HIV testing services missing the mark

New research has found that Voluntary Counselling and Testing (VCT) services in Zambia are squandering the opportunity to reach clients with information about how to reduce their HIV risk.

The study, conducted by Private Sector Partnerships–One, (PSP-ONE), a USAID project aimed at increasing the private sector's capacity to provide quality health services in developing countries, looked at VCT services offered by the private, non-governmental, government and faith-based sectors in one urban and one rural province of the country - Copperbelt and Luapula.

In a report compiling the study findings, the researchers emphasise that VCT services form a critical opportunity to provide risk reduction counselling and HIV prevention information and to act as a gateway to HIV/AIDS services for clients who test positive.

Zambia has an adult HIV prevalence of 14.3 percent, but the infection rate is as high as 20 percent in some urban areas. New HIV infections rose from an estimated 70,000 in 2007 to 82,000 in 2008 - the majority of them through heterosexual sexual contact.

"In a generalized HIV epidemic where multiple concurrent sexual partnerships are a significant driver of new infections, discussion of risk-reduction methods should be a main focus of pre-test and post-test counselling," comment the researchers.

However, the study found that across all sectors, while condom use was emphasized, only one in three clients received counselling on reducing their number of sexual partners and even fewer were advised on how to disclose their HIV test results to partners.

Pre-test counselling tended to over-emphasise the risk of contracting HIV through blood exchange, which is not a major driver of Zambia's HIV epidemic, and of living positively with HIV, even before a client's status was known.

The research also found that VCT services across all sectors were mainly accessed by the most educated segments of the population, and were largely failing to reach the 65 percent of women and 51 percent of men in Zambia who have no or only primary school education.

The study found the quality of VCT services provided by private sector clinics was on a par with or better than those provided by public and NGO clinics, despite the lack of HIV prevention training opportunities offered to private providers. This raised the question of how beneficial those trainings were and whether their cost was justified.

One positive finding that emerged from the study was that most people sought VCT services close to their homes indicating they did not fear being stigmatized by their communities. This is in contrast to other studies from the region in which clients reported choosing VCT and treatment sites far from home to avoid detection and stigma from neighbours.

Although most of the clients reported being satisfied with the qualify of VCT services they received, this often had more to do with the friendliness of counsellors than their technical competence at emphasizing risk reduction and behaviour change.

The researchers conclude: "A renewed focus on adapting counselling topics to the realities of Zambia’s HIV epidemic will improve the efficacy of VCT across all sectors."

See also: ZAMBIA: Wanted - more people for HIV testing

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