Making voluntary counselling and HIV testing work for South African miners

Voluntary counselling and testing (VCT) is an integral part of many HIV care and control programmes. Mineworkers in Free State, South Africa have had access to VCT at primary health centres since 1992, but few requested tests spontaneously. Researchers from the London School of Hygiene and Tropical Medicine and Aurum Health Research, South Africa evaluated these services using tools developed by UNAIDS.

The benefits of VCT include:

• early access to medical care
• on-going emotional and social support
• opportunities for prevention of mother-to-childtransmission
• support in HIVprevention strategies for those who test negative.

At the time of this study, one in four miners wasHIV-infected, rising to more than half of those who have sexually transmittedinfections (STIs). Counselling about HIV infection wasavailable at primary health centres for miners with STIs.The hospital also offered VCT to patients admitted with newly-diagnosed TB orother HIV-associated illnesses. Nurses provided the counselling at these sites,while counselling by trained community volunteers was available at a specialistoutpatient service for HIV-infected miners, the Prevention Clinic.

Researchers interviewed 22 nurse counsellors, six communityvolunteers and 24 clients and observed 24 counselling sessions. They aimed to:

• assess client and counsellor satisfaction
• evaluate service quality
• identify barriers touptake of VCT.

Although nine of the 22 nurse counsellors had had onlyin-service training for HIV counselling, the study showed that they generallyperform better than community volunteers, who have all had formal training. All14 clients seen by nurse counsellors were satisfied with the counselling theyreceived. Two of the ten clients seen by community volunteers feel they werenot given enough information on HIV. Most clients were happy with the amount oftime available with the counsellor. Clients and counsellors saw the mainbarriers to uptake of VCT services as fear of a positive result, relating tojob loss, sickness, death and stigmatisation, and worries aboutconfidentiality.

To increase uptake and improve quality of VCT services at Welkom, the researchers recommended:

• offering anonymous HIV testing with same dayresults
• ensuring that all clients receive their testresult, whether positive or negative, and appropriate post-test counselling
• encouraging a more sympathetic attitude fromhealth staff
• assessing counselling skills before new counsellorsbegin their duties
• tailoring training to the type of counsellor andusing appropriate local languages
• equipping community volunteers with more medicalinformation on HIV/AIDS to pass on to their clients
• holding regular meetings to keep counsellors up-to-dateabout HIV-related issues locally and nationally and to provide them withsupport
• promoting the role ofpeer educators in order to encourage testing and openness about HIV.

The researchers concluded that these evaluation tools forVCT services are feasible, acceptable and simple to use in an operationalsetting. They can easily be adapted to the local situation using existingresources and staff.