Strategies that relate to provision of services:
Ken Kobre, UNAIDS
The correct and consistent use of condoms will substantially reduce the risk of STIs, including HIV.
• Condoms (male and female) should be available in health centers and also in bars, the market area, food distribution centers and other areas where men, women and youth are likely to gather.
• Simple illustrated instruction leaflets should be available where condoms are distributed and condoms should be available wherever there are posters or leaflets regarding safe sex and HIV/AIDS.
• Base estimates for condom requirements should be on an average of 12 male condoms per sexually active male per month and 6 female condoms per sexually active female per month.19
STI prevention and management
STIs increase one’s risk of becoming infected and of passing on HIV for both men and women. Therefore, it is essential to establish and integrate STI services and condom distribution into general health services as soon as possible. Define a management protocol for STIs consistent with national protocols that includes:
• early and effective case finding, case management, partner notification and treatment;
• preventive voluntary counseling and testing if available;
• qualified staff trained in STI protocols;
• user-friendly confidential services with special consideration to meet the needs of women and adolescents;
• a consistent supply of the appropriate medicines and condoms;
• a functioning health information system to examine trends, as well as gender and age distribution of disease;
• program monitoring for the quality of STI case management;
• STI screening in antenatal programs; and
• all staff, including volunteer workers, trained in STI prevention and taught to utilize information materials, such as brochures, and to distribute condoms.
Voluntary Counseling and Testing (VCT) for HIV
VCT can be a useful tool in promoting behavior change among refugees who test positive or negative for HIV, and it can act as an entry point to health care and other support mechanisms for those who test positive. Good counseling combined with testing assists people to make informed decisions and cope better with their health condition. Establish VCT for HIV in a refugee setting only if:
• VCT is available in the host country or country of origin to ensure that interventions are in line with national programs;
• Informed consent, pre- and post-test counseling, and confidentiality can be assured (see box);
• A confirmatory testing strategy is in place, as outlined in UNAIDS Policy on HIV Testing and Counseling;20
• Counseling, services and support are available for those found to be HIV-positive; and
• Sufficient resources are available to train counselors and supply test kits.
Consent and Counseling
Informed consent requires an understanding of the implications of a positive test result and the voluntary decision to be tested. Pre-test counseling should include the individual’s personal history and possible exposure to HIV, as well as his/her understanding of the modes of HIV transmission. During post-test counseling, when the test result is positive, the person should be advised as gently as possible with emotional support and a discussion about available care and social services. If the HIV test is negative, then the person must be advised about the “window period” of three to six months when a negative result may be false. This counseling session is an important opportunity to discuss methods of HIV transmission and prevention.