VOLUNTARY COUNSELING AND TESTING [VCT] EFFICACY VIZ OTHER PREVENTATIVE STRATEGIES: LESSONS FOR POLICY- FROM A SYSTEMS APPROACH BY MARISEN MWALE- FELLOW- COM/CDC/PEPFAR

VCT EFFICACY VIZ OTHER PREVENTATIVE STRATEGIES:

LESSONS FOR POLICY-

FROM A SYSTEMS APPROACH

Most high prevalence sub-Saharan African countries- Malawi inclusive- tend to over-emphasize abstinence, fidelity and condom use as major preventative measures vis-à-vis the AIDS pandemic. Studies of behavior change that focus exclusively on the two measures of most interest to the prevention community- condom use and fidelity [faithfulness] or chastity [abstinence]- however bias examinations of behaviour change downward by ignoring other effective ways of limiting the epidemic. The prevailing debate over provider initiated testing in Malawi may depict a shift toward HIV testing and counseling in AIDS prevention. Not only that, the rejection of the National AIDS Commission’s proposal over counterproductive policy emphasis and neglect of efficacious strategies may depict the need for stringency in our AIDS prevention bid. The object of this short analysis is not to taut VCT as superior to other preventative strategies but rather to depict its central role in AIDS prevention. If we were to construe AIDS prevention from the systems approach with each preventative strategy considered as interconnected to other dissimilar strategies, I beg to vouchsafe how VCT could be perceived as the hub of the preventative system.

Based on empirically validated findings first, VCT has been shown to lead to safe sexual behaviors and increased condom use, thus preventing further spread of the disease [Vidanapathirana et. al, 2007]. Systematic review on the impact of VCT on risk behavior in developing countries reflects increased condom use. Second, VCT has been shown to be useful in targeting persons at high risk because risky behaviors are positively associated with the decision to take the HIV test [Miller, 1996]. A small Qualitative study conducted at MACRO empirically validates the observation. In focus group discussions conducted with three women groups with the objective of delineating facilitators and barriers to female uptake of VCT, it was universally alluded to that the VCT uptake rate among men may be higher because most men patronize HTC services to vilify themselves in face of their risky sexual debuts.

Third, research findings have documented how couple counseling could result in trust  and faithfulness between partners reinforcing intimacy and fidelity thus preventing the overall spread of HIV/AIDS and curtailing multiple and concurrent partnerships. The FGD referenced above also validated how couple counseling and testing could be a precursor to positive living as well as a means of limiting transmission of HIV to one’s partner in cases of sero-discordancy but only when all partners were aware of their serostatus since ignorance was shown to exponentially perpetrate the opposite trend. Forth, among the youth VCT has been proven to reinforce not only primary but above all else secondary abstinence. Youth tend to limit the number of their sexual partners and further indulge in safer sexual behaviors. Philosophies that are being promoted in AIDS prevention and whose efficacy has been verified in the name of ‘Zero Grazing’ in Uganda- adopted as ‘One Love’ in Malawi- have been reinforced where the youth know their sero-status through VCT.

From a systems approach, it is thus evident that condom use, fidelity [faithfulness], as well as abstinence [chastity] could be expedited and rendered more efficacious by scaling up and promoting VCT. The challenge however remains how programmes could be integrative in approach and emphasize the connectedness of the preventative strategies. In the absence of an efficacious vaccine and cure for HIV and AIDS, emphasizing on stringent mitigative strategies remains the window of hope in our desperate war against the HIV/AIDS pandemic not only in Malawi but sub-Saharan Africa in general.

BY MARISEN MWALE- FELLOW/MACRO