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Learning from Voluntary Counselling & Testing in Kenya

By Miriam Taegtmeyer

What is Voluntary Counselling and Testing (VCT)?

VCT is aimed at asymptomatic individuals wishing to know their own HIV serostatus. The service is client-centred, community based and confidential. Counsellors themselves are trained in rapid HIV testing and are able to perform pre-test counselling, post test counselling and rapid testing during a one hour session. Clients are able to observe the kits and are involved in the interpretation of their own results and therefore have confidence in and ownership of the results. New HIV rapid test technologies, which provide a result in fifteen minutes, ensure that 98% of those coming forward to test leave the session knowing their actual HIV status, while those who wish to may still leave the process before the results are ready.

The anonymous nature of VCT sites, at which clients are not asked to give names or contact details further strengthens the solution-focused, client-centred approach. In the words of a VCT counsellor from the Liverpool VCT centre in Nairobi, Kenya:

“I wake up in the morning and want to know my status. If I test negative how will I stay negative? If I test positive how will I live positively? It is only me who can change my life. If I have decided something for myself I am more likely to take action.”

VCT acts as an entry point to prevention and care services and the intervention itself, with its focus on risk reduction, has been demonstrated to impact behaviour change in a large-scale international randomised trial of voluntary counselling and testing [1]. Since the year 2000 the Kenyan government has opened over 390 VCT centres in all areas of the country and hundreds of thousands of asymptomatic Kenyans have come voluntarily to know their HIV status. The commitment to the expansion of VCT services and the accompanying media campaigns have led to a widespread change in perception. Instead of being associated with stigma, shame and poor confidence in the quality of services, VCT has become trendy, ‘hip’ and in demand [2]. It is viewed that a sexually active person is responsible for knowing the HIV status of themselves and their partner. Clients are able to queue openly in front of signs advertising VCT services and many youth boast of their awareness and involvement with VCT.

Example of a roadside advertisement promoting HIV counselling and testing in Kenya, July 2002.

Example of a roadside advertisement promoting HIV counselling and testing in Kenya, July 2002.

How can VCT be useful for Britain’s African communities?

Britain’s African communities suffer a disproportionate burden of HIV disease. Accurate knowledge of HIV status (i.e. based on recent HIV test) is lower among UK black and ethnic minority communities than other groups, and to date there is little evidence of HIV testing becoming normalised. HIV infection in UK is all too often a hospital-based diagnosis made in advanced HIV disease. Even in the testing of asymptomatic individuals, the prevention opportunity of negative result is lost in the UK system where phone results and abbreviated post test counselling for negative tests are becoming the norm. The current models of testing may well be failing to meet the needs of many individuals, especially those who fail to return for the results of their HIV test. It is with this in mind that the UK Government’s National Strategy for Sexual Health and HIV has recently called for interventions targeting populations at risk and investigation of new HIV technologies, including rapid-tests [3].

The current situation of UK Africans bears many similarities to the HIV testing situation in Kenya five years ago with many people fearing testing, concern about stigma and believing that knowledge of status itself would make them get ill more quickly. There are further similarities in vulnerability, risk perception and risk-taking behaviour making the VCT model applicable and replicable in a UK setting. The importance of same day rapid testing, of one trusted counsellor sharing results, of anonymity and confidentiality as well as of a truly client-centred approach cannot be over estimated. VCT has a proven role in the prevention of HIV in high prevalence settings and it is time that the approach to and quality of services available in countries like Kenya was made available here.

Dr Miriam Taegtmeyer is the former director of the Liverpool VCT centre in Nairobi, Kenya. She can be contacted on Miriam@liverpoolvct.org or further information obtained through the LVCT website on www.liverpoolvct.org

Reference List

1. Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial. The Voluntary HIV-1 Counseling and Testing Efficacy Study Group. Lancet 2000;356:103-12.

2. Okwemba, O. Horizon: Big Turnout Overwhelms VCTs. African Woman and Child Feature Services 7-10-0004. http://allafrica.com/stories/200410070124.html

3. Department of Health. National Strategy for Sexual Health and HIV. 2001. London, Department of Health. http://www.dh.gov.uk/assetRoot/04/05/89/45/04058945.pdf