HIV TESTING AND

COUNCELLING

JHM
 Introduction
• HIV testing and counseling (HTC) refers to a public health intervention whereby
an individual, couple, or family receives HIV testing and counseling on HIV
prevention, treatment,care, and support.
• Although many different approaches exist for administering HTC, in general,
the intervention consists of 5 core components:
1. Pre-test counseling that outlines the testing process
2. A risk-behavior assessment
3. Informed consent of each participant
4. Administration of the HIV test
5. Post-test counseling based on the test result(s)
Testing is recommended to those who:
❖ Have had multiple sexual partners in the last 12 months
❖ Have received blood transfusion in a lace blood is not
screened before transfusion or the sexual partner received
blood transfusion and later tested positive
❖ Are uncertain about their sexual partners risky behaviors
❖ Are homosexuals
❖ Have used street drugs by injection especially if the syringes
were not sterilized
❖ Have sexually transmitted disease including pelvic inflammatory
diseases
❖ Are heath care workers with direct exposure to blood at the job
❖ Want to make sure they are not infected with HIV before they get
pregnant
❖ Those are pregnant
❖ Are infected with tuberculosis
❖ NB Even if one does not have a risk factor for HIV infection, one may
still get tested to ease their own mind.
• Getting tested make everyone to be responsible about HIV
transmission
HIV COUNSELLING
• This is a confidential dialogue between an individual
and a counselor aimed at providing information about
HIV/AIDs and bringing about behavior change in the
client.
• It is also aimed at enabling the client to make
decisions regarding HIV testing and also
understanding the implications of test results .
• In any case it must observe: Informed consent,
Counselling and Confidentiality
COMPONENTS OF VOLUNTARY
COUNSELLING AND TESTING(VCT)
a) Knowledge of status is voluntary
b) Pre test counselling is offered either through one or more sessions.
The counselor helps the client to assess risk they may have been
exposed to.
• The counsellor explains the meaning of positive and negative tests so
that the clients makes informed decision
• Provides harm reduction plan to the client
c) Informed consent is obtained from the service provider
d) Post test counselling, the client is informed of test results, takes
place on same or different day
e) Follow up counselling : involves referral for treatment
f) Disclosure counselling: To tell or not to tell, whom to tell, immediate
sexual partners, friends or family members.
• Advantages of disclosure
1. Help prevent transmission
2. Psychological benefits
3. Increases social support, greater self esteem and low levels
of depression
4. Helps in compliance and adherence of HIV treatment
• Disadvantages of disclosure
1. Fear of discrimination or violence
2. Fear of rejection/harm/shame
• Challenges to disclosure
• Desire to maintain secrecy and one feels that with safe sex
there is no need for disclosure and that one needs to protect
themselves
Why it matters

• Every disclosure is unique, with specific risks and benefits. On the one
hand, it can be a practical means of getting support and referrals.
• It will also reduce the risk of HIV transmission to others and may help
keep loved ones close by allowing them to share the patient’s worries
and triumphs.
• Also, by informing a former sex partner, he or she can decide to get
tested.
• However, disclosure can also be emotionally and even physically
threatening, given the stigma people with HIV still face.
HIV DETECTION
• During the initial weeks of infection, there is high level of
virus in the body making one highly infectious. However it is
difficult to be diagnosed with HIV during this window period
because majority of HIV tests do not screen for the virus
itself but for the antibodies produced by the body against
HIV.
• It takes about 6 weeks to 3 MONTHS to generate the
antibodies detectable by most tests
Types of HIV testing in Kenya

• Voluntary counselling and testing(VCT)/provider initiated counselling and

testing (PITC) – A person’s own initiative/provider initiated
• Routine testing and counselling – like in a routine antenatal clinic
• Diagnostic testing and counselling (DTC) – when a diagnosis of disease has to
be made for example in case of clinical indications
• Required testing for example one is to travel abroad
• Testing for blood and tissue donation – when one wants to donate a body
organ
• Testing for medical research and surveillance – for research purposes
TYPES OF HIV TESTS
There are three types of HIV diagnostic tests available :
1.Nucleic acid tests(NAT)-looks for actual virus in the blood
2.Antigen/Antibody tests-look for both HIV antibodies and antigens
3.Antibody tests –look for antibodies against HIV in the blood,oral fluids
or urine.
• Characteristics of a good diagnostic test
▪ Sensitivity: proportion of patient without disease who test negative
▪ Specificity: proportion of patients with disease who test positive
BARRIERS TO ACCESS AND USE OF
VCT
▪ Concern about confidentiality of information
▪ Stigma associated with HIV/AIDs and the fact that those infected are
considered immoral
▪ Fear incase one tests positive
▪ Some people do not perceive themselves to be at risk and others do
not realize the benefits of knowing their status
▪ Lack of information on where to find VCTs
▪ Some people belief knowing their status will increase anxiety and
depression
ADVANTAGES OF KNOWING YOUR
HIV STATUS
• If you know you are HIV Negative ,, you may..
I. Have peace of mind
II. Possible motivation to avoid risky behavior
III. Possibly more empathetic to people with HIV
IV. Possible motivation to avoid risky behavior
• IF Positive
❖ Can get appropriate heath care to prolong and improve quality of life
❖ Can take steps to live positively wit the virus
DISAVANTAGES OF KNOWING HIV
STATUS
I. Fear of rumors spreading if you are seen at the testing site or
that the healthcare worker knows your results
II. Fear of stigma AND DISCRIMATION
III. Fear of facing violence or abuse or abandonment from your sexual
partners or family ,members
IV. If you know you are HIV positive you may
▪ Feel angry , resentful and depressed
▪ Very negative and worried about your future
▪ Worry about what you will tell your sexual partner or
family
▪ Tell people your status without knowing the possible
consequences
▪ Feel rejection by family, community
BENEFITS OF KNOWING YOUR STATUS
❖ Can access support services ,support groups, financial assistance
❖ Can avoid the expense of unnecessary tests and ineffective
treatments for unexplained illness
❖ Can take measures to protect partner and unborn children
❖ Can make informed decisions about pregnancy and infant feeding
❖ Can maintain a sense of control and dignity
❖ Can make plans for the future
HIV SELF TESTING
• Allows individuals to collect their own specimen, perform the test and
interpret the results on their own.
• If POSITVE a confirmatory test must be conducted by a trained health
provider
• Tests –oral based
Discordant couples

• HIV discordance refers to a situation where one of the partners is HIV positive while the
other is HIV negative .
• Kenya AIDS Indicator Survey (2014) showed that 44% of married/cohabiting HIV-
infected persons had an HIV uninfected partner.
• It is very confusing to the couple due to the many dilemmas and unanswered questions.
• Outcomes that occur:
Infection of the non-infected spouse
Re-infection for both of them
Abandonment of the positive partner especially in case of dependence, e.g. a
housewife who is dependent on her husband
• Couples and partners should be offered voluntary HIV testing and counseling with
support for mutual disclosure.
• ART reduces HIV transmission to the uninfected partner.