EXPANDING HIV TESTING AND COUNSELING INTO COMMUNITY SETTINGS
Ethical Challenges for Research-Related HIV Testing and Counseling: Community Perspectives
Celia Fisher, Ph.D.
This presentation draws on the voices of African-American, Hispanic, and non-Hispanic white male and female street drug users with and without a diagnosis of HIV to illustrate the ethical issues that arise in nontreatment drug abuse research involving HIV testing. As part of a National Institute on Drug Abuse-funded 3-year multisite project, content analysis from 11 focus groups identified the community misconceptions about HIV, personal fears and social consequences of learning oneís HIV status, and loss of privacy as deterrents to participation. Taking personal responsibility for oneís health, protecting loved ones, receiving education and counseling, and establishing a trusting relationship with an investigator emerged as participation incentives. The implications for policies encouraging the provision of HIV-risk-reduction counseling and testing for research participants are discussed.
HIV Testing and Counseling in Drug Abuse Treatment
James L. Sorensen, Ph.D.
Recently, HIV testing and counseling have undergone significant changes in technology (simplifying the collection of biological samples and reducing the lag between sampling and providing results to only 20 minutes) and in policy (emphasizing the public health benefits of testing). These changes are bringing a new set of ethical and practical challenges to the field. Although considerable research has documented the desirable impact of HIV testing and counseling on sexual risk behavior, the impact on drug use risk behaviors is less well understood. Among the Nationís drug abuse treatment programs there is considerable variation in the practices related to HIV testing and counseling. In some settings these practices are routine; in others, they are not available and are seldom used as referral options. The National Institute on Drug Abuse Clinical Trials Network is developing a protocol to study the impact of providing rapid HIV testing and counseling in drug abuse treatment programs. The study will examine the impact of providing rapid HIV testing onsite and the impact of providing enhanced counseling to patients. There is an urgent need for a greater understanding of HIV testing and counseling in the context of substance abuse treatment settings.
Voluntary Counseling and Testing: An International, Randomized Community Trial
David D. Celentano, Sc.D., M.H.S.
National Institute of Mental Health (NIMH) Project Accept is an HIV prevention trial in which 34 communities in Africa (South Africa, Tanzania, and Zimbabwe) and 14 communities in Thailand are being randomized to receive either a community-based HIV voluntary counseling and testing (CBVCT) intervention plus standard clinic-based VCT (SVCT) or SVCT alone. The CBVCT intervention has three major strategies: (1) to make VCT more available in community settings, (2) to engage the community through outreach, and (3) to provide posttest support. These strategies are designed to change community norms and to reduce the risk for HIV infection among all community members, irrespective of whether they participated directly in the intervention.
A community-level intervention based on modifying community norms can change the environmental context in which people make decisions about HIV risk and has the potential to alter the course of the HIV epidemic in developing countries. This is the first international, randomized, controlled Phase III trial to determine the efficacy of a behavioral/social science intervention with an HIV incidence end point.
NIMH Project Accept is funded as an NIMH Cooperative Agreement involving NIMH and several U.S. and international institutions. The HIV Prevention Trials Network (HPTN) is also providing support to the project [HPTN 043]; support has also been provided by the Office of AIDS Research, National Institutes of Health.