Despite wide acceptance of Voluntary Counselling and Testing (VCT) as a crucial entry point for the prevention, treatment, care and support of HIV-infected persons; the prevalence of testing in Ethiopia remains very low. A review of the literature identifies the set of factors that influence HIV testing of individuals to include socio-economic and demographic factors, knowledge of HIV/AIDS, risk perception, fear of stigma, social capital and the perceived benefit of VCT. By drawing assumptions based on the known literature, this mini-thesis explores the relationship between VCT usage and the above factors in order to explain the status of HIV testing in Moher and Aklil district, Gurage Zone, Ethiopia. The study hopes to address the dearth of material on VCT and contribute to it in a non-clinical and rural context.

Specific Aims: The objective of this research was to evaluate a home-based HIV counseling and testing (HBVCT) pilot implemented in three Ethiopian sites during the first six month of implementation (January 1, 2011 to June 30, 2011). This study sought to document the experiences and challenges from the community voluntary counseling and testing (VCT) counselors providing the HBVCT service as well as specific challenges and barriers faced by ever-married community members. Setting: The pilot HBVCT program was implemented in eight sites in four regions of Ethiopia. The three sites in the Amhara Region were selected for this study. These sites (and rural kebeles) are Bahir Dar (Tis Abay, Andasa), Dessie (Addis Mender, Habru 01), and Gondar (Loza Mariam, Tekele Hymenot). These sites were selected because they are in the Amhara National Regional State. Methods: Secondary counseling and testing reports were collected from each site to analyze the clients' demographic information and testing results. In-depth interviews were conducted with the community VCT counselors and the senior VCT counselors in all three sites. Male and female focus group discussions were held in each community for ever-married men and women age 18 to 59 years old. Counselors were asked about the challenges of providing home-based services and their experience during the first six months of implementation. The focus group participants were asked about the community's perception of the HBVCT program, benefits, and barriers to acceptance. Results: 6,757 clients were tested in the Amhara Region during the first six months of implementation. In all sites, 59.26 percent of clients were female, the age of clients ranged from less than one year to over 99 years of age, 45.37 percent were illiterate, and 79.38 percent reported never before being tested. The qualitative interview and focus group data revealed three major themes: acceptance, challenges and barriers to testing, and benefits of HBVCT. Acceptance included both the general acceptance of the service and the acceptance of the locally selected VCT counselors. Challenges faced by clients were primarily related to understanding and fear of stigma or discrimination. Challenges faced by the counselors were mostly regarding the logistical challenges of providing home-to-home service and the technical challenges of providing counseling service. Benefits of the home-based service included reduction of traditional barriers to counseling and testing and normalization of VCT, making it easier and more socially acceptable to receive testing. Conclusions: HBVCT may provide an important avenue for testing Ethiopia's rural population. In this pilot, 79.38 percent of the Amhara clients had never before been tested for HIV, higher than other reported findings highlighting the need for an alternate testing model (1). Through this study, the HBVCT model was found to be accepted by community members in the three Amhara sites. In addition, community members were comfortable and reported a sense of increased confidentiality when receiving VCT services in their homes, even with a local community VCT counselor. Acceptability and normalization of counseling and testing were strengthened by community-based HIV and VCT education or promotion activities. This occurred by reducing some challenges faced by the HBVCT counselors as well as increasing acceptability among the community. The logistics and discussion of HIV counseling and testing remains a barrier for couples. However, HBVCT can act as a catalyst for couples to discuss and receive testing, especially for couples with low levels of education and for those who reside in rural communities. As the only qualitative and quantitative evaluation of a HBVCT program in Ethiopia, further research is needed to better understand the cost and prevention benefits of home-based service.

In Kazakhstan, the HIV epidemic is largely confined to the injection drug user (IDU) population. Cultural stigma and discrimination discourage this population from seeking information on HIV testing, treatment, and prevention. The present study was designed to assess perceived barriers to seeking and accessing voluntary counseling and testing (VCT) and to examine factors that could account for those barriers. Participants were selected by a respondent driven sampling technique and were administered a standardized, face-to-face survey. The final sample included 1,071 IDU in Kazakhstan in 2006. Within the sample population, the mean age was 32.4 years (SD= 7.618), 80.4% were male, and 70.1% had reported being previously tested for HIV. A logistic regression model was developed to determine the influence of twelve common perceived barriers to HIV testing behavior. Three distinct barriers including fear of a positive result, the perception of more immediate problems, and inconvenient testing center hours predicted testing behavior. This analysis hopes to contribute to the development of HIV preventive approaches that may aid in creating effective programming and outreach efforts within the IDU population in Central Asia.