CDC's HIV Prevention Programs in South Africa:
Counseling and Testing
Vital to Preventing New HIV Infections
Counseling and testing (CT) provides individuals with critical information regarding their HIV status and plays a pivotal role in preventing new HIV infections as well as increasing access to care and treatment services. South Africa's HIV prevalence of 18.1% among 15 49 year olds is among the highest in the world. According to the 2008 UNAIDS report there are approximately 5.7 million people living with HIV, yet only about a quarter of the population have tested for HIV.
The U.S. Centers for Disease Control and Prevention in South Africa (CDC South Africa), through its Global AIDS Program (GAP), supports South Africa s National Department of Health's (NDOH) efforts to increase access to and demand for quality CT services through, support with policy development, development of guidelines, training, and providing technical assistance.
Offering a variety of CT models
In 2000, NDOH established a national CT program that only used the voluntary counseling and testing (VCT) model. Since then, the NDOH has expanded the national CT program to include a variety of models including mobile, stand-alone, provider-initiated, home-based, workplace, and couple counseling with the goal of reaching different target populations in South Africa. CDC South Africa partners are distributed throughout the country in support of NSP's goals to prevent HIV transmission.
In addition to assisting the NDOH in increasing access to CT for South Africans, CDC South Africa is working with the government to improve its data collection and management by collecting data from non-governmental organizations (NGOs), private pharmacies, and general practitioners to provide a complete picture of CT usage in the country. In 2009, CDC South Africa s target is to support its partners in providing CT services to approximately 2 million people.
CDC South Africa works with its partners to ensure the CT activities comply and complement the government s policies and activities. There are several hard-to-reach populations, which include men, youth, people living in rural areas, migrant workers, offenders, couples, and sex workers. PEPFAR partners use a variety of models to reach these populations, including home-based counseling and testing, and stand-alone and mobile testing sites that are set up in a variety of accessible sites such as malls and taxi ranks.
For example, Society for Family Health, through their New Start social marketing franchise, reaches out to the prison population in Cape Town. New Start takes their mobile counseling and testing tents each week to Pollsmoor prison where prisoners awaiting release or trial can be reached. The prison houses approximately 8,000 offenders, out of which 3,000 are juvenile offenders. New Start counsels and tests approximately 50 offenders per day.
In 2008, partners collaborated with provincial departments of health to launch a successful HIV Counseling and Testing campaign to test more men. Men are a key target group because they typically determine their status by their partner's status instead of accessing CT services. The national HIV testing week was observed from November 3 to November 8, 2008 in five provinces- Gauteng, KwaZulu-Natal, Eastern Cape, Mpumalanga, and Northern Cape. The theme was A Man Knows which encouraged South African men to be courageous, to get tested, and to know their status. The campaign was so successful that it exceeded the target of testing 30,000 people by 16%. Testing was offered at traditional and non-traditional VCT sites such as taxi ranks, workplaces, and shopping malls.
Creative approaches to couple counseling
Although couple counseling has been expanded nationwide to target married and cohabiting couples, it is difficult to attract clients as it is often difficult to get couples to visit together because of stringent work and lifestyle demands. For instance, mobile sites run during the week from 8 a.m. to 5 p.m. when most adults are at work. Partners are using creative approaches to attract clients such as offering extended hours and collaborating with faith- and community-based organizations. Couple counseling aims to lower the HIV prevalence by identifying and assisting discordant partners to prevent further HIV infection.
Training is a key component in increasing South Africa's capacity to provide essential CT services. CDC South Africa collaborates with its partners to identify training gaps and provide trainings on routine CT, couple counseling, and quality assurance around rapid testing. The Academy for Educational Development supports approximately 40 small NGOs that provide services in six provinces by training health-care workers and lay staff. Trainings are comprehensive and cover an array of topics including counseling individuals and couples, testing, running campaigns, and data management with the goal of building capacity to effectively manage all aspects of CT.
Counseling and Testing Partnership highlights
- Population Services International (PSI): New Start program targets men and couples, works in all nine provinces
- University Research Corporation: Specializes in provider-initiated models within public health facilities in five provinces
- Africa Medical and Research Foundation (AMREF): Implements TB and HIV programs in three provinces
- National Department of Correctional Services: Provides CT, care and treatment, prevention, and TB/HIV services for offenders and staff
- Catholic Medical Missions Board (CMMB): Focuses on home-based CT and community mobilization
- Montefiore Hospital: Provide counseling and testing using the ACTS model that targets youth in the Western Cape.