30 November 2009

VCT campaigns must evolve

Education and awareness programmes bear fruit as more than half of SA population have been tested at least once for HIV.

While more than 10% of South Africans over the age of two now are living with HIV - the overall awareness of the disease within the country has increased at a remarkable rate in recent years.

According to Dr Caroline Maslo, head of Clinical Governance of Prime Cure Wellness and internationally published author and expert in the management of HIV/Aids, about 50% of all South Africans have been tested at least once for HIV.

This compares most favourably when measured against other countries such as the United States and Europe where less than ten percent of the overall population have been tested. While the 'at risk' portion of the population in those countries is considered lower than that of South Africa it raises questions when it comes to the overall awareness levels of people, particularly younger individuals, living in these countries.

The fact that one out of every two South Africans now 'know their status' effectively means that at least half of the population have been tested at least once. While this is most encouraging, testing cannot and should not be a 'once off thing' as a single test is not sufficient to change behaviour in a meaningful way. Those that are at risk must therefore be re-tested for as long as they continue practising risky sexual behaviour," asserts Dr Maslo.

In the past five years there has been a total mind-shift change in terms of HIV testing, treatment and management. 

Not a once off thing
For example, explains Dr Maslo, "Voluntary Counselling and Testing (VCT) programmes are more widely used than ever before. However, unfortunately less than 30% of companies operating within South Africa run annual VCT programmes, which is a great pity. For any VCT programme to be truly effective it has to be ongoing. Essentially, the VCT programme is a holistic process that will have an extremely positive end-result if implemented and managed appropriately.

According to Dr Maslo the positive impact of role models at community level can also not be underestimated. "It is imperative that those that are employed and are being tested regularly and have changed their sexual mindset return to their communities with a message that a change in sexual behaviour is as important as is the need for regular screening.

Focus on behavioural change
Our entire approach within Prime Cure Wellness is focused on behavioural change and includes consultation and planning according to the needs identified through various assessment tools. It also includes participatory training and support on an ongoing basis. We have long recognised that it is critical to emphasise prevention and self care through the empowerment of individuals in order to stretch the healthcare rand as far as possible in a difficult climate. 

After all, all parties - medical scheme administrators, Government, providers and consumers – have to work together to ensure that the appropriate level of care remains accessible and affordable.

"What is gratifying," she adds, "is the fact that workplace and Government-driven education initiatives are clearly getting through to the people on the ground. The question is just whether those that are at risk are continuing to have themselves tested on a regular basis. By the same token, a point worth probing is how many people that are sexually not at risk are continuing to have themselves screened on a regular basis?" she asks.

According to the UN 2008 Global Report on the HIV and AIDS Epidemic, South Africa has the highest number of people infected globally. As at the end of 2007 it was estimated at around 5.7 million South Africans were infected with HIV and this included more than 300 000 children under the age of 15 years.

Sixth highest prevalence in the world
Although prevalence has reduced slightly since then according to the AIDS Foundation of South Africa, the country still has the sixth highest prevalence of HIV in the world, with 18.1% of the population estimated to be infected. The UNAIDS 2008 Global Report, estimated that in 2007, 350 000 people died from AIDS in South Africa. South Africa is regarded as having the most severe HIV epidemic in the world.

According to Dr Maslo if each and every company keeps on offering VCT programmes, at least on an annual basis, South Africa will be able to contain the high number of HIV infected people. 

"In view of this recent data, it is clear that VCT campaigns will have to evolve. Instead of focussing only on the up-take level of people that are being tested, it is important to pay attention to the sub-group who is reluctant to be tested." 

For example, if a company has an 80 percent update on their annual VCT campaigns - which is considered to be a really good performance - it may well be that it is always the same, well-informed individuals who are not necessarily 'at risk' that are being tested. On the other hand, if could be that it is the same 20 percent who continue to avoid being tested and counselled for HIV. The important indicator therefore is really the amount of individuals that are being tested for the first time," adds Dr Maslo.

In the same way, it is imperative to get those that are most at risk to be regularly tested until they change their sexually risky behaviour. For those individuals it may well be necessary to be tested as often as three times per annum.”

Dr Maslo says that at the end of the day the goal is not to get 45 million people tested every year but to educate everyone to such a degree that they would understand the need to get tested each time that they know that they have put themselves at risk.

Finally, it is important to highlight again and again that for those who have tested positive the overall aim of the VCT programme is really enrolment on a care and treatment plan."

After all our real aim with the testing programme is to try and assess risky behaviour and endeavour to correct this. We want to encourage introspection and we want to see a real and lasting change in sexual behaviour," concludes Dr Maslo.

Issued by Martina Nicholson Associates (MNA) on behalf of Prime Cure Wellness


(November 2009


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