Voluntary counselling and testing (VCT)

Step One – Pre-test Counselling

You will be assigned a code number- you will not be required to give your name. During the pre-test counselling session, which lasts between 20-45 minutes, you will be told about the test and HIV disease. Ways to cope with a positive diagnosis will be discussed. You will be able to ask questions.

If you agree to take the test, you will be asked to sign a consent form. You can also choose not to sign but to only give verbal consent. You must then supply a small sample of blood from a finger prick, or a saliva sample. Most hospitals and clinics use a rapid HIV test, which means that the results will be available within 20 minutes. If this test is not available an Elisa test will be done, which requires a larger blood sample from your arm. It also needs to be sent away to a laboratory. You will be told when to return for your results, which can take up to two weeks.

Your results will be given during a post-test counselling session. The health professionals and counsellors who conduct and discuss the test with you must, by law, keep the results strictly confidential. You decide whether to tell your family and friends if you are HIV-positive. Children over 14 years of age do not need permission from a parent or guardian to have an HIV test. Children under the age of 14 do require permission, although in emergency situations, such as after a rape when a HIV test is required, a doctor can authorise a test.

• If your test is negative you will be given advice on how to prevent HIV infection in the future
• If you have had unsafe sex in the three-month period before taking the test, you will be advised to come for a second test after another three months. This is because there is a time period after HIV infection, called the window period, when tests cannot accurately pick up the infection

• If your test is positive you will be given another different test to confirm the result
• If the second test is negative a blood sample will be taken and sent to a laboratory for further testing to establish the correct diagnosis
• If the second test is positive, counselling and advice on how to manage your health and delay the development of AIDS will be provided. You will also be advised on how to reduce the risk for your sexual partner(s) and how to deal with the issue of disclosure to your family and friends. The counsellor will refer you to a government HIV service point
• The next important step is to find out how advanced your disease is. You will have to undergo more tests to measure your CD4 count (which indicates how strong your immune system is) and your viral load (which measures the number of viruses in your blood). You will be given appropriate advice on how to stay as healthy as possible, and treatment if necessary

What the HIV test cannot show

• How a person was infected
• Who the person got the infection from
• When the person first became infected
• If a person has AIDS – different kinds of blood tests need to be done

• The majority (90+%) of government health facilities (hospitals and clinics) now provide a free VCT service, and the aim if for 100% coverage
• Most of the ATICCs (AIDS Training, Information and Counselling Centres) set up by the government throughout the different provinces provide free VCT
• Several national non-profit organisations (NPOs), such as the loveLife Planned Parenthood Association of South Africa (PPASA) Youth Centres provide a free VCT service (search the AIDSbuzz directory under VCT sites to find out which organisations offer a testing service as well as some of the government sites)
• Large corporates generally offer free VCT to their employees
• Private doctors and hospitals. Private laboratories will not do an HIV test without a doctor’s referral, and will only give the results to the referring doctor. This is because the doctor needs to provide pre- and post-test counselling. The person will be charged for this service. Medical Aids generally cover the cost of VCT
• Mobile VCT facilities. For instance, New Start, run by the Society for Family Health, provides a mobile VCT service. The organisation pitches its hallmark blue tents in poor and under-serviced areas on the outskirts of Johannesburg, Durban and Cape Town. This free and convenient VCT facility is aimed at people who do not usually visit clinics or travel to the city centres (see ADISbuzz directory for further information)

The AIDS helpline on 0800 012 322 or the karabo website can provide information about the nearest government VCT centre for any person wanting an HIV test. Any questions a person may have about the VCT process will also be answered by the AIDS helpline counsellors.

• If you test negative, you will be able to make sure that you do not put yourself at risk in future by adjusting your sexual lifestyle and practices.
• If you are worried that you may be HIV-positive because you have practised unsafe sex it is important that you take a test. If you are negative you can put your mind at rest and start making sure you do not put yourself at risk in future. If you test positive you can start to actively manage your health and also make sure that you do not infect any of your future partners.

There is good evidence to support the fact that most people who test positive immediately modify their behaviour and therefore reduce the risk of infection for others. Testing negative also tends to encourage people to adopt safer sexual practices in the future.

 

Uptake of VCT

It has been estimated that less than one in five people who are infected with HIV in South Africa know their status. This is why it is so important for everyone to adopt safe sexual practices as well as come forward to be tested. There is widespread concern that the uptake of VCT throughout the country is much too low, and ways of encouraging people to come forward voluntarily, are continually being explored. No country wants to undermine basic human rights by instituting compulsory mass testing. However it is a big problem when so few of the people who are infected know their status and are therefore putting their sexual partners at risk and helping to spread the disease. In addition too many people are presenting for treatment at a late stage in HIV disease, when they have become sick as a result of additional opportunistic infections such as tuberculosis or pneumonia. This makes the treatment more complicated and expensive, and the treatment outcomes are not as good.

• You have had unsafe sex with multiple partners
• You do not know the HIV status of your partner
• You are not sure if your partner is faithful
• You have been the victim of sexual abuse
• You have contracted a sexually-transmitted infection (STI) within the last 10 years
• You or your partner have used intravenous drugs and shared needles within the last 10 years

If people are to come forward for testing there must be advantages. One of the most powerful reasons to get tested is the knowledge that there is appropriate support and treatment available if the test is positive. In both developed and developing countries as soon as antiretroviral treatment (ART) becomes widely available more people start to come forward for testing. The Khayelitsha antiretroviral treatment (ART) programme in the Western Cape illustrates this point nicely. Since the ART programme was launched at the Site B Clinic the number of people being tested at this clinic went from less than 1 000 in 1998 to more than 12 000 by 2002 (DOH). Such dramatic increases in VCT uptake have not been seen in the areas where ART is not available.

 

HIV testing and your rights

Every person has the right to privacy, dignity, respect, to make their own decisions and to protect themselves from harm done by others. This means that each one of us has the right to have our own decisions about our body treated with respect. In other words, no patient can be given medical treatment without their consent.

Consenting to medical treatment has two parts to it: information (understanding) and permission (agreeing) This means you need to:

• Understand the type of treatment that you are going to get
• Give your permission for the treatment
  

With an HIV test, you must know what the test is, why it is being done and what the result will mean for you before you agree to the blood sample being taken. This is calle pre-test counselling. After the HIV test results have been received you must be counselled again to help you understand and accept the effect that a negative or a positive result will have on your life. This is called post-test counselling.

The Department of Health's National policy on Testing for HIV (2000) says the patient should:

Confidentiality of results
Confidentiality means that doctors, nurses, psychologists, dentists and other healthcare workers have a moral and legal duty to keep all information about patients confidential. Any information about the patient's illness or treatment cannot be given to another person unless: