title: Voluntary counselling and testing for HIV in a Zambian mining community: serial interviews with people testing negative.
abstract: OBJECTIVE
  To understand the influence of voluntary counselling and testing (VCT) and an HIV-negative result on subsequent sexual behaviour; and to identify the specific felt needs of those testing negative.
  
  
  METHODS
  Serial interviews, 6&emsp14;months apart, with people who had tested negative, and three one-off focus group discussions with counsellors. Interviews were transcribed verbatim and analysed thematically. Paired transcripts were analysed longitudinally.
  
  
  METHODS
  Purposively sampled from first attenders for VCT who had tested negative.
  
  
  METHODS
  Four health-facility affiliated VCT centres in two mining towns in the Copperbelt Province of Zambia.
  
  
  RESULTS
  Participants in the 42 initial and 31 follow-up interviews understood VCT as 'testing for HIV'. Most participants reported having adopted safer sexual behaviour months before attending VCT. They had already recognised personal susceptibility to HIV infection and reported engaging both emotionally and cognitively with the issues of testing. Ultimately attendance at testing was to know their status in order to regain control of their lives. Unmet post-test support needs were common and included additional information, supportive networks, life-skills training and access to recreational activities.
  
  
  CONCLUSIONS
  In this population who tested HIV negative the majority said they had made life changes months before attending VCT. Counselling served to consolidate pre-test decisions about risk behaviour. Those testing HIV negative are underserved compared with those testing positive. We recommend that counselling for HIV should be de-linked from testing to encourage earlier attendance for counselling and that clients testing negative should receive more post-test support to help them remain HIV negative.
authors.affiliation: Konkola Copper Mines, Medical Department, Community Medicine Section, Chingola, Zambia.
authors.forename: Janet
authors.initials: J
authors.lastname: Sikasote
authors.forename: Liz
authors.initials: L
authors.lastname: Grant
authors.forename: David J
authors.initials: DJ
authors.lastname: Chinn
authors.forename: Mubiana
authors.initials: M
authors.lastname: Macwang'i
authors.forename: Scott A
authors.initials: SA
authors.lastname: Murray
mesh_terms: D000328:Adult; D001294:Attitude to Health; D017280:Condoms / Q000706:statistics & numerical data; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000523:psychology; D018023:HIV Seronegativity; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D008906:Mining; D010342:Patient Acceptance of Health Care; D012725:Sexual Behavior; D047568:Unsafe Sex; D035141:Voluntary Programs; D055815:Young Adult; D015024:Zambia