HIV, AIDS and STI Prevention:
Voluntary Counseling and Testing Centers in Romania
Adriana was a young college student majoring in psychology and working at a voluntary counseling and testing (VCT) center run by the Romanian Association Against AIDS (ARAS), a partner of the Romanian Family Health Initiative (RFHI). While, like any other college student, Adriana had concerns about upcoming exams and ongoing relationships, her experience as a VCT counselor set her apart.
Adriana first came to ARAS in high school, when she trained as a volunteer peer educator. She was later hired as a volunteer coordinator, a position she held for six months before she began training to become a counselor. Adriana beamed as she described her mentorship with the center manager, who provided professional guidance and advice on balancing the pressures of counseling and personal life. Adriana also received ongoing training from the other counselors, who shared their client experiences with her. That accessibility on the part of the counselors was especially important, Adriana said, because of the emotional weight of the work.
According to the 1999 Reproductive Health Survey, more than 99% of Romanians had knowledge about AIDS, but less than 10% had been tested for HIV. Even fewer had ever received HIV counseling. These statistics were especially alarming, given that out of the sexually active population, only 10% of women and 22% of men reported condom use. Meanwhile, the rate of HIV infection in Romania was increasing among sexually active adults.
The Romanian Family Health Initiative's partner, ARAS, pioneered the delivery of voluntary counseling and testing in Romania. They based their centers on established models, such as those of the World Health Organization, United Nations Population Fund, and the United States Centers for Disease Control and Prevention. RFHI developed standards, protocols and guidelines for VCT services that took into consideration the Romanian health care system while placing client needs first. More than 500 healthcare professionals received VCT training, and three centers in the urban areas of Bucharest, Constan?a and Ia?i, where populations were most at risk for transmitting and becoming infected with HIV, were opened.
The model for the VCT centers was a learning model that was continuously being improved. As the centers developed, the referral system was streamlined and expanded to meet client demands. Part of the referral system's strength was attributable to the closer relationships that were established between RFHI/ARAS and the organizations that provided related social services, which made it possible to increase the number of referral services offered to clients.
A strong emphasis was placed on the value of pre– and post–testing HIV counseling in addition to testing itself, so that clients would understand their risks. At the centers, which were housed within county public health directorates, clients met first with a counselor like Adriana to undergo risk assessments before seeing a nurse for testing. Counselors scheduled follow–up visits for additional counseling about test results.
RFHI provided more than 12,000 clients with free and confidential HIV counseling and testing at its three VCT centers. During her time as a counselor, Adriana saw the client questionnaire expand and become a thorough risk assessment. She herself learned to improve the manner in which she spoke to clients about risk reduction and how they in turn could talk to partners about risky behavior. "Adults need to understand to use condoms, and that there is no shame in buying or talking about condoms. It is also important that they understand that their health is their responsibility," Adriana said.
Adriana's work at the center made her keenly aware of the needs of her clients and community. When Adriana asked what she would want others to learn from her she said, "As a counselor, it is very important to instill confidence in (one's) clients and have them feel respected."
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