|Counselling and Voluntary HIV Testing for Pregnant Women in High HIV Prevalence Countries - Elements and Issues (UNAIDS, 1999, 24 p.)|
|5. Operational considerations|
In most developing countries, specialist counsellors are in short supply. And there is unlikely to be enough money available to train and hire as many specialist counsellors as would be needed in the context of routine antenatal care.
It is recommended, rather, that existing reproductive health staff be trained in the basics of counselling and testing for HIV. They are already familiar with many of the issues surrounding reproductive health and infant feeding. Training existing staff to provide additional advice on HIV care and prevention in the context of pregnancy may be easier that training professional counsellors to deal with all the medical questions that may arise around the subject of reproductive health and childbearing. However, extra staff will probably need to be hired to cope with the extra volume of work created by providing counselling and HIV testing services.
The work of providing information and of counselling should be diffused as efficiently as possible though the hierarchy of care, according to the particular needs of each client. Much of the routine provision of basic information about HIV transmission, prevention and testing for example, can be done in groups and carried out by staff with little special training in counselling. For more complex issues - analysis of resources in helping HIV-infected mothers reach feeding decisions, or counselling of discordant couples, for example - specialized counsellors may be needed and discussion with clients on a one-to-one basis will be essential. Regular staff should be able to refer those in need to progressively more specialized levels of counselling. The more specialized counselling may be provided by dedicated voluntary counselling and testing centres outside the reproductive health facility. Facility managers will need to identify services to which they can refer clients, and would be well advised to discuss their clients needs with key staff in those services.
Health workers will need additional training in all the basic areas of pre- and post-test counselling if they are to provide useful HIV-related counselling to women contemplating a test or digesting its results. In addition, they may need extra training to help them deal non-judgmentally with clients in often difficult situations. Perhaps most importantly, health workers need a rigorous understanding of the importance of confidentiality.