What Works for Women and Girls

other reproductive health services may encourage people to access VCT despite the factthat “people diagnosed with HIV/AIDS in Haiti still risk tremendous social stigmatization.”The study conducted a retrospective review of patient records (Peck et al., 2003).(Gray III) (HIV testing, counseling, contraception, condoms, STIs, Haiti)A 2005–2007 study in Kenya using a pre-post design found that provider-initiatedtesting and counseling is feasible and acceptable in family planning services, does notadversely affect the quality of the family planning consultation and increases access toand use of HIV testing in a population who would benefit from knowing their status.One group of 28 family planning providers were trained for nine days in integratedfamily planning and HIV testing and counseling to family planning clients, using rapidHIV tests and another group of 47 planning providers were trained for five days to referclients interested in a HIV test. Staff in the intervention clinics were updated on contraceptivemethods, STIs and HIV, reproductive rights, informed choice and consent, safesex and dual protection, values clarification, risk assessment and reduction, recordkeeping and logistics management. The proportion of clients requested an HIV testincreased from 1% to 26%, with approximately one-third of these never having had anHIV test previously. In 2003, 38% of all women who had intercourse in the previousmonth and 44% of unmarried women who had had intercourse in the previous monthreported using a contraceptive method, with the majority of these women attendingclinics for family planning. The study took place in twenty-three public sector hospitals,health centers and dispensaries. Focus group discussions were held prior and followingthe intervention. Implementing the intervention required two to three minutes perclient. For clients who decided to have an HIV test with the family planning provider,the median time increased from 10 minutes to 17 minutes, which included time bothfor the HIV test and counseling the client on the result. The incremental cost per familyplanning client ranged from USD$5.60 per client in the hospital to $9.63 in the dispensaryand compares favorably with an estimated cost of $27 per client for stand-aloneVCT (Liambila et al., 2009). (Gray III) (HIV testing, family planning, health facilities,Kenya)Among 7,400 patients between 2006 and January 2008 in a Malawian STI clinic whohad not yet had an HIV test were offered VCT, of whom 49.6% accepted. Uptake washigher among males (51.5% for men compared to 48.3% for women). Including thosereporting a previous positive result, overall HIV prevalence was 41%: 43% amongwomen and 38% among men (Powers et al., 2008b). (Gray IV) (counseling, HIV testing,Malawi)A program in Nigeria found that although free HIV testing is available in ANC, mostwomen refuse to test in ANC settings due to issues of confidentiality related to theirhusbands, along with lack of HIV treatment options. When VCT is offered in primaryhealth care posts for treatment of malaria in children, women who had not previouslytested for HIV were more likely to test (Olebara and Barrera, 2008). (Gray V) (HIVtesting, antenatal care, malaria, Nigeria)156 CHAPTER 6 HIV TESTING AND COUNSELING FOR WOMEN