HIV Testing and Counseling for Women
Gaps in Research
- 1.
- Further interventions are needed that support women safely through the disclosure process.
- 2.
- Additional efforts are needed to identify opportunities to offer HIV testing and counseling in health care settings that might reach women who are otherwise inaccessible.
- 3.
- Further efforts are needed to ensure optimal counseling strategies and topics, with detailed information about accessing treatment and risk reduction.
- 4.
- Enforcement of standard protocols is needed to reduce the risk of provider coercion in HIV testing, particularly in provider-initiated testing and counseling.
- 5.
- Further efforts are needed to guarantee confidentiality of HIV test results.
- 6.
- Strengthened post-test counseling for those who test HIV positive must explain who is eligible for treatment; the importance of treatment and reducing transmission; and where to access treatment.
- 7.
- Further efforts are needed to determine the optimal frequency of testing in order to minimize HIV transmission in a cost-effective way.
- 8.
- Links are needed between religious leaders and health facilities.
- 9.
- In some countries, knowledge of how and where to access HIV testing is needed.
- 10.
- Older adults need HIV testing and counseling.
- 11.
- Affordable incidence assays need to be developed which will distinguish new and recent HIV infections.
- 12.
- Rapid testing is needed in some countries so that people can quickly learn their serostatus without long follow up.
- 13.
- Further efforts are needed to make HIV testing and counseling available and accessible to young people.
1. Further interventions are needed that support women safely through the disclosure process. [See also Antenatal Care - Testing and Counseling] Studies found that women in some settings experienced increased violence and abandonment following disclosure or feared violence as a result of disclosure. Some HIV-positive women wish to disclose their serostatus but want trained health providers to help them do so.
Gap noted, for example, in Ethiopia (Deribe et al., 2010; Deribe et al., 2009); Uganda (Emusu et al., 2009); Tanzania (Milay et al., 2008; Maman et al., 2001a); Brunei, Cambodia, Indonesia, Lao People’s Democratic Republic, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Vietnam (Ishikawa et al., 2011b).
2. Additional efforts are needed to identify opportunities to offer HIV testing and counseling in health care settings that might reach women who are otherwise inaccessible.
Gap noted generally (Askew and Berer, 2003; De Bruyn, 2003; Oosterhoff et al., 2008a) and among sero-discordant couples in Rwanda and Zambia (Grabbe et al., 2009).
3. Further efforts are needed to ensure optimal counseling strategies and topics, with detailed information about accessing treatment and risk reduction. Studies found that women who went for an HIV test prior to marriage felt they did not need another HIV test for the duration of the marriage and that pre-test counseling was important. Providers do not feel comfortable asking about sexual practices. Studies have found that those who test HIV-negative engage in a high frequency of sexual risk behaviors.
Gap noted, for example, globally (Jurgens, 2007a); South Africa (Venkatesh et al., 2011a); Pakistan (Hussain et al., 2011); Tanzania (Mmbaga et al., 2009); and Zimbabwe (Sherr et al., 2007).
4. Enforcement of standard protocols is needed to reduce the risk of provider coercion in HIV testing, particularly in provider-initiated testing and counseling. Studies found that significant numbers of women reported that they could not refuse an HIV test or that HIV testing was mandatory.
Gap noted, for example, in 22 countries in the Eastern Mediterranean region (Hermez et al., 2010); Zimbabwe (Sambisa et al., 2010); India (Joseph et al., 2010); Kenya (Karau et al., 2010); South Africa (Groves et al., 2009); Botswana (PHR, 2007a; Weiser et al., 2006a); China (Li et al., 2007); and Ukraine (Yaremenko et al., 2004).
5. Further efforts are needed to guarantee confidentiality of HIV test results. A study found that nurses and physicians did not access HTC because of fears of confidentiality.
Gap noted, for example, in Zambia (Bond, 2010); Cameroon (Njozing et al., 2010); Vietnam (Nam et al., 2010); Malawi (Namakhoma et al., 2010).
6. Strengthened post-test counseling for those who test HIV positive must explain who is eligible for treatment; the importance of treatment and reducing transmission; and where to access treatment. A study found that women who tested positive did not know about treatment nor where to go to access treatment.
Gap noted, for example, in Vietnam (Nam et al., 2010) and Ghana (Tenkorang and Owusu, 2010).
7. Further efforts are needed to determine the optimal frequency of testing in order to minimize HIV transmission in a cost-effective way. In some settings, testing for acute infection is warranted which would require testing every three to six months. A study found that 12% of women and 10% of women who had reported testing HIV-negative were found to be seropositive one to two years later. Modeling studies have found that screening one time, annually, can be cost-effective and that yearly testing in a high incidence area found that potential high-risk transmission with high viral load could be reduced by yearly HIV testing.
Gap noted, for example, in Kenya (Huchko et al., 2011); Botswana (Novitsky et al., 2010); Malawi (Powers et al., 2011b) and South Africa (Walensky et al., 2011).
8. Links are needed between religious leaders and health facilities. A study found that religious leaders wanted to refer people living with HIV for counseling and up to date information on HIV but did not know where to advise people to go.
Gap noted, for example, in Senegal (Ansari and Gaestel, 2010).
9. In some countries, knowledge of how and where to access HIV testing is needed. Studies found that significant proportions of youth did not know where or how to take an HIV test, with cost being a barrier.
Gap noted, for example, in Yemen (Al-Serouri et al., 2010) and Nigeria (Uzochukwu et al., 2011).
10. Older adults need HIV testing and counseling. A study found that significant proportions of adults, particularly adult men, had not had HIV testing yet had unprotected sex with multiple partners and paid partners.
Gap noted, for example, in Thailand (Ford and Chamratrithirong, 2009).
11. Affordable incidence assays need to be developed which will distinguish new and recent HIV infections. No affordable incidence assays, which can detect recent and new infections, have been developed or have to be used with conditions that no longer exist, such as lack of access to ARVs. Such an incidence assay could be used to assess impact of particular programmatic efforts and distinguish between older and more recently acquired HIV infections.
Gap noted, for example, in Africa (IOM, 2011; Kim et al., 2010; Duedu et al., 2011); South Africa (Fiamma et al., 2010).
12. Rapid testing is needed in some countries so that people can quickly learn their serostatus without long follow up. In some countries, HIV testing is only done by ELISA tests, takes one month for test results and requires follow up appointments.
Gap noted, for example, in Ukraine (Brown et al., 2011b).
13. Further efforts are needed to make HIV testing and counseling available and accessible to young people. [See also Increasing Access to Services] Opt-in testing for young people, with consent of guardians, may increase the number of young people learning their serostatus.
Gap noted, for example, in Zimbabwe (Ferrand et al., 2011).