Lifeline’s Voluntary Counselling and Testing (VCT) Programme is still in its infancy, but since it was initiated in August 2003, the results have been very encouraging.

We are funded by the Western Cape Department of Health, and we offer free Voluntary Counselling and Testing to all members of the 13 different provincial government departments. This programme is known as PEAP (Provincial Employee Assistance Programme).

People are under no obligation to have the test. What we do is go to the various departments and run a two-hour awareness session. After this, should people choose to be tested, they come to us for a further 30-minute, one–on-one pre-testing counselling session. Here we explore all the issues involved with testing, and make sure that people are ready to deal with the implications of being tested and finding out that they are HIV positive. Disclosure becomes a very important issue in these first counselling sessions. People who think they may be HIV positive have to be absolutely sure that this is the right time to be tested. For example, if someone is dealing with personal issues, (having discovered, say, that their partner has been unfaithful) they may not be strong enough emotionally to cope with the added stress of being tested. In situations like this, we suggest further counselling and refer them to agencies like FAMSA. They can return to be tested when they feel better equipped to do so.

The government requires that we provide monthly statistics, and obviously, for them, the more people who are tested the better. However, despite this need for statistics, we adhere strongly to LifeLine principles. The person is what is important here, not the fact that he or she will become a number in a monthly report.

Some departments have made attendance at the awareness session compulsory. This can lead to difficulties. People who have to come to the session can bring a great deal of negative energy with them. We have to break down the barriers of resentment and indignation before we can lead into the subject of testing, and why it is a good idea. It is far better to work with small groups of people who are there of their own accord. And, of course, when it is non-compulsory, there are positive side effects: people tell their colleagues about the process, their colleagues realise how beneficial it has been, and so we are often invited back to talk to another group from the same department.

My work as co-ordinator of this project is to filter through the requests we get for testing, to assess the feedback we receive, to organise dates and venues for the awareness sessions and the pre- and post-test counselling. Before I took this job, I worked as a LifeLine volunteer. I used to be a teacher, and when I left teaching in 1997, I wasn’t sure which direction I wanted to move in. One thing I learned about myself when I was a teacher was that I very interested in dealing with students in a counselling role, but I didn’t have the skills. I did the LifeLine Personal Growth course at the Bishop Lavis centre, and shortly after that I started to work for an NGO in an HIV related position. In 2001 I went to the LifeLine National Centre, where I worked on the AIDS Helpline for eight months. It was then that I was approached to co-ordinate this programme. I felt well equipped from the point of view of experience with HIV and AIDS related issues, but the thought of setting up a programme of this sort was daunting to say the least! I had to shift roles, move from being a counsellor to becoming a manager. Finding my feet, learning how to delegate, giving guidance, all of this was new to me, but I was helped by the great people I work with. My staff are passionate about the work we are doing, they are fully committed to the aims of the programme, and working side by side with such motivated people has made my job not only easier, but joyful and rewarding.

We speak carefully to the management of the various departments before we go in to see their staff. We want management to realise that the decision to be tested is not something that can be taken lightly. Just because society has become so used to the idea of HIV and AIDS, just because huge steps have been taken in the field of anti-retroviral (ARV) treatment, doesn’t negate the trauma of being tested for HIV - a trauma that has to be acknowledged.

Formerly, someone going for an HIV antibody test would have to wait a week before getting results. Now, thanks to the rapid testing techniques that have been developed, the person being tested can be told within the space of just over an hour whether or not he or she is HIV positive. We have a nursing sister on our team to administer these tests.

The first test we administer is known as the ABBOT test, a simple finger prick test, very similar to a pregnancy test. It takes about 20 minutes for lines to show up on the test paper. If only one line shows, the test is negative. Two lines indicate that antibodies are present in the blood. When this happens, we administer a second test, the EFOORA. Once again, this takes 20 minutes. Two lines means that the person is HIV positive. During the whole testing process, a counsellor is present; no-one has to wait alone to hear the results.

And so, in the space of an hour, your life can change.

The post-test counselling that takes place immediately after a positive result takes the form of containment counselling. People aren’t interested in hearing that ARV’s are available, or that being tested HIV positive is not a death sentence. They are fearful and worried, they are scared of the stigma attached to being tested HIV positive. They need to be allowed to express these fears. During this time we make sure that they can cope with simply leaving the room, that they have someone they can rely on for support, that they can deal with the news they have just received. Post-test containment counselling deals with immediate, critical issues.

Throughout this process, the person sees the same counsellor. Each counsellor is fully trained to deal with the issues connected to discovery, containment, the need to disclose and further referral.

We work in conjunction with CACTUS (City AIDS Counselling, Testing and Support), situated at 46 Church Street Cape Town. We have negotiated with them to use their facilities. We are at The CACTUS Centre every Monday and Tuesday, and on Wednesdays and Thursdays we do onsite testing. The great thing about working in conjunction with CACTUS is that, whereas we can only test government employees, CACTUS offers free, discreet and confidential counselling and testing to the general public. Thus, if a government employee tests positive, and a member of his family also wants to be tested, we can refer them to the CACTUS Centre.

Lifeline’s Voluntary Counselling and Testing programme doesn’t just focus on the test. We regard education as being as important a part of the process as the actual test. We aim, through all the aspects of the HIV and AIDS programme, to tackle the stigma, the prejudices attached to HIV and AIDS.

In our one-day HIV and AIDS workshops we discuss the legal and discriminatory issues connected to AIDS. As well as giving people basic information about HIV and AIDS, we incorporate elements of LifeLine’s Personal Growth training. The aim of this is to foster a change in mindset about HIV and AIDS We try to take people into the world of the HIV positive person – and we always have an HIV positive person on our team. Towards the end of the workshop, this team member talks to the group and discloses his or her status. This goes back to what I was saying about statistics. So many people think of HIV and AIDS as the numbers they read in the newspapers. They do not realise that there is a person behind each of those numbers, a person who is living with HIV. During one workshop, there was a woman who was very vocal. As far as she was concerned, all HIV positive people, all people with AIDS should be put somewhere else, away from “normal” people. When our team member disclosed, this woman was very moved. She came up and apologised, said that this disclosure had helped her to realise that the woman who had disclosed was no different to her – she was a mother, she had a job. It works so well, to show people, “Hey, they’re just like you or me.”

This has to be one of the most rewarding jobs in the world. To be able to go out and have people say, “You’ve changed the way I thought about HIV”, makes all the effort, all the criticism, all the heartbreak worthwhile.

LifeLine has been contacted by the prison services. They want us to look at setting up an onsite testing programme for them. The more awareness grows, the more we are receiving requests from companies to go in and run our workshops and set up testing for them. People are becoming more and more aware – but this awareness needs to reach further and further.

Of all the people we have tested so far, only a small number have tested positive. So, in addition to being able to offer support and information to those who are HIV positive, testing also offers peace of mind to those people who are worried that they may at some point have been exposed to the virus.

I’d like to know that people felt secure enough to access us, because they know what LifeLine offers. The government programme we are involved with is fantastic, but I’d like to see similar programmes in every sphere. Money is, as always, the stumbling block. I’d like to know that all organisations, from the biggest to the smallest, could afford to set up Voluntary Testing programmes. No matter who you are, where you work, what your salary is, whether you are unemployed or not, you should have access to this sort of service.

If you are interested in learning more about the LifeLine’s Voluntary Counselling and Testing programme, you can phone LifeLine Western Cape (021 – 4611113) or email me: lolita@LifeLinewc.org.za

*The names of some people in this story have been changed in keeping with LifeLine’s policy of confidentiality.