On 1 April 2010, a massive government campaign in the fight against HIV was launched. The revamping of the National Strategic Plan on AIDS and STIs (2007-2011) was developed by various stakeholders, including government, civil society and private sector, to reach 80 percent of those needing antiretroviral drugs (ARVs) by 2011 and contribute to a 50 percent reduction in HIV infections within the same timeframe. With these high reaching objectives, it is important to question the continued high HIV infection rates and persistent risky behaviour of our future generation – the South African youth.

16 months down the line and working for a HIV Counselling and Testing (HCT) service provider in the Cape Town metropole and in schools, what has been the impact of the campaign in preventing the spread of the HI-virus?

The HCT campaign (HIV Counselling and Testing) has focused on healthcare providers taking the prerogative to engage clients to get tested when visiting their local healthcare facility.  According to HCT protocol, the healthcare worker should explain and reinforce the importance of knowing one’s status through habitual testing for HIV. This ideology emphasises the need for individuals to seek a long, productive and healthy life. We know from experience that one encounter with a counsellor does not have the power to change a person’s behaviour completely. However, a conversation around behaviour and an engagement with a person is undoubtedly valuable in facilitating a mindset change which may affect future actions.

What we need to ask is whether or not health seeking behaviours are inherent in us, or are they created through awareness and behavioural change methodologies? Do we need to teach healthy ways of living in a personalised, individually-related way in order for people to adopt them?  If so, is HCT providing this in its methodology?

Looking at the epidemiology of a variety of illnesses offers some sort of semblance to the way in which people choose health-related behaviours. Smoking is incredibly harmful to one’s health. Although, it has proven to cause cancers, affects blood pressure, results in fertility problems and heart disease, people continue to smoke. Another example is that of unhealthy eating habits. Saturated fats, sugars and processed carbohydrates have a direct link to high cholesterol resulting in diabetes, irritable bowel syndrome and obesity. Yet obesity is a worldwide affliction, knowing the dangers is not enough. Similarly, knowing that unsafe sex can lead to HIV infection is not enough. What we need to assess is every individual client’s risk to infection; their behavioural patterns, their support network, their risk reduction strategies, their dreams and aspirations for their future.

An HCT protocol, where high infection rates are such an issue, needs to be based on a client-centred approach, with an awareness of the Health Belief Model. If a person feels that behaviour has the potential to have a negative impact on their life, if there is a positive expectation to modified behaviour and there is a belief that one can take control of his/her health through action, then behavioural change can occur. Our lay counsellors working in prevention need to be trained in order to work through a client’s perceived susceptibility, perceived severity, perceived benefits and barriers.

While knowing one’s status is valuable, making the connection between status and choices is pre-emptive in making decisions about the risk factors involved in behaviour choices as well as living your life to the best of your ability through healthy life choices.

The current debate in schools centres on the possible mandate given by the Department of Basic Education to prevent HCT happening in schools during contact learning hours. This means that the learners will only be able to take part in HCT during break times and after school. This gives very little time to provide in-depth and quality HCT protocol to these learners. The concern here lies in whether or not the shortened protocol will in fact question and challenge risky behaviours in HIV-negative youth, and reducing infection in already HIV-positive youth.

The question at hand is whether or not the HCT protocol has the potential to challenge the youth, in addition, will prevention stand a chance by reducing contact time with learners?

As it has been communicated at a national level, the need for a revitalisation of primary health care is imperative. Working towards HCT as an integrated and comprehensive health programme in schools is a good idea. Life skills, peer education, HCT and career guidance are all part of a set of services in which learners are exposed to the possibilities for growth and achievement. What we need to be unpacking is why HCT is currently so focused on targets, targets and more targets. Why is quantity high on the agenda and quality so low? Are the clients’ best interests at heart – the learners, adults, children, sex workers, teachers or the doctors?

What has been reinforced in my experiences at a grassroots level over the past few weeks is that viewing a process at a micro level is far more conducive to making solid, grounded choices that function at a preventative level rather than a huge campaign rolled out.

Testing as a prevention method is undoubtedly not enough, but assessing a client’s risk, how they feel, and making them aware of their need to change behaviours and norms is the way forward. A service that provides information, that creates relationships with individuals and also works with clients, discovers different ways of behaving in order to work towards a full and exciting future.

– Elizabeth Hobbs is Voluntary Counselling and Testing Coordinator in Cape Town.