Voluntary Testing and Counseling Rare in South Africa
Although only 10% of South Africa's HIV-positive residents are aware of their serostatus, voluntary counseling and testing services are lacking throughout the country, Health-E reports. Many health facilities will perform VCT only if a doctor requests it for a patient with AIDS-related symptoms, but not for healthy individuals "who simply want to know their HIV status." Hospitals do not offer VCT to the general public, but "limited" public demand for these services places little pressure on VCT programs to provide the services. The National HIV/AIDS Directorate currently refers requests for VCT to AIDS Training and Information Centers. But a Health-E "snap survey" of 15 ATICs nationwide found that only six would provide counseling and testing services on request. Thembela Masuku, South Africa's deputy director of Counseling Programs, said that the Department of Health "will actively promote the increased use of voluntary testing services" and has allocated 71 million rand to expand VCT services over the next three years. By that time, the department hopes that VCT services will be available "in all health facilities."
Some believe, however, that the plan to expand voluntary HIV testing lacks provisions for follow-up counseling of those who test positive. Health-E cites "[i]ncreasing evidence" that those who test positive and do not receive additional counseling and support "may go into a state of denial or even become anti-social and start infecting others on purpose." Dr. Liz Floyd, director of the Gauteng HIV/AIDS and STD Program, plans to implement VCT "gradually" and evaluate its progress. "In theory, the plan is to have VCT in all antenatal clinics but we can't put VCT services into areas without basic HIV care and support services. ... We know from experience that having diagnosed, but unsupported people [does not] achieve prevention and treatment goals," she said. "Ignorance is bliss" is another argument against VCT, as some say that there is little point in knowing one's status without access to HIV medications. "Unless you are able to offer people treatment, there is no incentive for them to be tested," Morna Cornell of the AIDS Consortium said (Stein, Health-E, 12/8).