Voluntary Counselling and Testing Projects

Tshwarisanang couple centre

The Tshwarisanang Couples Counseling Centre at the Perinatal HIV Research Unit was opened in June 2004. This Centre is currently the only dedicated provider of Couples HIV counseling and testing in Soweto. Led by a qualified social worker, the team at Tshwarisanang aim to provide high-quality HIV counseling and testing to couples.

It is recognized that much HIV transmission occurs between regular partners, such as married couples or cohabiting couples. Many South Africans living with HIV/AIDS do not know their HIV status. This leads to a common situation where one member of a couple will assume, in the absence of a test result, that their results are the same as their partner, a phenomenon known as “testing by proxy”. For Original article Click here

A key condition of CHCT is that partners test and receive their results together. All phases of CHCT are conducted with both members of the couple present. This avoids the dilemma faced by individuals learning they are HIV positive in individual VCT and having to disclose these results to a partner who may not be adequately prepared. Owning the results together may help reduce problem situations, reduce blame and possible violence. CHCT also assists the couple to make decisions and planning adequately for the future.

Project Accept

Project Accept is an HIV prevention trial in which communities have been randomized to receive either a community based voluntary counselling and testing (CBVCT) intervention plus clinic based standard voluntary counseling and testing (SVCT) while others will receive SVCT alone. The research study is conducted in 5 international sites namely:

• Vulindlela, KZN, South Africa (rural)
• Soweto and surroundings, South Africa (urban)
• Mutoko, Zimbabwe (rural)
• Tanzania (rural)
• Chiang Mai, Thailand (rural)

What is the overall aim of the research?

The Aim of research is to create awareness about open dialogues around HIV and AIDS in the community, Enhance the community’s understanding of participation in, and enthusiasm for VCT and PTSS, To foster understanding and acceptance of HIV positive members of the community and promotion of risk reduction and lastly to make testing a community norm

Strategies of Project Accept

The intervention has three major strategies: Firstly to make VCT more available in community settings through a mobile VCT caravan, secondly to engage the community through outreach, education, and mobilization and thirdly to provide high quality post-test support. These three strategies are designed to change community norms and reduce risk for HIV infection among ALL community members, irrespective of whether they participated directly in the intervention.

What kind of research is this?

• Behavioral
• Prevention of HIV infections through behavioral change.
• Community-based
• Our focus is on community context—how can whole communities participate in HIV prevention?
• Intervention research
• How can we prevent the spread of HIV through a specific behavioral and community based intervention programme?

How is the research being conducted?

• 8 communities were chosen to participate in the study
• 4 of the communities were randomly assigned to receive the CBVCT intervention and the other 4 communities were randomly assigned to receive the standard VCT.
• A baseline behavioral survey was conducted before the intervention began.
• At the end an assessment will be conducted to measure outcomes.
• The cost effectiveness analysis of CBVCT (mobile) compared to SVCT (hospitals, clinics) will also be done.
• Qualitative research is used to assess risky behaviors, existing sexual attitudes, stigma attached to HIV/AIDS, changes in sexual behavioral practices, community dynamics which may or may not be clearly associated with HIV/AIDS

How do we work in partnership with study communities?

• Established relationships with stakeholders
• Communicate clearly and transparently about the research procedures
• Encourage communities to “buy in” and feel ownership of the research study
• Established Community Based Outreach Volunteers (CBOVs)
• Established Community Working Groups (CWGs)

What are the practical implications of the study?

• If we find CBVCT to be more effective than SVCT in preventing HIV infections and reducing stigma, we will be able to recommend that the CBVCT model be implemented as “standard of care” throughout the country.