A sex worker taking an HIV test
HIV testing provides the gateway to accessing other services; a person living with HIV cannot receive any care until they have been diagnosed. The conventional model is VCT (voluntary counselling and testing), requiring people to come forward to be tested. Recent years have seen increasing promotion of routine testing as well. Under this system, everyone attending certain healthcare facilities – for example antenatal clinics, sexual health clinics or doctors’ surgeries – is routinely tested for HIV unless they refuse.
Early diagnosis enables more effective treatment and care. If HIV is first detected in the late stages of infection then more complex care may be needed, and there is less chance that treatment will work. Early diagnosis also reduces the risk of onward transmission; once someone knows they have HIV they are more likely to take precautions to avoid infecting others.
Counselling and psychosocial support
Receiving an HIV positive test result can be traumatic. Psychosocial support aims to help HIV positive people and their caregivers cope with psychological distress, adjust to change and resume a normal life. Patients who receive good quality counselling are less likely to develop serious mental health problems. Health workers should be able to provide psychosocial support, and additional care can come from trained volunteers or AIDS service organisations.
Support is also crucial to the success of any medical treatment. People should understand why and how HIV-related illnesses should be treated, and should be informed of what forms of treatment and care are available locally and how to access them.
Malnourishment hastens the progression from HIV infection to AIDS and death. Nutritional counselling can enable people to stay healthy for longer, delaying the point at which they need to begin antiretroviral therapy.
Prevention of onward transmission
HIV positive people should receive counselling to help prevent them transmitting HIV to other adults. This means promoting safer sexual behaviour through condom use, fidelity and voluntary abstinence. Counsellors should ask about partners who might be at risk of HIV infection, and discuss how these partners may be notified.
Some sexually transmitted diseases – most notably genital herpes – can increase the risk of HIV transmission. It is therefore particularly important that people diagnosed with HIV receive treatment for any other sexually transmitted infections they might have.
Mother-to-child transmission of HIV can occur during pregnancy, at the time of delivery, and after birth through breastfeeding. Antiretroviral drugs and safer infant feeding can greatly reduce the risk of a baby becoming infected. Pregnant women with HIV must be diagnosed early to receive the maximum benefit, including education and counselling on prevention methods.
Protection from stigma and discrimination
Stigma and discrimination are triggered by many factors, including lack of understanding of the disease, myths about how HIV is transmitted, prejudice, lack of treatment and social fears. These negative attitudes can deter HIV infected people from getting tested, contribute to them infecting others, and prevent them receiving adequate care and treatment.
The involvement of people living with HIV/AIDS in activities for reducing stigma and discrimination is essential. Having people speak openly about their HIV status is one of the first steps to be taken in tackling stigma and discrimination. This can make people realise that HIV is part of their community and not just “someone else's problem”. In addition, the role of people who are HIV negative should not be underestimated. HIV negative people who speak out about HIV/AIDS can help to promote wider support for those who are infected.
