3.6 CBVCT practices The main principles for CBVCT’s practices are not very different from those identified by most health policies in particular those drawn up by the World Health Organization. According to what was said before, CBVCT should take some general factors into consideration before launching the service As regards the environment (in public spaces or venues like bathhouses, events, parties or the CBVCT office, it is very important to offer people a safe, quiet and warm place, which encourages confidentiality and fosters the expression of feelings (positive and/or negative. It is important to have enough time for the counselling, testing process and linkage to care not being in a hurry. Finally, some basic conditions have to be met before performing a test asepsis and hygiene, temperature, sufficient lighting to read the results, infectious waste management risk. CBVCT should clearly determine the referral process for those receiving a positive result confirmatory test, linkage to health department HIV or STI specialist etc. To establish how those being tested will be supported while they are waiting for the result. To establish algorithms of actuation for every situation (window periods, negative results, candidates for pre and post-exposure prophylaxis
37 Consider the legal aspects in every country for carrying out the test (for example what kind of tests are possible to use, which personnel are authorized to perform the test, etc, for offering other health services (medication, vaccines) and for facilitating access to health services (free or not free access, social security coverage, …) To stimulate the work between peers and among communities Initial and continuous training on issues like HIV, sexual health, harm reduction and counselling for staff. Identification of the users in the centers where anonymity is guaranteed and how data collection is organized. Information on those factors (and others that maybe relevant for CBVCT) should be collected in a quality assurance program (see following chapter. Attending a CBVCT centre is a voluntary act. Those attending should get adequate information and specific support appropriate to each one’s choices (sexual practices, their willingness or otherwise to adhere to harm reduction programmes, life and health priorities. Creating a supportive environment (confidential and safe) between clients and providers is necessary. With this aim, the WHO policy framework Scaling up HIV testing and counselling in the WHO European Region highlights five principles of HIV testing (the five Cs”) 26 : Counselling and information about HIV/AIDS before and after the test Consent to be tested given in an informed, specific and voluntary way by the person being tested Confidentiality regarding test results and the fact of seeking a test Correct test results. Testing must be performed and quality assurance measures followed according to internationally-recognized testing strategies, norms, and standards based on the type of epidemic. Results must be communicated to the person tested unless that person refuses the results. Connection/linkage to prevention, care, and treatment 26 World AIDS Day 2012: Statement on HIV testing and counselling. http://www.who.int/hiv/events/2012/world_aids_day/hiv_testing_counselling/en/index.html
38 These five principles are present throughout the process before, during and after the test as in the next figure.