Missed Opportunities for Strengthening HIV Testing and Counseling Services in Southern Africa

Missed Opportunities for Strengthening HIV Testing and Counseling Services in Southern Africa

{Photo credit: MSH/South Africa.}Photo credit: MSH/South Africa.

Cross-posted from SHARE: Southern Africa HIV/AIDS Regional Exchange. (SHARE is an initiative of the USAID Southern Africa Regional HIV/AIDS Program with support from the Knowledge for Health project and the Southern Africa HIV and AIDS Information Dissemination Service.)

The Southern Africa Development Committee (SADC), with support from USAID through Management Sciences for Health’s Building Local Capacity for Delivery of HIV Services in Southern Africa (BLC) Project and other funding partners, held a two-day meeting last October for SADC member states to discuss HIV prevention efforts in the region. SADC and member states presented new research coming out of the International AIDS Conference and regionally, and their experiences with prevention of mother to child transmission (PMTCT), behavior change, and medical male circumcision. Other areas explored at the meeting included capacity building for HIV prevention and positive health, dignity, and prevention.

Towards the end of the meeting a brief session was devoted to HIV counselling and testing (HCT), perhaps in the misplaced belief that member states are doing well in this particular HIV prevention strategy. Dr Kevin Kelly from Centre for AIDS Development, Research and Evaluation (CADRE) briefly highlighted that over the last few years there has been no research on HCT despite the need to improve the quality of HCT services.

I couldn’t agree more, and I share my story to illustrate this. In my opinion, HCT remains a cornerstone in the HIV & AIDS response in the region and deserves much more attention and discussion at national and inter-governmental levels.

In the 14 years I have worked in HIV & AIDS and health, I have talked to my partner, relatives, friends, clients, about the need to get tested. However, in the years before access to life-saving antiretroviral drugs (ARVs) became available, I had no incentive to know my status.

Despite being a sexually active adult and at risk of contracting HIV, fear of the effects of the disease kept me from testing.

I felt I was not ready to deal with an HIV-positive diagnosis and I was also too scared I would die without dignity, like all the people dying around me. In addition, I felt unable to deal with the then pervasive stigma and discrimination associated with being HIV positive.

Even though I knew about discordant couples, when I made the decision to have a baby I used my husband as a proxy for my HIV status as he regularly tested and donated blood. Three years after my daughter was born, I woke up with a raging fever and excruciating pain in my throat. As an "informed" HIV front liner, I did the “usual checks” which included checking for swollen glands and lymph nodes, and oral thrush. Of course the “examination” did not tell me anything.

Despite being ill, I decided to go to work; I was facilitating behavior change training for AIDS service organizations in Zimbabwe. As the day progressed and the pain increased, I decided to go for an HIV test over lunch. The workshop venue was near a NGO testing center in downtown Harare. After 45 minutes in the queue with the same eight people ahead of me, I gave up and went back to work. I eventually wound up in the casualty unit of a private hospital where I got antibiotics, a hypertension treatment starter-pack, and a note to see a physician to monitor my chronic condition.

The HIV test was forgotten and replaced by new fears.

A year and half later, I decided to go to a private institution to take the test. Again, with a thumping heart, I walked into the center, was greeted by the receptionist, and asked to wait as they were a few people ahead of me in the queue. On inquiry, I was informed that I would get my results after a few days when they came back from a laboratory. After waiting for almost an hour, my resolve fizzled out and I left. Again, another missed opportunity---if only I had been attended to right away.

In the last three years I have been living in South Africa, I have had two HIV tests. This was largely due to the fact that I managed to overcome my fear of testing and I am confident that there is life after an HIV-positive diagnosis. I have friends and relatives on antiretroviral therapy (ART), who as a result of an HIV test, are healthier and able to achieve their dreams.

My husband accompanied me for the first HIV test. To my recollection, the pre-test counseling lasted two minutes and most of that time was spent recording our bio-data. No questions were asked regarding our risk perception and how we would deal with our results. We had no post-test counseling except to be reminded to come back after three months. There was no queue because of the expedited nature of the whole process.

I returned alone to the clinic for the second test. I was extremely apprehensive and it took a lot of willpower to walk into that clinic. I was relieved to see only three people in the queue. Little did I know that I would sit on a bench for five solid hours. About an hour into the wait, two emergency cases were brought in and the counseling and testing room immediately transformed into an emergency room.

A nurse came out and asked us to come back another time: "HIV is not emergency". I found this ironic: as HIV was declared an emergency in the early 2000s in some SADC countries. I decided to call some private pharmacies to see if I could get a test. Both pharmacies indicated that I needed to have booked a nurse, and besides, it would take a few days for me to get the results from the laboratory.

I tried my doctors’ clinic, again without success, as I was told the same story. Sometime later a young man joined the queue, and after a lengthy wait, decided to loudly lobby for us to get tested. Ten minutes later, I was sitting in the car park getting my two-minute pre-test counseling. This was followed by ten minutes of searching for a free testing room, getting the results, and being reminded to come back after three months.

When I left, I was happy that I had my results, but was shocked and depressed at the process.

At the close of the SADC HIV prevention meeting, I feel there are key questions and issues to be considered:

  • How many people are “lost” due to the quality of HCT services provided?
  • Is anyone held liable for poor HCT service delivery?
  • How many similar incidents go unreported and undocumented?
  • Is SADC in a position to ensure adherence to recognized HCT standards?
  • How do we maintain and build on the momentum gained in HCT service delivery, and ensure that no one is overlooked?

Instead of wasting many hours at the testing center again, please give me the HIV home test kit and I will do it in the comfort and privacy of my home.

Sheilla Benyera is a capacity building advisor for Building Local Capacity for Delivery of HIV Services in Southern Africa Project (BLC) based in Pretoria, South Africa. 

BLC strengthens government, parastatal, and civil society entities to effectively address the challenges of the HIV and AIDS epidemic. BLC provides technical assistance in organizational development, including leadership, management, and governance in three key program areas: 1) care and support for orphans and vulnerable children (OVC); 2) HIV prevention; and 3) community-based care. In Lesotho, the BLC project supports community based services through civil society organizations who provide care to children and caregivers in five target districts. Supported clinical services include: HIV counseling and testing (HTC), care and treatment, and PMTCT.