|The Impact of Voluntary Counselling and Testing: A global review of the benefits and challenges (UNAIDS, 2000, 96 p.)|
|6. Negative outcomes following VCT|
Finding out that one is seropositive, as with other serious medical diagnosis, will almost inevitably cause shock and distress and have a major effect on the individual and his or her family (Dautzenberg et al., 1992197, Ankrah1993198, Lippmanet al., 1993199). The aim of counselling is to help the person understand, accept and cope with the diagnosis and prevent serious reactions such as suicide or long-term intractable depression.
In Rwanda, a prospective study of seropositive women found that although the majority reported good morale, chronic difficulties with sleep, performing daily routine and feelings of depression were reported by a third of the women (Keogh et al., 1994200).
In Zambia, although many people who tested seropositive expressed sadness, anger or anxiety following testing this was relatively short lived and no cases of attempted suicide occurred (Baggaleyet al., 1998). Some people who had suspected that they were positive said that they felt at ease on receiving their result, since they were now able to understand symptoms and make plans for treatment or for their dependants. People who tested seronegative expressed relief, but some also expressed guilt or sadness when partners or family members had tested positive.
In the multi-centre trial 81 people were interviewed in depth about their emotional feelings following VCT (Sangiwa, 2000201). Seronegative clients reported feelings of relief, decreased anxiety, improved hope and increased confidence in themselves. Seropositive people reported better coping skills to deal with their situation, increased hope, disappearance of suicidal thoughts and help in decreasing isolation and normalizing their situation. Among seropositive people, most distress was described as transient. However, some participants reported persistent feelings of sadness, desperation and a sense of loss as they felt they may have to give up having children and abstain from sex out of concern about infecting others.
There have been several studies examining psychological outcomes following testing among MSM. Two studies show increases in stress and depression for those testing positive. Nevertheless, the long-term outcomes are not reported and very serious consequences (such as suicide) are not reported. In one study there was no difference in psychological outcomes between men who did not know their status and those who did.
A study of homosexual men showed that those who tested seropositive following VCT were more likely to suffer adverse consequences such as stress, depression and break-up of their primary relationship than those who tested seronegative or those who refused testing (Coates et al., 1987202).
Another study compared MSM who were aware of their HIV status with men who had been tested but declined to receive their test result (Doll et al., 1990203). Those who chose to learn their status were no more likely to report depression or anxiety following testing than those who chose not to know their status.
In a study of 22 seropositive MSM, 22 seronegative MSM and 12 men who were tested (but did not want to know their HIV status), subjects who tested positive experienced an increase in anxiety, depression and AIDS anxiety. Subjects who tested negative experienced a decrease in these feelings after learning these results (Huggins et al., 1991). People who did not learn their results experienced no change in these feelings.
In a small study of IDUs attending a detoxification programme in Long Island, the United States, people testing seropositive displayed a wide range of emotional reactions to learning their results (Magura et al., 1990204). There were, however, no serious or damaging reactions. People with seronegative results were uniformly relieved. Almost all had informed someone of their status with unremarkable consequences.
A study from New York of seropositive blood donors showed that depressive symptoms scores for both men and women were substantially higher than scores typically found in representative population samples. More than a quarter of men and a third of women reported seeking psychological or psychiatric services in the first few weeks following notification of their positive result (Cleary et al., 1993205).
In the home sampling services, used extensively in the United States, seropositive people receive their test results over the phone (Branson, 1998206). From a sample of 865 seropositive people telephone counsellors said that 7% expressed shock or dismay at an unexpected positive result and 5% hung up immediately and one client expressed suicidal thoughts (the phone counsellor ascertained he was with a friend who could give mental health support). Although 65% of people accepted referral there is not information as to whether people took up the referral or the long-term psychological impact of this type of service.