The waiting room is very quiet. We don’t talk to one another as we wrestle with our own private ghosts – haunted by unsafe sexual encounters and a hundred “what ifs”. The pressure mounts as we go one by one to take The Test.

No wonder Vee-Cee-Tee — Voluntary Counselling and HIV Testing – has become one of the hottest weapons around in the fight against HIV/AIDS. There’s nothing quite like it to make you face your own mortality.

A number of surveys show that, while most South Africans understand that they can protect themselves from HIV by practising the ABC – abstaining from sex, being faithful to one partner and using a condom – many people are simply not protecting themselves.

At the same time, there is a large body of evidence to show that VCT gets people to change their behaviour and adopt safer ways of having sex, thus reducing HIV transmission.

The reason why it is so powerful, say the experts, is because it promotes individual responsibility.

“VCT creates an opportunity for clients to discuss factors that might hamper their resolve to change their sexual behaviour,” says psychologist Heidi van Rooyen from the University of Natal’s HIV/AIDS Counselling, Research and Evaluation Group.

“For example, the fact that drinking alcohol weakens their resolve. Possible strategies for dealing with such situations can be generated in the counselling session

“The one-on-one contact with a non-judgmental counsellor enables a person to ask the embarrassing and awkward questions about sexual behaviour that are not always possible in other prevention processes.”

A range of surveys that have followed up on people who have been for HIV tests have shown significant changes in behaviour patterns.

In 1999, researchers followed a group of 2 505 Ugandans after they had been for VCT. Before the test, only 10% were using condoms. Six months after being tested, 89% were using condoms with their steady partners and 100% were using condoms with casual partners.

This finding is echoed by studies in Thailand, Zambia, Rwanda, Zambia and Kenyan. Generally, men reacted by using condoms while women cut down on the number of partners.

In 2000, the South African government made VCT one of its three key national HIV/AIDS interventions in a bid to get individuals to take control of their sex lives.

Dr Nono Simelela, head of government’s HIV/AIDS directorate, speaks of the tendency for people to “externalise responsibility” for their health to government.

Government is being called on to help people infected with HIV, she says, yet many citizens are not committed to changing their behaviour to protect themselves against the virus.

“Uganda cracked mother-to-child transmission of HIV by encouraging couples to go for HIV tests before they decided to have a baby,” Simelela told a meeting of faith-based organisations recently. “But in South Africa we are not dealing with issues of responsibility and morality.”

Less than 10% of South Africans with HIV know that they are infected, according to the South African Health Review (SAHR) 2001.

“The stigma and denial around HIV have resulted in most South Africans regarding HIV to be a problem of other groupings, and therefore very few South Africans see the need to be tested,” says the SAHR.

“A national VCT programme led by the leaders of all sectors of society would help to undermine the stigmatisation and denial that is helping to fuel the epidemic.”

Unlike Uganda, very few prominent South Africans have been able to stand up and say that they have HIV. Yet most people who go for the test confide in someone if they test positive. So the more people who are tested, the more common it will be to know someone with HIV.

The crucial part of the HIV test is its packaging between two counselling sessions, one before and the other after the test.

In the pre-test session, counsellors explain to individuals how HIV is transmitted and how they can protect themselves. The post-test session is a one-on-one meeting in which the individual is told his or her result. If HIV negative, people are told how to stay that way. If HIV positive, they are encouraged to live healthily in order to avoid opportunistic infections. If local HIV support groups exist, they are referred to one so that they can meet people in the same position.

While government is intent on “rolling out” VCT countrywide, Gill Gresak of AIDSlink, an organisation that provides support to people with HIV, cautions that a number of things have to be in place if VCT is to work.

“VCT should be available in a clinic that deals with other diseases. This removes stigma and increases attendance,” says Gresak. “Nurses (those who draw the bloods) need to be scrutinised to ensure confidentiality. Test kits must be readily available, and (those who test positive) should have access to a wellness programme.”

Some argue that there is little point knowing your HIV status in a country like ours that does not offer anti-retroviral treatment. In addition, some people get depressed and have experienced abuse and marital break-ups after finding out that they are HIV positive.

While anti-retrovirals are not available in the public health sector, treatment for opportunistic infections and prophylactic drugs to prevent TB and pneumonia are available.

There is widespread consensus from AIDS experts – from Treatment Action Campaign’s Zackie Achmat to Anglo American’s Brian Brink – that it is best to know your HIV status. This knowledge empowers you to take decisions about how to live better and longer, and to plan for the future.