UNFPAState of World Population 2004
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State of World Population
Population and Poverty
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Gender Equality and Women's Empowerment
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Preventing HIV/AIDS
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Preventing HIV/AIDS

Impact and Response
Linking HIV Prevention and Reproductive Health Programmes
Voluntary Counselling and Testing
Key Challenges

Voluntary Counselling and Testing

VCT programmes confidentially and sensitively let women and men know their status and risks, and promote healthy adaptations of behaviour. They are an effective means of preventing HIV transmission and an important entry point for treatment of HIV-related illnesses, prevention of mother-to-child transmission, tuberculosis control, and psychosocial and legal support.

Pilot projects in Côte d’Ivoire and India indicate that integrating VCT into sexual and reproductive health services reduces the stigma associated with HIV/AIDS, strengthens awareness of healthy sexual behaviour, and increases access to and utilization of services. Yet, all too often, VCT has been introduced in isolation from other services.(28)


Nazret, Ethiopia, is on a busy trucking route between Addis Ababa and Djibouti, and sex workers commonly work there. An estimated 18.7 per cent of adults in the area are HIV positive. To better understand and address this high prevalence, the Family Guidance Association of Ethiopia started offering VCT two days a week at its reproductive health clinic in Nazret, which serves about 100 clients each day.

Discussions with community members and providers revealed a need for VCT integrated with other services. Some clients said they would not visit the existing, freestanding VCT centres because of the stigma associated with them, but would use VCT services if offered at the reproductive health clinic. Plans were developed for testing, pre- and post-test counselling, community education on HIV prevention, treatment for the most common opportunistic infections, and referrals for further care and support.

Clinic staff were given training on HIV/AIDS, and nurses were also trained to diagnose and treat STIs. A community-based service to distribute condoms was established, and outreach workers were trained to promote their use. Local institutions were involved in creating mechanisms to provide medical, social and economic support for clients who test positive. Monitoring and evaluation systems were also developed.

More than half the VCT clients are men, and 43 per cent are young people. Approximately 20 per cent of the tests are positive, a prevalence rate similar to those found at other VCT providers in the area. See Sources

PREVENTING MOTHER-TO-CHILD TRANSMISSION. Reproductive health programmes can help prevent mother-to-child transmission of HIV by preventing infection among women, by ensuring that HIVpositive women and men have information on their options and risks so they can make informed choices, and by providing access to ARVs and to a range of contraceptive methods to help support those decisions.

In many settings, pregnancy is often one of the few times when women access health services, providing an excellent opportunity for HIV prevention, especially through counselling and VCT. Integrated services for HIV prevention and maternal health can promote condom use, manage STIs, and provide prenatal and post-delivery care, safe delivery and counselling on infant feeding.

There is a great need to scale up initiatives for the prevention of mother-to child-transmission, which currently reach only a small percentage of women.(29)

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