Skip to main content
SpringerLink
Log in

Approaches to HIV Counselling and Testing: Strengths and Weaknesses, and Challenges for the Way Forward

  • Chapter
  • First Online:
HIV/AIDS in South Africa 25 Years On

Abstract

South Africa has the highest rates of HIV infection of any country in the world. The two main goals of the National Strategic Plan on HIV & AIDS and STIs, 2007–2011 (NSP) are to reduce the incidence of new HIV infections in South Africa by half by 2011 and to ensure that at least 80% of those who are already HIV-positive have access to treatment (National Department of Health, 2007). Knowledge of HIV status is considered critical for both these prevention and treatment goals. Once an individual has been tested for HIV, prevention can be reinforced and referral made to available treatment, care and support services. A potential added benefit is that increasing the number of people who know their HIV status through expanded access to HIV counselling and testing may also result in a decrease in HIV-related stigma, leading to a “normalisation” of the HIV epidemic (Anderson, 2006; De Cock et al., 2002).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

Notes

  1. 1.

    The UNAIDS/WHO policy refers to Provider Initiated Testing and Counselling (PITC), but the acronym Provider Initiated Counselling and Testing is preferred in South Africa. Both terms refer to the same thing, i.e. counselling and testing initiated by the provider.

  2. 2.

    Rollins, N., et al. (2005). Assessing the impact of the PMTCT programme on vital child health indicators in KwaZulu Natal. Unpublished proposal.

References

  • Allen, S., Tice, J., Van de Perre, P., Serufilira, A., Hudes, E., Nsengumuremyi, F., Bogaerts, J., Lindan, C., and Hulley, S. (1992). Effect of serotesting with counselling on condom use and seroconversion among HIV discordant couples in Africa. BMJ, 304, 1605–1609.

    Article  PubMed  CAS  Google Scholar 

  • Allen, S., Karita, E., N’Gandu, N., and Tichacek, A.(1999). The evolution of voluntary testing and counselling as an HIV prevention strategy. In L. Gibney, R.J. Di Clemente, and S.H. Vermund (Eds.), Preventing HIV in developing countries: biomedical and behavioural approaches. New York: Plenum Press.

    Google Scholar 

  • Anderson, B. (2006). A human rights approach to HIV testing: voluntary, mandatory or routine?, AIDS Legal Quarterly, 1–7.

    Google Scholar 

  • Asante, A.D. (2007). Scaling up HIV prevention: why routine or mandatory testing is not feasible for sub-Saharan Africa. Bulletin of the World Health Organization, 85(8), 644–646.

    Article  PubMed  Google Scholar 

  • Baggeley, R. (1997, December). Fear of knowing: why 9 in 10 couples refused HIV tests in Lusaka, Zambia. Abstract No. E.1266. 10th International Conference on AIDS and STDs, Abidjan Africa.

    Google Scholar 

  • Bassett, M.T. (2002). Ensuring a public health impact of programs to reduce HIV transmission from mothers to infants: The place of VCT. AJPH, 92(3), 347–351.

    Article  Google Scholar 

  • Bond, L., Lauby, J., and Batson, H. (2005). HIV testing and the role of the individual- and structural-level barriers and facilitators. AIDS Care, 17(2), 125–140.

    Article  PubMed  Google Scholar 

  • Chopra, M., Jackson, D., Ashworth, A., and Doherty, T. (2004). An evaluation of the quality of counselling provided to mothers in three PMTCT pilot sites in South Africa. World Health Organisation.

    Google Scholar 

  • Coovadia, H.M. (2000). Access to voluntary counselling and testing for HIV in developing countries. Annals of the New York Academy of Sciences, 918, 57–63.

    Article  PubMed  CAS  Google Scholar 

  • Day, J., Miyamura, K., Grant, A., Leeuw, A., Munsamy, J., Baggaley, R., and Churchyard, G. (2003). Attitudes to HIV voluntary counselling and testing among mineworkers in South Africa: Will availability of antiretroviral therapy encourage testing?, AIDS CARE, 15(5), 665–672.

    Article  PubMed  CAS  Google Scholar 

  • De Cock, K., Mbori-Ngacha ,D., and Marum, E. (2002). Shadow on the continent: public health and HIV/AIDS in Africa in the 21st century. The Lancet, 360, 67–71.

    Article  Google Scholar 

  • Delva, M., et al. (2006). Quality and quantity of antenatal HIV counselling in a PMTCT programme in Mombasa, Kenya. AIDS Care, 18(3), 189–193.

    Article  PubMed  Google Scholar 

  • Denison J.A., O’Reilly, K., Schmid, G.P., Kennedy, C.E., and Sweat, M.D. (2008). HIV voluntary counselling and testing and behavioral risk reduction in developing countries: A meta-analysis, 1990–2005. AIDS and Behavior, 12, 363–373.

    Article  PubMed  Google Scholar 

  • Dixon-Meuller, R., and Germain, A. (2007). HIV testing: the mutual rights and responsibilities of partners. The Lancet, 370, 1808–1809.

    Article  Google Scholar 

  • Ellen, J.M., Liang T.S., Jacob, C.A., Erbelding, E., and Christmyer, C. (2004). Post-HIV test counselling of clients of a mobile STD/HIV clinic. STD & AIDS, 15, 728–731.

    Article  Google Scholar 

  • Etiebet, M., Fransman, D., Forsyth, B., Coetzee, N., and Hussey, G. (2004). Integrating prevention of mother-to-child HIV transmission into antenatal care: learning from the experiences of women in South Africa. AIDS Care, 16, 37–46.

    Article  PubMed  Google Scholar 

  • Family Health International (2002). Voluntary counselling and testing and young people: A summary overview. Retrieved on 30 April 2007 from http://www.fhi.org

  • Family Health International/YouthNet (2002). Voluntary counselling and testing (VCT). Retrieved on 30 April 2007 from http://www.fhi.org/youthnet

  • Fylkesnes, K., and Siziya, S. (2004). A randimised trial on acceptability of voluntary counselling and testing. Tropical Medicine and International Health, 9(5), 566–572.

    Article  PubMed  Google Scholar 

  • Genberg, B. L., M. Kulich, S. Kawichai, P. Modiba, A. Chingono, G. P. Kilonzo, L. Richter, A. Pettifor, M. Sweat, and D. D. Celentano. 2008. HIV risk behaviors in sub-Saharan Africa and northern Thailand: baseline behavioral data from Project Accept. Journal of Acquired Immune Deficiency Syndromes 49: 309–319.

    Article  PubMed  Google Scholar 

  • Gruskin, S. (2006). Its time to deliver right! HIV testing in the era of treatment scale up: concerns and considerations. AIDS Legal Quarterly, 11–14.

    Google Scholar 

  • Higgins, D.L., Galavotti, C., O’Reilly, K.R., et al. (1991). Evidence for the effects of HIV antibody counselling and testing on risk behaviors. Journal of the American Medical Association, 266, 2419–2429.

    Article  PubMed  CAS  Google Scholar 

  • International HIV Counselling and Testing Workshop. (2008, January). Lusaka, Zambia.

    Google Scholar 

  • Joint Civil Society Monitoring Forum (2006, October). Scaling up HIV voluntary counselling and testing in South Africa: time for new models. 9th National Meeting,

    Google Scholar 

  • Kalichman, S., and Simbayi, L. (2003). HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa. Sexually Transmitted Infections, 79, 442– 447.

    Article  PubMed  CAS  Google Scholar 

  • Kamb, M.L., Fishbein, M., Douglas, J.M., Jr., et al. (1998). Efficacy of risk-reduction counselling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial. Project RESPECT Study Group. Jama, 280(13),1161–1167.

    Article  PubMed  CAS  Google Scholar 

  • Kamenga, C., and Sangiwa, G. (2008) Premarital HIV counselling and testing for couples: A neglected opportunity. Presented at the International HIV CT Workshop, Lusaka, Zambia.

    Google Scholar 

  • Kamenga, C., Ryder, R.W., Jingu, M., Mbuyi, N., Behets, F., Brown, C., and Heyward, W.L. (1991). Evidence of marked sexual behaviour change associated with low HIV-1 seroconversion in 149 married couples with discordant HIV-1 serostatus: experience at an HIV counseling centre in Zaire. AIDS, 5, 61–67.

    Article  PubMed  CAS  Google Scholar 

  • Kawichai, S., Celentano, D.D., Chariyalertsak, S., Visrutaratna, S., Short, O., Ruangyuttikarn, C., Chariyalertsak, C., Genberg, B., and Beyrer, C. (2007). Community-based voluntary counselling and testing services in rural communities of Chiang Mai Province, Northern Thailand. AIDS and Behavior, 11(5), 770–777.

    Article  PubMed  Google Scholar 

  • Khumalo-Sakutukwa, G., S. F. Morin, K. Fritz, E. D. Charlebois, H. van Rooyen, A. Chingono, P. Modiba, et al. (2008). Project Accept (HPTN 043): a community-based intervention to reduce HIV incidence in populations at risk for HIV in sub-Saharan Africa and Thailand. Journal of Acquired Immune Deficiency Syndromes 49: 422–431.

    Article  PubMed  Google Scholar 

  • Krabbendam, A.A., Kuijper, B., Wolffers, I.N., and Drew, R. (1998). The impact of counselling on HIV-infected women in Zimbabwe. AIDS Care, 10(1), S25–S37.

    Article  PubMed  Google Scholar 

  • Leclerc-Madlala, S. (1997). Infect one, infect all: Zulu youth response to the AIDS epidemic in South Africa. Medical Anthropology, 17, 363–380.

    Article  PubMed  CAS  Google Scholar 

  • Lie, G., and Biswalo, P.M. (1994). Perception of appropriate HIV/AIDS counsellors in Arusha and Kilimanjaro regions of Tanzania: implications for hospital counselling. AIDS Care, 6(2), 139–151.

    Article  PubMed  CAS  Google Scholar 

  • Lie, G.T., and Biswalo, P.M. (1996). HIV-positive patients choice of a significant other to be informed about the HIV test result: findings from an HIV/AIDS counselling programme in the regional hospitals of Arusha and Kilimanjaro, Tanzania. AIDS Care, 8, 285–296.

    Article  PubMed  CAS  Google Scholar 

  • Maman, S., Mbwambo, J., Hogan, M., Kilonzo, G., Sweat, M., and Weiss, E. (2001). HIV and partner violence. Implications for HIV voluntary counselling and testing programmes in Dar es Salaam, Tanzania. New York: Horizons/The Population Council.

    Google Scholar 

  • Matovu, J.K.B., Kigozi, G., Nalugoda, F., Wabwire-Mangen, F., and Gray, R.H. (2002). The Rakai project counselling programme experience. Tropical Medicine and International Health, 7(12), 1064–1067.

    Article  PubMed  Google Scholar 

  • Matovu, J.K.B., Gray, R.H., Makumbi, F., Wawer, M.J., Serwadda, D., Kigozi,G., Sewankambo, N.K., and Nalugoda, F. (2005). Voluntary HIV counselling and testing acceptance, sexual risk behavior and HIV incidence in Rakai, Uganda. AIDS, 19, 503–511.

    Article  PubMed  Google Scholar 

  • Metcalf, C., and van Rooyen, H. (2008). Situation analysis of HIV counselling and testing (CT) services in South Africa (Phase 1). Draft Proposal Submitted to CDC.

    Google Scholar 

  • Metcalf, C., Douglas, J.M., Jr., Malotte, C.K., et al. (2005). Relative efficacy of prevention counselling with rapid and standard HIV testing: a randomized, controlled trial (RESPECT-2). Sexually Transmitted Diseases, 32(2), 130–138.

    Article  PubMed  Google Scholar 

  • Morin, S.F., Khumalo-Sakutukwa, G., Charlebois, E.D., Routh, J., et al. (2006). Removing barriers to knowing HIV status: same-day mobile HIV testing in Zimbabwe. Journal of Acquired Immune Deficiency Syndrome, 41, 218–224.

    Article  Google Scholar 

  • National Department of Health (2007). National Strategic Plan on HIV & AIDS and STIs: 2007–2011. Pretoria: National Department of Health.

    Google Scholar 

  • Obermeyer, C.M., and Osborn, M. (2007). The utilization of testing and counselling for HIV: A review of the social and behavioural evidence. American Journal of Public Health, 97(10), 1762–1774.

    Article  PubMed  Google Scholar 

  • Perez, F., Zvandaziva, C., Engelsmann, B., and Dabis, F. (2006). Acceptability of Routine HIV Testing (Opt-Out) in ANC services in two rural districts of Zimabawe. AIDS, 41(4), 514–520.

    Google Scholar 

  • Pettifor, A., Rees H., Stefenson, A., Hlongwa-Madikizela, L., MacPhail, C., Vermaak, K., and Kleinschmidt, I. (2004). HIV and sexual behaviour among young South Africans: a national survey of 15–24 year olds. Retrieved 15 April 2007 from http://www.lovelife.org.za

  • Rennie, S., and Behets, F. (2006). Desperately seeking targets: the ethics of routine HIV testing in low-income countries. Bulletin of the WHO, 84(1), 52–55

    Google Scholar 

  • Rollins, N., et al. (2005). Assessing the impact of the PMTCT programme on vital child health indicators in KwaZulu-Natal. Unpublished proposal.

    Google Scholar 

  • Rollins, N., Little, K., Mzolo,S., Horwood, C., and Newell, M. (2007). Surveillance of mother-to-child transmission prevention programmes at immunization clinics: the case for universal screening. AIDS, 21, 1341–1347.

    Article  PubMed  Google Scholar 

  • Shisana, O., and Simbayi, L. (2002). Nelson Mandela/HSRC Study of HIV/AIDS. South African National HIV Prevalence, Behavioural Risks and Mass Media Household Survey2002. Retrieved 15 April 2007 from http://www.cadre.org.za/pdf/HIV%20Report.pdf

  • Shisana, O., Rehle, T., Simbayi, L.C., et al. (2005). South African national HIV prevalence, HIV incidence, behaviour and communication survey. Cape Town: HSRC Press.

    Google Scholar 

  • Simpson, W.M., Johnstone, F.D., Boyd, F.M., Goldberg, D.J., Hart, G.J., and Prescott, R.J. (1998). Uptake and acceptability of antenatal HIV testing: Randomised controlled trial of different methods of offering the test. BMJ, 316(7127), 262–267.

    Article  PubMed  CAS  Google Scholar 

  • Steen, T.W., Seipone, K., Gomez, F.L. et al. (2007). Two and a half years of routine HIV testing in Botswana. AIDS, 44(4) ,484–488.

    Google Scholar 

  • Strode, A., van Rooyen, H., Heywood, M., and Abdool Karim, Q. (2005). Scaling up HIV testing in resource-constrained settings: debates on the role of VCT and routine opt-in or opt-out HIV testing. Southern African Journal of HIV Medicine, 20, 45–49.

    Google Scholar 

  • Swanepoel, P.H. (2004). Persuading South Africans at risk of HIV/AIDS to voluntarily present themselves for counselling, testing and referral (VCT): Using theory and empirical evidence in formative research for VCT message design. Unpublished Working Paper: University of South Africa.

    Google Scholar 

  • Taegtmeyer, et al. (2005, June). In Addressing Violence Against Women in HIV Testing and Counselling: Strategies and Recommendations. Meeting Report, Geneva.

    Google Scholar 

  • UNAIDS. (2001).The impact of voluntary counselling and testing. A global review of the benefits and challenges. Geneva: UNAIDS. Retrieved 1 May 2007 from http://www.uniads.org.

  • UNAIDS/WHO. (2004). UNAIDS/WHO policy statement on HIV testing. Geneva, Switzerland: UNAIDS.

    Google Scholar 

  • UNAIDS. (2006). Report on the global AIDS epidemic. Retrieved 15 June 2008 from http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2006/

  • Van der Straten, A., King, B., Grinstead, O., Serofilira, A., and Allen, S., (1995). Couple communication, sexual coercion and HIV risk reduction in Kigali, Rwanda. AIDS, 9, 935–944.

    Article  PubMed  Google Scholar 

  • Van Dyk, A.C., and van Dyk, P.J. (2003). To know or not to know’: service-related barriers to voluntary counselling and testing (VCT) in South Africa. Curationis, 26(1), 4–10.

    PubMed  Google Scholar 

  • Voluntary HIV-1 Counselling and Testing Efficacy Study Group (2000). Efficacy of voluntary HIV-1 counselling and testing in individuals in Kenya, Tanzania and Trinidad: A randomized trial. The Lancet, 356, 103–112.

    Article  Google Scholar 

  • Weinhardt, L.S., Carey, M.P., Johnson, B.T., and Bickham, N.L. (1999). Effects of HIV counselling and testing on sexual risk behavior: A meta-analytic review of published research, 1985–1997. American Journal of Public Health, 89(9), 1397–1405.

    Article  PubMed  CAS  Google Scholar 

  • WHO (2006, June). Addressing violence against women in HIV testing and counselling: strategies and recommendations. Meeting Report, Geneva.

    Google Scholar 

  • Wolitski, R.J., MacGowan, R.J., Higgins, D.L., and Jorgensen, C.M. (1997). The effects of HIV counselling and testing on risk related practices and help seeking behavior. AIDS Education and Prevention, 9(Suppl. B), S52–S67.

    Google Scholar 

  • Wolff, B., Nyanzi, B., Katongole, G., Ssesanga, D., Ruberantwari, A., and Whitworth, J. (2005). Evaluation of a home-based voluntary counselling and testing intervention in rural Uganda. Health Policy and Planning, 20(2), 109–116.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Lauren Kleutsch for her contributions in editing this chapter.

Author information

Authors and Affiliations

  1. Human Sciences Research Council, Durban, South Africa

    Heidi van Rooyen

  2. Human Sciences Research Council, Pretoria, South Africa

    Linda Richter

  3. David Geffen School of Medicine, Los Angeles, California, USA

    Thomas J. Coates

  4. Formerly at Human Sciences Research Council, Pietermaritzburg, South Africa

    Merridy Boettiger

Authors
  1. Heidi van Rooyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Linda Richter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas J. Coates
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Merridy Boettiger
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Revelstoke Road 12, London, SW18 5PD, United Kingdom

    Poul Rohleder

  2. Springer Science + Business Media, Spring St. 233, New York, 10013, New York, USA

    Leslie Swartz

  3. Center for HIV Intervention and, Prevention, University of Connecticut, Hillside Road 206, Storrs, 06269, Connecticut, USA

    Seth C. Kalichman

  4. Plain Park Bldg, 13th Fl 69-83, Cape Town, 8001, South Africa

    Leickness Chisamu Simbayi

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

van Rooyen, H., Richter, L., Coates, T.J., Boettiger, M. (2009). Approaches to HIV Counselling and Testing: Strengths and Weaknesses, and Challenges for the Way Forward. In: Rohleder, P., Swartz, L., Kalichman, S., Simbayi, L. (eds) HIV/AIDS in South Africa 25 Years On. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0306-8_12

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-0306-8_12

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-0305-1

  • Online ISBN: 978-1-4419-0306-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation