social context of disclosing hiv test results: hiv testing in tanzania

6.1 Introduction
6. COUNSELLING AND HIV TESTING
HIV counselling should ideally be a confidential dialogue between a client and a
counsellor to enable the client to cope with stress and make informed decisions related to
HIV infection and disclosure. The provision of HIV/AIDS-related counselling services in
Tanzania started in 1988, only five years after the first three AIDS cases were identified.
HIV counselling usually includes two counselling sessions: a pre- and a posttest session.
Although some VCT centres offer group and/or couple counselling, most counselling
sessions are individual. All respondents confirmed that they had attended both pre- and
posttest counselling sessions.
Pretest counselling sessions are intended to ensure that any decision to take the
test is fully informed and based on an understanding of the personal, medical, legal, and
social implications of a positive result. Pretest counselling prepares the client for the test
and posttest counselling is supposed to prepare the client to receive and cope with the test
results. According to Tanzania’s MOHSW, because AIDS and HIV infection are
associated with profound psychosocial impact to the individual, family, and community,
both pre- and post-test counselling are supposed to be done by a trained counsellor.
6.2 The Process of Counselling and Testing
Because most of the first interviews with the respondents who had just taken an
HIV test took place either at the counselling and testing facility or in another private
place near the VCT facility, we had an opportunity to see the layout and design of the
VCT facilities to accommodate the processes of counselling and testing. The counselling
procedures that we noticed were three types: individual counselling, counselling for
couples, and occasionally group counselling. Group counselling was done only during the
pretest phase of counselling. We were told by counsellors that sometimes they were
forced to conduct group counselling because the clients were too many for their staff to
manage. For sexual partners who came to the facility (boyfriend and girlfriend or married
couples), the counsellors normally asked them whether they were real sexual partners and
whether they would like to be counselled together or separately. They also asked them if
they wanted to receive their test results together or separately.
6.2.1 How Counselling and Testing Took Place in the Study Sites
When clients arrive at the VCT centre, they go directly to reception where they
are directed to a counsellor. In practice each counsellor occupies one room that has a door
that can be closed. Pretest counselling seeks to encourage people to be tested as well as
make them aware that there are two possible results, positive and negative. If the client
agrees to be tested, the counsellor completes the consent forms and takes the client to the
laboratory where blood is drawn for testing. If the procedure of testing uses rapid testing
kits, clients are usually brought back to the reception where they wait a while for the
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