Ethical considerations and importance of training
Clients should receive adequate information enabling them to make a personal and voluntary decision whether to decline one or all of the proposed tests without coercion.
The provider must ensure that the decision-making ability of the person who uses drugs is not impaired by intoxication before they discuss and decide on testing for HIV and other infections. Clients should receive adequate information enabling them to make a personal and voluntary decision whether to decline one or all of the proposed tests without coercion.
Confidentiality must be strongly enforced with regard to test results and information obtained during counselling and testing. In addition, when providing HIV counselling and testing to socially marginalized groups such as people who use drugs, it is fundamental that testing will not result in any harm or negative effects to the tested person. The clients should be aware of the legal regulations related to HIV disclosure in respective countries and the potential risks of knowing his own HIV status (e.g.: as discrimination, abandonment or violence). In some countries, for example, it is still mandatory to disclose the HIV status to health care workers in case that the contact with blood is required (like in dentistry, surgery, etc.), otherwise the person can be prosecuted under the criminal code. And, the disclosure of HIV status very often results in denying the services to the person.
THE IMPORTANCE OF APPROPRIATE TRAINING OF STAFF ON TESTING COUNSELLING
Counsellors play a critical role in any VTC services, since they are the key to effective intervention. Competencies and skills are the basis upon which trainers should be evaluated and selected. When talking about VTC on HIV and HCV among people who use drugs, these competencies must include a thorough knowledge and understanding of infections, pre- and post- counseling, testing methodologies (including the methodology of the outreach approach and recruitment of clients, as well as follow-up and referral to health care services), and also of drug use and harm reduction programs for PWUD.
These topics cannot be properly treated if the counsellors do not have a long working experience in the field of drug use and harm reduction and are not properly trained.
The counsellor should be:
- empathetic (see the problem as the client sees it while remaining objective);
- non-judgmental and culturally sensitive (respect the client’s cultural and belief systems); and
- able to listen.