HIV and AIDS

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Voluntary HIV Counselling and Testing ( VCT) Services

Introduction

In Mpumalanga Province, according to the Summary Report:National HIV and Syphillis Antenatal Sero-prevalences Servey in South Africa 2002, the prevelance of HIV infections is at an average of about 28.6% for the (adult) population from 15 years old and above. It is estimated the about 10% of the overall population in the Province live with HIV and AIDS. Our province has the fourth highest prevalence of HIV infection in the country, after KwaZulu-Natal, Gauteng and Free State. Thus, the need for co-ordinated and effective interventions to both prevent, care and treat those that are afflicted with HIV and AIDS becomes greatest. The provision of voluntary HIV counselling and testing services is one such intervention.

Background

History of AIDS

The Acquired Immunodeficiency Syndrome (AIDS) made it appearance more than two decades ago (around 1980). It was only in 1985 that the diagnostic tools were developed. During that time, there was little counselling if any all. The objective of testing was diagnosis instead of prevention and behaviour change.

As more knowledge was gained about AIDS and issues of prevention were taking priority, testing entered another role. This role was that of testing 'healthy' people to inform them of their status. Additionally, more education (lifeskills) and information was given to people that were tested, which brought about the element of continuous care and support

All these are actually the history of conception and birth of voluntary HIV counselling and testing, which is today a stand alone programme.

The National Integrated Plan for People infected and affected by HIV and AIDS

In addressing the HIV and AIDS epidemic, the South Africa Government developed a five-year strategic plan (2000 - 2005), which sort to have an integrated plan. In this plan, the Departments that play a leading role are Education, Health, Social Development and Agriculture. The programmes

that were developed by these Departments are Lifeskills (by the Department of Education), Voluntary HIV Counselling and Testing (VCT), the Prevention of Mother-to-Child-Transmission of HIV (PMTCT) (by department of Health), Home/Community-Based Care (HCBC) (by the Department of Health and Social Development) and Poverty Alleviation (by the Department of Agriculture)

The (South African) VCT Strategy

Voluntary HIV counselling and testing (VCT) is the provision of service sites where people can test for HIV and / or get information about protecting themselves from HIV and AIDS on a personal level. HIV rapid tests are used so that a person can know his/her status immediately after testing. This process also offers the opportunity for referral to other health related services and no-going counselling and support for people that test HIV positive

The goal of VCT is:

To provide universal access to voluntary HIV counselling and testing services, through public health and non-governmental sector partnership, to an adult population between 15 to 49, targeting the worried well to facilitate behavior change and HIV prevention

The Benefit of VCT

Firstly, VCT has been shown to decrease risk sexual behaviors, which in turn, results in decreased transmission of HIV infections. This is based from number of research done which show that, as more people choose to be tested for HIV, they realise that they are vulnerable to it and also gain knowledge about their HIV status. This knowledge influences people positively to decrease the risk of being infected, re-infected and /or infecting other with HIV.

Secondly, the realization of one's own personal vulnerability to an HIV infection will make people to regard the HIV like other infections, and thus, decrease the stigma that is associated with HIV and AIDS in the communities. In other words, VCT brings HIV and AIDS in the open for people to talk about and begin to see ways of preventing and / or managing them on a more personal level.

Thirdly, through the VCT services, people infected with HIV will benefit from early detection of the virus by leading healthy lives and also by accessing medical interventions and other barrier methods. VCT is the entry point to access other medical interventions such being part of the PMTCT and the ARVT (Anti-Retroviral Treatment) programmes, if one is infected with HIV

Lastly, an individual becomes part of a system of ongoing care and support through the counselling services offered by VCT. Such a system of ongoing care and support helps people to cope living with HIV and AIDS.

The VCT Sites/ Centres

At the end of 2003, 145 facilities were providing VCT services throughout the province. These sites are medical integrated sites (such as public and private hospitals and clinics, that offers other primary health care services for STI's, TB, ANC, etc), mobile (health) units, and stand-alone sites (provided by NGO's /CBO's/ FBO's,etc). The stand-alone sites are linked to the medical integrated sites for the administration of HIV rapid tests.

Health care workers (professional nurses and health promoters) and volunteers have been trained as HIV/AIDS counsellors to provide HIV voluntary counselling and testing services in these sites. Some sites have counsellor-mentors, who provide professional support and supervission to the VCT counsellors.

The Community Involvement

The success of the voluntary HIV counselling and testing programme and other interventions in preventing AIDS and decreasing the spread of HIV rely on multi-disciplinary teams at local, district and provincial levels of government, from the private sectors, the community's involvement.

In conclusion, while the 'ABC method' to preventing HIV and AIDS is still recommended-that is, Abstaining from sex, Being faithful to one's sexual partner, and Using Condoms in all sexual encounters - people are also encouraged to go to any of the VCT sites and get counselled and tested for HIV so as to know their HIV status and prevent the spread of HIV and AIDS.

Prevention of Mother-to-Child Transmission of HIV

Background Information

The incidence of HIV and AIDS infection in South Africa has reached alarming proportions. It is not worthwhile to speculate on incidence rates as it varies on a year-to-year base. Even just a day makes a tremendous impact, however it is estimated that more than 4 million people in South Africa are HIV positive. It is estimated that 20% - 30% of women attending prenatal care are positive.

In the absence of intence prevention of mother to child transmission probably 25% - 35% of babies born to HIV positive mothers will be infected. The proper management of pregnant mothers can save a third of the babies during prenatal care, during labor and during the puerperal care.

Mpumalanga, like all the the provinces, has the duty to reduce the incidence of mother-to-child transmission. The transmission may occur during pregnancy, labor, and delivery or during the breast-feeding period.

The practice in the PMTCT program is guided by the fact that management of all clients and patients must within the laws of the country based on:

The patient's right charter
The Health Act
The Country's Constitution
Batho Pele

Factors That Increase The Risk Of Transmission From Mother-to-Child

Maternal viral load
Maternal immunological responses
Obstetrical events during labor
Feeding practices
Behavioral factors such as smoking, drugs and unprotected sex
Sexually Transmitted Infections
Placenta infections
Fetal trauma
Prolonged rupture of membranes
Presence of blood and mucus during delivery

Factors That May Reduce The Risk Of Transmission

Safe sexual practices
Safe infant feeding practices
Prompt management of Sexually Transmitted Infections in pregnant mother.
Avoiding fetal trauma.
Elective caesarian section
Avoiding routine episiotomies
Avoiding routine rupture of membranes
Avoiding unnecessary suction of the neonate as well as other invasive interventions such as intrauterine foetal-scalp monitoring
Disclosing HIV status