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The hidden cost of voluntary counseling and testing for women
Women and AIDS Support Network (WASN)
By Emedie Gunduza
December 31, 2002

While Voluntary Counseling and Testing (VCT) may appear cheap, with clients paying a meager Z$50 at most VCT centers, there are numerous hidden costs that deter women from accessing the service.

VCT, according to the World Health Organization (WHO), is a confidential dialogue between a client and the care provider, aimed at enabling the client to cope with stress and take personal decisions related to HIV. Normally this dialogue takes place before and after an HIV test.

The above explanation makes VCT’s an integral part of women’s health as it helps them cope with infection. It is therefore important to take a close look at how women are serviced by existing VCT’s. This is with a view to enlightening communities, women and organizations offering VCT’s, on some of the hindrances women face in accessing this much needed service.

Most VCT centers are located in the urban areas, making accessibility by poor women virtually impossible because of the high bus fares involved. Therefore, in addition to the Z$50, women also have to bear the cost of transport to these centers.

In the event that a woman tests positive, the issue of shared confidentiality is yet another cost for this woman. In the event of disclosing her status, she may be rejected, dispossessed or even deserted by her spouse and stigmatized by the community.

The cost of stigma is quite high, more so than the bus fare to town. Often the woman suffers rejection and shame. Without social support and further counseling, she is isolated and haunted by feelings of loneliness, resulting in chronic depression.

Indirectly this triggers some of the opportunistic infections, thereby creating yet another cost, that of medical bills, which the majority of women cannot afford. Away from the counseling centers and media that churn out information on positive living, the woman continues to live a lonely life in a community full of people who are insensitive to her plight.

In the event that there are benefits specifically targeted at people living with HIV/AIDS, such as treatment, the woman has to trade her confidentiality in exchange for access to the services. Once again, this is at the risk of being stigmatized once her status is known. The question is, how many dare to expose themselves in return for stigma, isolation and rejection and at the same time fail to access the intended benefits because the stocks at the local clinic are always empty.

Often people find it difficult to disclose their HIV status to close members of the family for fear of the negative impact. Clearly, it is even more difficult to disclose to people at public places such as a community clinic where relations between the patient and health personnel may be negative. This, once again, is a hidden cost.

The Voices and Choices research, conducted by WASN in collaboration with the International Community of Women living with HIV/AIDS, showed that most women who reveal their HIV status to their husbands or partners, suffer some form of gender violence, including physical abuse.

Normally the woman is accused of bringing the virus home. The tension that this woman goes through is quite traumatic. She falls into a dilemma and is torn between the need for comfort by confiding in someone and the fear of rejection after disclosing her status. This added cost of shared confidentiality is often unbearable, hence most women opt to remain ignorant of their status by choosing not to be tested.

The hidden cost is dear to pay for most women particularly, the ordinary woman. The introduction of VCT centers and mobile testing units in rural areas will reduce some of these mentioned costs.

However, a great deal more work needs to be done in order to deal with the social costs such as stigma. AIDS Service Organizations (ASO’s) should intensify their operations by educating communities through various means. This will help people to accept HIV/AIDS as a disease that cuts across race, class and gender. Such forms of social support will go a long way in reducing the hidden costs that women incur in the face of HIV/AIDS.

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