HIV testing at rural clinic in Mukono, Uganda. (Photographer: Arne Hoel)
I was at a hospital recently, and I witnessed the most-flagrant display of ignorance I’ve ever seen. An obviously rich man came in to the reception with a young lady who looked like she was his help (going off of the way she was being ordered around). He asked her to sit down while he approached the front desk personnel. He asked if HIV testing services were offered at the hospital and said that he wanted his help tested. The lady at the front desk replied, “Yes, sir,” however we don’t just test clients like that without having them see “the doctor for a discussion.” This man replied in a very loud and cocky tone, “I do not want to see the doctor, are you going to offer me the test or not? I can go somewhere else to do this.” The maid looked so helpless as she sat looking on, awaiting her fate as decided by her boss. In my mind, I thought, When did wealth become a substitute for ignorance?
Now, besides the obvious breach of medical ethics, this got me thinking, How do you impose HIV testing on an individual without proper counseling? Hence this post.
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Today, we’ll be taking a quick look at voluntary counseling and testing for HIV. In as much as we are all being encouraged to know our HIV statuses via early and regular testing, it is important to be armed with the right information as we go about it – it’s not enough to just walk in to a hospital or testing centre and simply have your blood taken.
What Is HIV?
Before we go further, I’ll refresh our memories by talking briefly about what HIV is.
HIV is a virus known as the Human Immunodeficiency Virus. This virus is an organism that can only infect human beings. It weakens the immune system by destroying important cells that fight infection and disease, therefore rendering the individual susceptible to all and any kinds of illnesses.
HIV is like a lot of other viruses that cause illnesses, e.g. the common cold or flu, but the important difference is that while the body’s immune system clears these other viruses out, with HIV, the human immune system can’t get rid of it.
This means that once you get infected with HIV, you’ve got it for life.
Typically, what HIV does is destroy your immune system over time such that your body can’t fight off infections and diseases anymore, and when this happens, all sorts of illnesses creep in. At this stage, the infection is known as AIDS – Acquired Immunodeficiency Syndrome. With proper treatment though, not everyone who is infected with HIV progresses to AIDS.
HIV is transmitted through contact with body fluids, such as blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk, from an infected person. Modes of contact that can lead to infection include sexual contact, pregnancy, child birth, breastfeeding, sharing of sharp objects like injections, blood transfusions, organ donations, and occupational exposure in health workers.
There’s currently no cure for HIV/AIDS, but there are medications that have been found to dramatically slow down the progression of the disease and control the virus so that infected persons can live a longer, healthier life and reduce the risk of transmitting HIV to others.
Now, let’s get into the meat of today’s discussion.
What Is Voluntary Counseling and Testing (VCT)?
VCT, as already mentioned above, stands for voluntary counseling and testing. VCT is when a person who wants to undergo HIV/AIDS testing — or is mandated to take the test — receives some education and counseling so that they can make an informed decision about whether to be tested for HIV or not and what to do moving forward.
VCT is crucial because it arms us with the information and support we need to live healthy lives whether we discover we are positive or not.
What the counseling does for people who find out they are infected with HIV includes the following:
- Helping them learn more about the virus and how it affects their bodies
- Teaching them how to look after their health so that they can stay as healthy as possible for as long as possible
- Helping them get information and support around how to live positively with the virus. This means learning to accept the fact that they are HIV-infected, seeking emotional support, eating healthful diets, learning how to control the amount of stress in their lives, making sure they don’t become re-infected, and planning for the future.
- Helping them learn to recognize the signs of opportunistic infections so that they can get treated promptly
- Helping them find out what community resources are available to help manage their status and live positively.
- Helping them access drugs for managing the HIV infection and preventing opportunistic infections.
- Helping them make sure they don’t infect anyone else or get re-infected.
Also, if people who undergo this test discover they are negative, the VCT helps motivate them to stay HIV negative and educate them on how to accept and support those who are infected.
What To Expect When You Go in for VCT
The VCT session is typically a private and confidential discussion with a trained physician or HIV specialist aimed at helping you understand what HIV is all about, how it relates to you based on your past or present decisions, and how to help yourself. Most of the time, the VCT is conducted free of charge, however, in most private health facilities, the test itself is paid for.
There are two phases to the VCT:
- You must receive counseling before the test, this is known as the pre-test counseling. What this does is help you make an informed decision whether to have the test or not. It also helps you understand and come to terms with the possible impact the result of the test may have on your life.
- You will then receive counseling as well. This is known as the post-test counseling. It is during this time your result will be made known to you.
In VCT, there’s also something known as on-going counseling. This is the series of counseling sessions that follow once you already know you’re infected, helping you to live positively with HIV and provides support and guidance with any problem you might face.
During the pre-test counseling, some of the things you will discuss with the counselor include:
- Why you decided to come in for the test and counseling
- What the counseling is about and what the counselor’s role is
- Your personal history, including sexual history, orientation, and preferences, drug use, past medical history and on-going health conditions, blood transfusions, and organ transplantation if any.
- Your risk of being HIV infected
- Your knowledge and understanding of what HIV/AIDS is about
- What impact you think a positive, indeterminate, or negative result will have on your life and how you’d react to having any of these results
- Who will you be able to tell should you test positive
- What support systems do you think you’ll have should you test positive
- Your coping strategies when you’ve had problems in the past
- Correct, up-to-date information about HIV/AIDS and what to do to stay healthy for positive individuals
During the post-test counseling, expect to discuss the following with your counselor:
- Your test results and what it means
- Your feelings about your result
- Immediate problems that may arise as a result of your result and deciding a plan of action
- What to do to live a positive, healthy life
- Information about what resources are available in your community to help you, e.g. hospitals and health facilities, other testing centres, drug supply centres and facilities and even societal support groups and NGOs.
While it is absolutely important for everyone to know their HIV status, having the test done is truly a matter of personal decision and no one can force you to have it. However, like I always say, When you know better, you do better. Know your HIV status today and do better with your health, but do it the right way and get properly counseled first.
Stay healthy, folks!
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