, and also helps people make healthier choices. Those individuals who are found to be HIV-positive can then be referred into treatment and care.

Under normal conditions, a person would only undergo HIV testing after they have given their informed consent, that is consent based on fully understood information about the test and what the result may mean. A signed consent form is not needed in Ethiopia for PITC (although it is for VCT), but obtaining verbal consent is essential.

Respecting an individual’s rights is an integral part of the process of HIV counselling and testing, and this is often referred to as the ‘3 Cs’consent, confidentiality, and access to counselling.

Mandatory HIV testing, on the other hand, does not require the consent of the individual about to be tested. It is done by force or without informed consent, and is usually performed at the request of a court in cases involving rape or other sexual assault.

24.1.2  The barriers to HIV testing

24.2.1  The five steps in PITC