VCT presupposes the right to: know one’s HIV status; link with further and ongoing information, supportive counselling, treatment, care and support systems; and efforts to raise public awareness about HIV/AIDS and reduce stigma and discrimination.
Critical to the provision of VCT services are the principles of voluntary attendance, informed consent and confidentiality, and of high quality, reliable and affordable counselling services. These are basic essentials and should be adhered to. If there is any doubt about their implementation in a given situation, VCT should not be supported.
Linkage to support systems
VCT should not be provided as an end in itself, but as part of a continuum of services and support, ranging from advocacy and community mobilization to reduce stigma and discrimination around HIV/AIDS, behaviour change strategies to prevent HIV/STI infections and re-infections, and psychosocial support, care and medical treatment including treatment for opportunistic infections and anti-retroviral (ARV) therapy where it exists.
When introducing VCT services in a community, concerted effort must be made to ensure the range of services and support systems either through direct provision or by referral and linkage with other programmes providing these aspects.
While couple counselling has many benefits, not everyone is part of ‘a couple’. Providers of VCT services must not insist on partner consent or presence as a prerequisite to providing HIV counselling and testing. Couple counselling must uphold voluntary, consensual practice. Coercion by one partner and/or organization (for example in the case of pre-marital mandatory testing) may result in adverse consequences for either party, but particularly for women that test positive.
In some countries mandatory testing has been introduced for certain categories of individuals – prospective students applying to enter University (Ecuador), new military recruits (China), first time antenatal attendants, refugees, those in institutionalized care like orphanages, detention centers, prisons, etc.
A common feature of mandatory testing is the lack of counselling and supportive services offered after testing.
UNFPA should not support the concept of mandatory testing and should ensure that individuals and couples are provided with all the information necessary to make an informed decision as to whether or not to test, and the enabling environment to cope with the outcome/results of the test.