Voluntary Counselling and Testing for HIV: Perspectives on Implementation

Dr David Miller of UNAIDS India presented a strong case for the continuation of voluntary testing with counselling (VCT) as an integral part of national and local responses to HIV/AIDS. Initially there was a sense that the counselling associated with testing might be a concept that might not translate well into all cultures. It is now clear that counselling has been well translated into the African AIDS experience and can also be translated into Asian and Pacific responses. In the interest of efficiency and cost-effectiveness, countries and services have at times tried to leave out the counselling component of testing, preferring either no counselling or the provision of short information to groups of people before testing. Miller argued strongly that VCT is a vital entry point for development of prevention and care responses. At an individual level it provides an opportunity for proper informed consent for testing, begins the conversations that lead to access to condoms and to information about safe sex, provides the basis for providing support for newly diagnosed people with HIV. At a program level it is a key part of the enabling environment - the provision of confidential and supportive HIV testing, building the trust of marginalised groups to come forward and engage with the public health response to HIV/AIDS. Miller expressed concern that, in an effort to make best use of limited resources, some countries and services were streamlining HIV testing and leaving little time and resources for conversations with individuals and groups about the meaning of HIV, about risk and safety and about how to engage with the range of treatment and support services available. He argued for additional resources, training and support for the people who are carrying out HIV counselling and support. There are many models for adapting VCT to local need and there is now strong evidence that the core principles of counselling should continue to be an essential part of HIV testing programs.