Counseling services in four West African countries: Benin Burkina Faso Guinea and Mali August 20 - September 3 1993. AIDSCAP.

An evaluation of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) counseling activities in four West African countries--Benin Guinea Mali and Burkina Faso--revealed that counseling has not been integrated into HIV testing or patient care. Guinea is the only country to have developed HIV counseling guidelines and standards. In many cases patients are given seropositive results with no further contact with the health care system. Although physicians tend to believe they alone possess the skills essential for counseling they are too overburdened or unprepared to provide this service. Representatives from the four countries participated in an AIDSCOM seminar on counseling held in Abidjan in 1989; however the impact of this effort was undermined by reassignment of personnel and (except for Guinea) lack of a national commitment to counseling. Recommended is the development of protocols that define the content and approaches of pre- and post-HIV test counseling and follow-up suggest appropriate responses to specific types of situations and individuals set forth the roles and skills necessary for counseling personnel and identify ways counseling personnel can support each other. Policies concerning the interrelationships of patient confidentiality partner notification and protection of public health need clarification. Finally nongovernmental organizations religious and political leaders and traditional practitioners should be enlisted in a campaign to extend psychosocial support of HIV-infected persons to the community. Technical assistance by USAID and other donors may be required to facilitate the organization of HIV/AIDS counseling services on a national level.