Abstract
Sir: Since the first AIDS case in China was reported in 1985, the HIV/AIDS epidemic has entered a widespread phase. 1 In 2005, it was estimated that 650,000 people were living with HIV in China, including about 75,000 AIDS patients. 2 Till now there has been neither any vaccine to prevent AIDS nor any treatment to cure AIDS.
HIV voluntary counselling and testing (VCT) is a cost-effective method of reducing high-risk sexual behaviour and preventing HIV transmission. 3 In 2004, HIV VCT was initiated in Hangzhou, which is located in southeastern China and has a population of 6.2 million, 0.8 million of whom are migrants, 4 but little is known about the state of play. The survey was conducted to investigate the attendees' requirements for HIV VCT in Hangzhou, who were recruited at the Center for HIV VCT in Hangzhou. Giving informed consent, attendees were then asked to complete a questionnaire.
From July 2005 to July 2006, a total of 450 attendees were enrolled in the study. More than half of the attendees were men (72.2%). The average age was 32.5 years (ranging from 17 to 70 years). Overall, 69.3% of attendees reported gaining initial information about HIV/AIDS from the Internet and 73.8% of them were not satisfied with the information they obtained. According to the requirements for HIV VCT, 68.6% thought their confidentiality was not respected enough; 85.8% requested to be informed of their HIV test result in one working day; 81.6% preferred to seek HIV counselling at night.
In China, it is estimated that a great proportion of people with HIV/AIDS are not aware of their status. 5 Therefore, access to HIV VCT is a key for successfully implementing antiretroviral therapy and avoiding re-infection and transmission by behavioural changes. 6 There were 4293 VCT sites at the end of October 2007 in China and millions of attendees received VCT services every year. 7
According to the results of our survey, HIV VCT is far from satisfactory and leaves much room for improvement. First, with the popularization of the Internet, more and more Chinese prefer to look for information on the network. 8 However, our attendees were often frustrated because sometimes different websites offered different answers to the same question. So our government will need to invest resources into building and maintaining more professional websites to provide consistent, authoritative knowledge about HIV/AIDS. 9 Second, to ensure confidentiality for attendees, we should supply a private room for HIV VCT and make sure that we have implemented appropriate measures to safeguard the attendees' confidential information. Also we should provide clients with the option of anonymous HIV testing. The third is to shorten the time for the HIV test result as much as we can. As is well known, rapid HIV testing can also improve medical care at the time of initial diagnosis. 10 Unfortunately, medical resources remain limited in China, which can lead to blood samples being kept for a number of days so as to be tested together. To change the present situation, we should devote more energy to providing HIV counselling, testing and referral services. In this way, unnecessary delays can be eliminated and test results can be obtained more easily. 11 Last but not least, the available hours for HIV VCT were inconvenient for many attendees because they had to work in the daytime. In light of the specific conditions, we should understand the urgent need for night counselling. Several limitations to this study must be noted. First, the attendees of our survey were clients from one clinic for HIV VCT, which may potentially introduce sample selection bias. Second, the study did not evaluate the cost-effectiveness of HIV VCT. Third, some important information such as the level of HIV knowledge and attitude toward HIV were not collected in our survey. All the topics should be addressed in future research.