As the World Health Organization abandons the time-tested and rights-respecting method of VCT to adopt untested and rights-abusing routine testing and counselling, it is good to see that some in Myanmar / Burma are thinking about how to make VCT work.

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Integrating voluntary counseling and testing (VCT) into existing sexual and reproductive health clinics in Cambodia, Myanmar and Viet Nam
TUPE0599

C. Om1, D. Shaw1, T. Ros1, K.T. Tar2, N.B. Hang31Marie Stopes Cambodia, Phnom Penh, Cambodia, 2Marie Stopes International Myanmar, Yangon, Myanmar, 3Marie Stopes International Vietnam, Hanoi, Viet Nam

Issues: The demand for VCT services in Cambodia, Myanmar and Viet Nam is high. While coverage is increasing, many people cannot access services, with stigma and discrimination being significant barriers, especially in Myanmar and Viet Nam.

Description: Marie Stopes International (MSI) clinics in the three countries provide comprehensive sexual and reproductive health (SRH) services to women (90% of clients) and men, including vulnerable groups. In 2005, family planning, STI management, antenatal care and abortion complication services were provided to 16,753 clients in Cambodia, 122,415 in Myanmar and 37,460 in Vietnam. A clinic client survey (2006) showed a strong demand for VCT services, with 78.3% of clients in Cambodia, 48.5% in Myanmar and 42.4% in Viet Nam wanting a HIV test, with the MSI clinic being the preferred service provider. A survey of community youth (2006) found a similar strong demand for HIV testing in Cambodia (88.3%), in Myanmar (72.8%) and in Viet Nam (32.8%). A model which integrates VCT services into existing SRH settings is effective and can reach vulnerable groups (STI clients, pregnant women and youth), as well as contributing to reducing stigma and discrimination.

Lessons learned: A "one-stop-service" where women and men can receive a range of SRH services can increase access to VCT. Access and uptake are also increased for female factory workers and housewives where clinic hours are extended into evenings and weekends.

Recommendations: A VCT service integrated into an existing SRH setting needs innovative approaches to promote the services to current and potential clients, including male partners and couples. This model also needs an established quality assurance process for counseling and testing and a responsive monitoring and evaluation system.

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Sustainable voluntary counseling and testing (VCT) services in Cambodia, Myanmar and Viet Nam: who is willing to pay?
THPE0334

C. Om, D. Shaw, T. Roes, K.T. Tar, K.M. Wai, N.B. Hang, N.D. AnhMarie Stopes Cambodia, Phnom Penh, Cambodia

Issues: Free VCT services cannot be sustained long term. Can user fees contribute to sustainability? Description: VCT is an entry point for HIV prevention, care and support services. VCT services are usually provided free in Cambodia, Myanmar and Viet Nam, through external donor support which is not sustainable. Marie Stopes International (MSI) seeks to provide comprehensive, sustainable and quality sexual and reproductive health services (SRH) through user fees. Baseline surveys were conducted to assess the willingness to pay for HIV testing of important target groups. Of MSI clients wanting a HIV test, 93.7% in Cambodia, 75% in Myanmar and 71.2% in Viet Nam are willing to pay for testing. Most clients in the three countries prefer a fee of $US2 or less. Among a community and factory worker youth sample in Cambodia, 53.3% were willing to pay for a HIV test (72.2% for female factory workers). Among a similar sample in Viet Nam, 68.7% of youth were willing to pay (92.9% for factory workers), while in Myanmar, 84% of youth were willing to pay. However, in Cambodia, sex workers felt strongly that HIV testing should be free for sex workers. Lessons learned: With a strong demand for VCT services, most SRH clinic clients are willing to pay for HIV testing. This cost recovery complements donor funds and contributes to sustainability and improved service quality. Fees from those willing to pay can provide free or subsidized services to target groups such as sex workers and youth for whom fees present a barrier to service access.

Recommendations: Fees for HIV testing need to balance concerns about sustainability with increasing access to services for vulnerable population groups. Promotion of VCT services through outreach and SRH clinics should promote the benefits of testing and provide a transparent and equitable fee structure