Report on the Global HIV/AIDS epidemic

Opening new doors with counselling and testing

over the past decade. Thousands of HIV-positive and HIV-negative people tested at
the Centre have joined the Post Test Club, which not only offers its members health
care and other services, but sends them into the community to spread information
about HIV prevention. Between 1992 and 1998, Club members, trained during fourday courses to become peer educators, have reached 180 000 people and distributed 1.2 million condoms. Individuals like these combat the invisibility of the epidemic by giving it a human face.
Unfortunately, HIV testing facilities in the developing world are still far from adequate. In many places, especially in rural areas, it is simply not possible to get a test.
In others, the quality of the counselling is poor. Often, clients have reason to fear that
their results will not be kept confidential. People may be tested for HIV without their
knowledge or against their will, and employers or family members may be told of a
person's HIV status - all flagrant violations of human rights. Testing without prior
counselling is especially common in medical facilities; doctors sometimes choose
not to inform infected patients that they have HIV for fear of depressing them.
Perhaps surprisingly, the middle class and the wealthy may be especially poorly
served. One thorough inventory of HIV counselling, testing, care and support services in the Kenyan capital of Nairobi found that slums and low-income areas were
relatively well provided with HIV support services. Almost all of these services are
donor-funded and are run by nongovernmental and community organizations. No
such services exist for the better-off.
Even where testing and counselling services of reasonable quality are available, the
stigma may be so strong that people choose not to know their infection status -
which is their right. Improving the quality and availability of testing services must
therefore go hand in hand with efforts to diminish the fear and rejection of peoplewisctu
with AIDS, and with the establishment of policies and practices to ensure confiden- ' 7
tiality of HIV test results and related information. Countries in the developed and
developing world have had some success in combating the stigma of AIDS through
public campaigns urging solidarity with HIV-affected persons and through public
statements by respected leaders.
The challenge of prevention for couples
Voluntary counselling and testing can help prevent HIV transmission in long-term
relationships when other prevention options - abstinence, fidelity and condom use /
- may be problematic.
Few if any individuals in a stable partnership are willing to abstain permanently from /
sexual intercourse. Not many will remain satisfied with a lifetime of sex that does not / 4',
involve penetration. As for fidelity, people can be sure of their own behaviour but
many have doubts about whether their partner is always faithful. In any case, fidelity

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