|The Impact of Voluntary Counselling and Testing: A global review of the benefits and challenges (UNAIDS, 2000, 96 p.)|
Role of VCT in promoting normalization of HIV, challenging stigma and increasing acceptance of people with HIV
Overcoming the stigma associated with HIV is the biggest challenge to its prevention and care. It has been proposed that wider access to VCT and a larger number of peoples greater awareness of their HIV status within a community are important elements in challenging stigma (Lambouray, 1998167). Countries where VCT is well established, such as Uganda, have a less stigmatizing attitude to HIV. However, for it to be effective in challenging stigma, HIV testing has to be a voluntary process associated with counselling that helps people understand and accept their status (UNAIDS, 1999168, UNAIDS, 2000169). For example, there are countries such as Russia, where HIV remains highly stigmatized, despite the fact that all women have routine testing as part of their antenatal care and a large proportion of the population has been tested routinely for HIV.
It has also been suggested that if VCT were offered routinely, and more people would accept VCT as an important component of medical care, it would promote normalization of HIV (De Cock et al., 1998170, Godfrey-Faussett et al., 1998171). De Cock states that the excessive caution around HIV testing has had the detrimental effect of preventing people with HIV from accessing care. It also has contributed to the stigma and secrecy associated with testing.
A study from Zambia contrasts the individual confidential approach to counselling with a more open, family-oriented one. It proposes that the latter creates more open and proactive responses at the community level (Goma et al., 1999172). There are, however, no studies that look specifically at the role of VCT in promoting openness in communities and this is an important area in which to prioritize future research.