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Taking an HIV test in Zimbabwe: A personal experience
Fugai Machirori, Partners Zimbabwe Key Correspondent
March 08, 2010

This is an open account of my recent experience at the New Start Voluntary Counselling and Testing (VCT) Centre in Union Avenue, Harare, which I feel is important to share.

As many of us know, testing for HIV is an important entry point for individuals to make informed decisions about their health. If a person tests negative, this provides an opportunity for them to take up, or continue to make use of, proven HIV prevention measures such as abstinence, monogamy and consistent and correct use of condoms.

If a person tests HIV positive, then this acts as a gateway to positive living which may include adoption of a healthier lifestyle and the commencement of ARV treatment, where CD4 test results are low enough to warrant this.

I give this background to set up the scenario for the test I undertook early in February as part of a general investigation into the quality of HIV testing and counselling services across centres.

Since the test is such a crucial entry point to so many other health-seeking behaviours, it is of utmost importance that patients feel comfortable throughout the process of both counselling and testing.

One of my initial concerns was with a group information session. The counsellor gave a group of us this session before we engaged in the one-on-one pre-test counselling sessions. The group was large, about ten people or so, which is understandable as the demand for the service is high.

The first problem arose when the counsellor asked what language to conduct the session in. Most of the group wanted the session to be conducted in Shona but two gentlemen raised issue with the fact that they weren-t fluent in the language. So they had to lose out to the majority. However, a compromise was reached as the counsellor used 'Shonglish-; a hybrid of Shona and English, throughout the session.

In all honesty, I think she only managed to sprinkle five English words into the whole session; barely enough to ensure that the non-Shona speakers could fully understand the communication.

For me, that just isn-t good enough. That information session is so important for people who know nothing about HIV, AIDS and TB as it gives them an idea of how HIV is transmitted and functions in the human body, and also how untreated opportunistic infections can lead to AIDS. This is important information that we should never assume all people know.

After that session, we were told to go and sit in the waiting room and wait to be called for counselling.

The counsellor assigned to me was a woman who seemed very disinterested in the task of counselling. In fact all she asked me to tell her was where I lived, my age and what brought me to the centre for a test. There was no real dialogue being sought here, just the basic facts about who I was, which is definitely not the way to create a safe environment for a client.

In fact, I am certain that before a counsellor begins the process of counselling a person, they should ask the client if they are comfortable with the counsellor, or if they feel that they would be more communicative with a counsellor who is younger, older or of the opposite sex etc.

None of this was asked of me. Also, the counsellor didn-t even ask me if I wanted the session conducted in Shona but chose to assume that I understood the language and proceeded to direct the counselling session completely in Shona.

As she asked her questions, I began to question in my head whether this would be the type of counsellor that people, particularly young people, would feel they could confide in. I mean, even if she asked, I don-t think anyone would feel too comfortable divulging their sexual history to a person so obviously unapproachable.

Ultimately, the counselling function of the process is about creating a relationship from the beginning of the journey right to the end, by trying to ensure that the client doesn-t drop out at any stage of the process.

After having my blood drawn, I went back to sit in the waiting room of people, all anticipating their results.

One particularly twitchy young man who had kept his ear phones plugged in throughout the waiting period finally succumbed to whatever battle was waging within himself and walked hastily out of the room. Throughout my 20-minute wait, I did not see him return. His fears must have overcome his will.

As I continued to think about him, I heard a voice call me for the post-test session.

And there was yet another problem: my post-test counsellor was different to the counsellor I had been with prior to the test.

Like I said, my understanding of the HIV counselling process is that it's about building trust and a relationship that must be strong enough to endure any eventuality that might come at the end of the journey. For example, providing convincing counselling that must influence, in some way, the client-s health-seeking decisions thereafter.

This cannot be achieved through the switching and mixing of counsellors. One counsellor, whom the client has identified as a comfortable confidant should be used throughout the process.

Perhaps my final concern is the biggest the one.

As the post-test counsellor prepared to show me my results, she asked me a deeply loaded question,

"Are you sure you won-t kill yourself if you find that you are HIV positive today?"

If that isn-t the epitome of the very stigma that we are trying to conquer through testing, then I don-t know what is. How can a counsellor speak in that way and even suggest such a negative reaction to a positive test as death?

It-s one thing to say people are coming in their droves to get tested, and this is probably why the centre is unable to meet the high quality of standards that is each client-s right. But it isn-t a good enough excuse.

I hope this matter will be looked into with all seriousness.

Email: fmachirori@yahoo.com

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