Quality of HIV counselling in South Africa

HIV counselling and testing (HCT) has become increasingly available in South Africa since the 1990s. Over 4500 public health facilities offer client and provider-initiated HIV counselling and testing. Counselling and testing remain key components of HIV/AIDS prevention as they provide an entry point into prevention, care, treatment and support services. This paper examines the quality of HIV counselling in government and Nongovernmental (NGO) facilities and reviews adherence to the HCT policy guidelines during counselling sessions in 67 HIV counselling and testing (HCT) sites across 8 South African provinces. The assessment used both quantitative and qualitative methods. In total 149 structured observations of counselling sessions were conducted using a written checklist and audio recording. This assessment confirms that while counselling does occur prior and post HIV testing, the quality of counselling differs between sites and does not match the South African HCT policy guidelines. The following key aspects were not adequately discussed with clients: risk assessment and reduction, partner involvement, supportive care and treatment for those testing HIV positive. Confidentiality was also compromised by frequent interruptions during some sessions. The assessment indicated that ongoing training and mentoring of counsellors needs to be addressed, to make the HCT programme more effective.