Voluntary HIV testing and counselling is essential for HIV prevention but as yet few health facilities in South Africa provide the service.

The national health department’€™s Directorate for HIV/AIDS and STDs does not have accurate recent figures regarding available voluntary counselling and testing (VCT) services but the bottom-line, says MsThembela Masuku, Deputy-Director of Counselling Programmes, is that it is still limited.

According to Masuku, however, public demand for VCT is equally limited and there is no pressure on the few services that do exist.

But people should be encouraged to have the test, says Brett Anderson of the Western Cape Business Forum, who voluntarily went for a test and was diagnosed HIV positive last year.

He says only about 10 percent of South Africans who are infected know that they are HIV positive. The other 90 percent are infecting other people and re-infecting themselves with other strains of the virus.

Tembi (not her real name) from Johannesburg is another one of the few who have voluntarily taken an HIV test. She decided to have the test when she realised that even healthy people could be HIV positive. Her result was positive. But she is glad she had the test.

“Now that I know, I can protect myself and the person I’€™m going out with. And I can decide on what to do with the rest of my life,” says Tembi.

But unlike the Hillbrow AIDS Training and Information Centre where Tembi had her test, most public health facilities only provide VCT when a doctor requests it because the patient already has AIDS-related symptoms.

As yet, health facilities still don’€™t provide VCT on request to healthy people like Brett and Tembi who simply want to know their HIV status.

The National HIV/AIDS Directorate states that requests for VCT are currently referred to AIDS Training and Information Centres (ATICS).

But a snap survey by Health-e revealed that only six out of 15 ATICS contacted countrywide claimed to provide both counselling and testing services on request.

According to Masuku, the AIDS Helpline can also inform members of the public of a VCT site closest to them.

But when asked for the whereabouts of a free VCT service in the Western Cape, the AIDS Helpline operator suggested “any government hospital near you”.

This referral was offered despite the fact that hospitals do not provide VCT to the general public. (The Western Cape does however have six clinics offering VCT.)

According to Masuku, the Department of Health will actively promote increased use of voluntary testing services, especially by the youth.

R71 million has been set aside to expand VCT services countrywide over the next three years and the training of counsellors has already started, says Masuku.

According to the health department’€™s VCT strategy, “it is envisaged that by the third year, 100 percent of the health districts will have VCT services in all health facilities”.

But some argue that the national VCT plan makes inadequate provision for ongoing follow-up counselling of those infected with HIV.

HIV positive Tembi says that without ongoing counselling and active participation in a support group for people living with HIV, she may not have coped with her HIV positive diagnosis.

“When they give you the news in the post-test counselling session, it’€™s such a shock ‘€“ you don’€™t hear anything else they say. It’€™s only in the second or the third session that counselling helps you with how to live and what you should do,” says Tembi.

Increasing evidence from Uganda suggests that without additional counselling and support, people who receive an HIV positive result 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 Programme, agrees that without follow-up and support, VCT may be counter-productive.

“We must be cautious because without enough support it can go wrong,” says Floyd.

Floyd plans to expand VCT services in Gauteng gradually and evaluate the programme rather than implementing VCT in all clinics at once.

“In theory, the plan is to have VCT in all ante-natal 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 doesn’€™t achieve prevention and treatment goals,” says Floyd.

The value of voluntary testing to individuals in South Africa has also been debated by those who argue that there is little point in knowing one’€™s HIV status if drugs for the prevention of AIDS-related illnesses are still largely unavailable.

“Unless you are able to offer people treatment, there is no incentive for them to be tested,” says Morna Cornell of the AIDS Consortium.

But increased access to VCT sites, as planned by the Department of Health, will mean that individuals can decide for themselves whether or not they want to know their HIV status.