|The Impact of Voluntary Counselling and Testing: A global review of the benefits and challenges (UNAIDS, 2000, 96 p.)|
|3. Care: Improving access to medical, emotional and social support|
Knowledge of HIV status can enable people to seek appropriate emotional support. Those who are seronegative will usually feel relief, but may have ongoing emotional difficulties, which need addressing. They may have a partner who is positive or who is untested and may therefore feel at continuing risk of HIV infection. Others may feel guilt at being negative, especially if a partner is infected or has died from HIV.
People who test seropositive may experience a range of emotions from denial and anger to despair and suicidal ideation. These emotional responses are normal, but counselling can help people cope with their emotional reactions and prevent serious or long-term, intractable problems.
Emotional problems were found to be common in a study of 307 people who had attended VCT from six centres in Nairobi (Vollmer and Valadez, 1999112). Accessing emotional support has been shown to help people cope more easily with the psychological sequelae of testing seropositive.
The majority of people attending VCT, whether they test positive or negative, will attend one or at the most, two post-test counselling sessions. In Zambia, although further counselling sessions or referrals to specialized counselling services were offered, many people said that they did not want to have further counselling, at least not in the immediate future. Only 10% of seropositive people and 6% of seronegative people had more than two post-test counselling sessions (Baggaley et al., 1998). Some people attended for further counselling in the one to five years following VCT. This often coincided with a crisis or change in personal circumstances. When interviewed 6 to 18 months following VCT, many people said that they had found other informal services or resources in the community to help them with their emotional needs. Church groups, family members, friends and traditional medical workers were cited as providing emotional support.
In the multi-centre trial 86% of people had only one pre-test and one post-test counselling session, although ongoing counselling was offered (Sangiwa, 2000). Those who tested seropositive were more likely to attend further counselling sessions.
In lower prevalence countries, such as Romania, longer-term support may be needed for PLHAto help them cope, especially when the majority of people with HIV are from risk groups that are already marginalized (Buzducea et al., 2000113).
Three studies among MSM (Hays et al., 1990114,Catania et al., 1992115,Peterson et al., 1995116) have shown that seropositive men are more likely to seek emotional support following VCT than seronegative or untested men. However, people who were symptomatic were the most likely to seek help and the authors conclude that this may be a more important factor than knowledge of HIV status. However, VCT may enable MSM to receive services most fitting to their needs.
A study of IDUs showed no difference in uptake of services between those who were seropositive and symptomatic, seropositive and asymptomatic and seronegative (Solomon et al., 1991117). This should not be viewed as an ineffective outcome as both positive and negative IDUs may be in need of emotional and medical support. VCT may mean that IDUs are able to seek health and psychological care services appropriate to their needs.
Ongoing emotional support can also be provided outside formal coun-selling services. Spiritual support for people with HIV has been shown to be important in both developing and industrialized settings (Kaldjian et al., 1998118). In Thailand, Buddhist monks provide ongoing support for people with HIV and teach mediation to facilitate coping and relieve stress (Sittitrai et al., 1994119).