What Works for Women and Girls

More Testing Modalities Enable More People to LearnTheir StatusAttention to testing in HIV/AIDS programming has resulted in a proliferation of HIV testingand counseling (HTC) 1 modalities. Some of these modalities include provider-initiated testing;couples counseling; client-initiated testing, also known as voluntary counseling and testing(VCT); and home-based testing, among others. Increased use of a variety of testing modalitieshas allowed more and more people know their HIV status. While only 0.5% of adults inreporting countries received HTC in 2005 (Stover and Fahnestock, 2006), by December 2009,nearly half of all people living with HIV were aware of their serostatus (UNAIDS, 2009e).Among the 45 countries that reported data on sex workers, the median proportion of sexworkers who knew their status from a recent HIV test was 38% (UNAIDS, 2009e).Experts disagree, however, on the best testing modality. Each modality has advantages anddisadvantages. For example, home-based testing may reach people in rural areas where transportis a barrier, particularly for women. But home-based interventions need to have the infrastructurein place to provide safe counseling and testing, for example, provider capacity, availabilityof quality assurance, and the ability to protect fundamental human rights. Other studiesshow that different HIV testing strategies should be used for men and women: on-site testingfor women and mobile HTC services for men (Zamanillo et al., 2008). A recent analysis inthe Lancet called for universal HIV testing with immediate treatment access as a way to haltthe epidemic (Granich et al., 2009). This “Test and Treat” approach has received a range ofcritiques about methodology and operational constraints from a number of experts worldwide(Cohen, Mastro, and Cates, 2009; Wilson, 2009b: Ruark et al., 2009: Epstein, 2009;Jurgens et al., 2009a; Hsieh and Arazoza, 2009: Jaffe, Smith, and Hope, 2009: Assefa andLera, 2009). Further expert consultation on this topic is likely.1 The term HIV testing and counseling (HTC) covers the range of options for ensuring that people know theirHIV status. Different terminology has been used in HIV testing over the past three decades. Voluntary Counselingand Testing (VCT) has long been used to refer to client-initiated testing and can also refer to free-standingclinics where people go for the purpose of accessing HIV tests and counseling (Obermeyer and Osborn, 2007)at any facility that provides HIV testing. Many of the points in the “what works” list are based on evidence thatdiscussed “VCT” and thus that term is used most commonly. “Provider-initiated testing” refers to HIV testingand counseling “which is recommended by health care providers to persons attending health care facilitiesas a standard component of medical care” (WHO, 2007c: 19). Additionally, reference is made to “routine” or“opt-out” testing where HIV tests are given routinely unless a client decides specifi cally to “opt-out.”144 CHAPTER 6 HIV TESTING AND COUNSELING FOR WOMEN