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close this bookThe Impact of Voluntary Counselling and Testing: A global review of the benefits and challenges (UNAIDS, 2000, 96 p.)
View the document(introduction...)
View the documentAcknowledgements
View the documentAbbreviations
View the documentBackground
close this folder1. Prevention of HIV transmission
View the document1.1 HIV incidence/seroconversion
View the document1.2 STI rates
View the document1.3 Reported sexual behaviour
View the document1.4 Studies demonstrating counselling can reduce risk behaviour
View the document1.5 Pregnancy
View the document1.6 Voluntary partner notification and partner testing
View the document1.7 Couple counselling
View the document1.8 Premarital VCT
close this folder2. Prevention of HIV transmission in special populations following VCT
View the document2.1 Men who have sex with men (MSM)
View the document2.2 Sex workers
View the document2.3 STI clinic attenders
View the document2.4 Injecting drug users (IDUs)
View the document2.5 Prison populations
View the document2.6 Truck drivers
View the document2.7 Blood donors
View the document2.8 Young people
close this folder3. Care: Improving access to medical, emotional and social support
View the document(introduction...)
View the document3.1 Access to medical care
View the document3.2 Access to ongoing emotional/psychological care
View the document3.3 Psychological coping and adjustment (for the individual as well as for the family and community)
View the document3.4 Sharing of HIV test result with family and friends
View the document3.5 Post-test clubs/support groups
View the document3.6 Access to social support
View the document3.7 Legal and future planning
View the document3.8 Access to interventions to prevent mother-to-child transmission of HIV, specialist antenatal care and family planning services
View the document3.9 Access to HIV transmission prevention services
View the document4. Societal
close this folder5. Cost
View the document5.1 Developing countries
View the document5.2 Industrialized countries
View the document5.3 Cost effectiveness associated with MTCT interventions
close this folder6. Negative outcomes following VCT
View the document(introduction...)
View the document6.1 Abandonment and abuse
View the document6.2 Marital break-up
View the document6.3 Discrimination
View the document6.4 Psychological distress, stress and depression
close this folder7. Operational
View the document(introduction...)
View the document7.1 Uptake, return rates and acceptability
View the document7.2 HIV testing methods: Simple-rapid (S/R) testing/same-day testing
View the document8. Client satisfaction with the service
View the document9. Counselling without testing and other behavioural interventions
View the document10. Testing without counselling/minimal counselling
View the document11. Conclusion
close this folderAppendix
View the documentStudies from developing countries
View the documentStudies from industrialized countries
View the documentStudies among MSM
View the documentStudies among IDUs
View the documentReferences
View the documentBack Cover

3.1 Access to medical care


In industrialized countries the development of highly active antiretroviral therapy (HAART) has had a dramatic effect on the long-term survival of people with HIV. This has meant that there is great benefit for people with HIV to be aware of their seropositive status so that they can start treatment earlier, thus avoiding HIV-associated illnesses and prolonging their life. In Europe and the United States the death rate from HIV has fallen significantly over the past five years as a result of the availability of HAART (Carpenteret al., 200096). Ongoing counselling has been shown to be an important factor in ensuring adherence (Revsin et al., 199897, Greene et al., 200098).

Preventive therapies

Less costly interventions to reduce the incidence of HIV-associated infections, such as tuberculosis preventive therapy (TBPT), have been shown to reduce the incidence of TB among people with HIV (Mwinga et al., 199899), (WHO/UNAIDS100). Two studies from sub-Saharan Africa (Godfrey-Faussett et al., 1995 101, Aisu et al., 1995102) have shown that VCT can be an appropriate site for screening and treating people who test seropositive for active TB, and providing TBPT to those without active TB. In Haiti, a community-based programme offering VCT and screening for TB was effective in identifying early TB and instigating prompt and effective treatment (Desormeaux et al., 1996103). In Zambia, a pilot project of integrated HIV and TB counselling for families is being developed. Early results demonstrate that this is to be acceptable but longer-term follow-up is awaited (Ayleset al., 2000104). In Malawi, the Malawi AIDS counselling and resource organization (MACRO) provides VCT at two sites. It also provides TB and STI screening and treatment and family planning. There is considerable demand for these services by people following VCT, even among people who attend VCT for primarily non-medical reasons (Phiri et al., 2000105).

Other preventive therapies such as cotrimoxazole prophylaxis (Anglaret et al., 1999106, Wiktor et al., 1999107 Sassan-Morokro et al., 1998108) have also been shown to prevent morbidity in PLHA in some settings (seropositive TB patients in Cd’Ivoire and Senegal). Cotrimoxazole is cheap, easy to administer and requires minimal monitoring. UNAIDS has recommended that it should be made more widely available to PLHA.

Family planning services

Referral for other services, such as contraception, can help couples (both seropositive and seronegative) make informed decisions about family planning methods and having children (Pugh et al., 1998109). In many high-prevalence countries the desire to have children is strong and there have been no significant differences in the uptake of family planning services for seropositive and seronegative women. In Rakai, Uganda, 13% of positive women and 12% of negative women used female-controlled family planning following VCT (Lutalo et al., 2000110).

Ongoing medical care

One of the most valued services offered to people following VCT at Kara, Zambia, was the provision of basic, ongoing medical care for the treatment of HIV-associated infections (Baggaley et al., 1998). Similar findings were evident from The AIDS Support Organization (TASO), Uganda, evaluation.

Complementary medical services

In many countries where ARVs are not available because of cost and lack of laboratory infrastructure PLHA may have symptomatic benefit from complementary/traditional medicines (Gouskov, 2000111). However, sometimes counsel-lors may have a role in challenging unrealistic beliefs about complementary therapies or assisting clients in discussing the pros and cons regarding decisions about allocating limited family resources to these therapies.