HUMAN IMMUNODEFICIENCY VIRUS

VCT
(VOLUNTARY COUNSELING TESTING)

Vimal Jairaman
0902005195
OVERVIEW
INTRODUCTION

TRAINING RESOURCE OUTLINE
Module 1
Module 2
Module 3
Module 4
Module 5

SUMMARY
INTRODUCTION
HIV voluntary counseling and testing (VCT) services
provide a critical entry point to both HIV/AIDS
prevention and care and support of infected and
affected individuals.
HIV Voluntary Counseling and Testing (VCT): A
Reference Guide for Counselors and Trainers is an
extremely valuable tool.
TRAINING RESOURCE OUTLINE
MODULE 1
MODULE 2
MODULE 3
MODULE 4
MODULE 5
MODULE 1
INTRODUCTION TO HIV TESTING
HIV testing provides the gateway to accessing other
services; a person living with HIV cannot receive any
care until they have been diagnosed. The conventional
model is VCT (voluntary counseling and testing),
requiring people to come forward to be tested.
Early diagnosis enables more effective treatment and
care. If HIV is first detected in the late stages of
infection then more complex care may be needed, and
there is less chance that treatment will work.
REASONS
Surveillance : This is anonymous and unlinked
serological testing which is used to develop
epidemiological data that assists in HIV prevention
and service planning.
Blood screening : Donated blood is screened for HIV
to ensure the safety of clinical blood supplies.
Voluntary individual testing : Individuals voluntarily
choose to test in order to learn their HIV status.
Diagnostic testing : This testing is conducted when
clients present for management of an illness.

Role of VCT
facilitating planning for the future;
orphan care;
will making;
acceptance and coping with one's serostatus;
facilitating behaviour change in seronegative and sero-positive people thus keeping HIV
negative those who test negative;
reducing mother-to-child transmission;
VCT is also the platform for facilitating early management of HIV-related infections and
STIs;
identifying the need for prophylaxis and effective/safe use of HIV antiretroviral
therapies.
it also enables psychosocial support through referral to social and peer support and
increases
the visibility of HIV in the communities.
this fosters the enhancement of destigmatisation of those with
HIV/AIDS as HIV will be seen as a problem faced by many normal people in the
community.
this process can promote normal attitudes to the disease, which is known as
normalisation of HIV/AIDS.
MODULE 2
BASIC COUNSELLING TECHNIQUES

Basic HIV infection

Rationale for VCT

Behavior change communication

Basic counseling microskills

Clinical risk assessment

Pre-test counseling

Post-test counseling

Ongoing psychosocial care planning

BASIC COUNSELLING TESTING CONSISTS OF:
i. Overview of pre and post HIV test counselling.
ii. Pre HIV test counselling (sex assault, occupational
exposures).
iii. Post-HIV test counselling.

MODULE 3
INJECTING DRUG USERS
IDUs inject drugs into veins, under the skin (skin
popping), or inject substances intramuscularly (steriod
injectors).
Sharing is also common among regular sexual
partners. If one member of the group or a partner in a
sexual relationship with a member of the group has
HIV infection, and sharing of injecting paraphernalia
occurs, the chances of infection spreading rapidly to
other members of the group is extremely high.
SEX WORKERS
Sex workers are especially vulnerable to HIV
transmission due to their large numbers of sexual
partners and often high rates of other sexually
transmitted diseases.
Sex workers often feel disempowered to negotiate safe
sex practices with clients on whom they rely for
income. In some cases, sex workers may accept a
higher price with men who refuse to use a condom.
YOUTH AND CHILDREN
Young people aged 15 to 24 years old account for more
than 50% of all HIV infections worldwide (excluding
perinatal cases) and more than 6,000 young people are
newly infected with HIV each day throughout the
world.
Yet VCT services are not always designed to target the
specific needs of youth. This represents a missed
opportunity not only to provide testing and
counselling, but also to provide behaviour change
communication about safer practices during a persons
formative years.
MEN HAVING SEX WITH MEN
(MSM)
MSM can include the following:
Men who exclusively have sex with other men
Men who have sex with other men but mostly have sex
with women
Men who have sex with both men and women without
any particular preference
Men who have sex with other men for money or
because they do not have access to sex with women, for
example, men in prison, men in the military.


MOTHER TO CHILD TRANSMISSION
When an HIV-infected woman passes the virus to her new born
baby.
Without treatment, around 15-30% of babies born to HIV
positive women will become infected with HIV during
pregnancy and delivery.
A further 5 to 20% will become infected through breastfeeding.
In 2008, around 430,000 children under 15 became infected with
HIV, mainly through mother-to-child transmission.
About 90% of these MTCT infections occurred in Africa where
AIDS is beginning to reverse decades of steady progress in child
survival.

In high income countries MTCT has been virtually eliminated
thanks to effective voluntary testing and counseling, access to
antiretroviral therapy, safe delivery practices, and the widespread
availability and safe use of breast-milk substitutes.
MOBILE POPULATION
Migration and mobility have increased over the past
several years and are likely to continue to increase as:
Land and air transport become more readily available
Economic imbalances between communities push
people to move in search of better lives or to survive
Closed societies and borers such as in Eastern Europe
and China open up
Wars continue to displace people
Organized migration and trafficking continue to
flourish.


Contributing factors to HIV vulnerability may include the
following:

limited access to health services;
health services which are not well versed in the traditions and
practices of migrants;
limited exposure to public health campaigns around HIV/AIDS.

There are several different categories of migrants. These include:

Those who choose to migrate to another country to seek a better
quality of life
Those who are forced to migrate to escape disruption and
turmoil in their home country (refugees) and those who migrate
from one part of their home country to another (often for
economic reasons but not always for economic reasons only)


PRISONS
Prisons and detention centers are some of the most
difficult sites in which to carry out effective HIV/AIDS
prevention and to provide appropriate care and treatment
for people with HIV or AIDS.
Worldwide, most societies give low priority to public health
issues in prisons. This is unfortunate as prisons can be very
efficient sites for the transmission of blood borne or
sexually transmitted viruses such as HIV. If prisoners or
detainees become infected with HIV during incarceration
this only increases the potential for the spread of HIV in
the broader community as most prisoners are likely to have
relatively short term sentences and then return to the
community.
The same behaviors that might put people at risk in the
outside world, such as unprotected sexual intercourse and
injecting drug use, also occur in prisons.

MODULE 4
COUNSELLING AND CARE
Consideration of psychosocial issues is fundamental to
HIV/AIDS counselling and care. Counselors need to
view the client in a holistic manner within the context
of their social environment.
As the disease progresses and immune suppression
occurs, the individual may experience a range of HIV-
related neuropsychiatric conditions. These conditions
may cause severe disturbance to an individuals
capacity to perform the activities of daily living.
COUNSELLING FOR TREATMENT
ADHERENCE
Treatment adherence, or compliance, broadly means
the extent to which the patient follows medical
instructions in taking their medications. It means
taking the correct dosage, the correct way (for
instance, with food) and every time. Medications,
which need to be taken on a long-term basis, are
common for many chronic illnesses, including
HIV/AIDS. These medications include antiretroviral
medications, prophylactic medications for
opportunistic infections and medications for
treatment of opportunistic infections (in particular,
treatment for tuberculosis).
MODULE 5
COUNSELLOR SUPERVISION AND
SUPPORT
A working relationship between a supervisor and a
supervisee. The supervisee offers an account or record
of his or her work to reflect on and receive feedback
and/or guidance. The objective of this alliance is to
enable the supervisee to gain ethical competence,
confidence and creativity so as to give the best possible
service to his or her clients.
The supervisory relationship:
Is purposeful
Ensures that the supervisees concerns are explored
Facilitates change
Is confidential (as per the contractual agreement)

Autonomy is promoted in terms of:
Choices
Decisions
Responsibilities
Actions

The relationship ensures:
Trust
Honesty
Warm acceptance
Empathy or understanding or communication
COUNSELLOR ETHICS
HIV or AIDS is a highly emotive and sensitive subject for both
individuals and societies and can pose complex ethical issues for
counselors and other health care workers.
Often ethical dilemmas will arise when there are conflicts between the
interests of the client and those of the community. Some examples
include:

The client who refuses to give up high risk behavior
The client who asks not to be told the results of HIV testing and who
tests positive
The HIV positive person who refuses to tell his/her sexual partner
Blood samples taken in an anonymous research programme to confirm
a diagnosis of anaemia are also used to collect statistics on HIV
prevalence.


SUMMARY
INTRODUCTION

MODULE 1- introduction of HIV testing, reasons and
the role of VCT.
MODULE 2- basic counselling testing.
MODULE 3- counselling for specific target groups.
MODULE 4- counselling and care including ARV
treatment.
MODULE 5- VCT service delivery and programme
management.
SUMMARY!!!
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