HIV Counselling and Testing in Nova Scotia: The Provincial Strategy in the Context of an International Debate (Commentary) (Report)

HIV counselling and testing policies and practices in Canada are at a crossroads. For example, the Public Health Agency of Canada (PHAC) is currently revising the Canadian Medical Association (CMA) guidelines for HIV Testing from the mid-90s and developing a new HIV counselling and testing policy framework for all Canadians. (1) It is not surprising these revisions are occurring at a time when an international debate about the importance of voluntary HIV testing and counselling procedures is ongoing. (2-7) A major driver of this debate is the fact that many individuals are unaware of their infection or receive late diagnoses, both of which may result in forward transmission and poorer health outcomes. (8,9) This is a pivotal time to consider how national HIV counselling and testing developments and strategies may influence the HIV testing experiences of people living in smaller provinces, such as Nova Scotia. Nova Scotia, as a small province with unique cultures and communities, provides health care professionals and policy analysts with many challenges for developing and implementing appropriate HIV prevention strategies, particularly in relation to HIV counselling and testing. Since the beginning of the epidemic, approximately 700 persons have tested positive for HIV in Nova Scotia, though the actual number is probably higher since many do not get tested. (10) Nominal and non-nominal testing became available in Nova Scotia in 1985 and 1991, respectively. In 1994, an anonymous HIV testing service was initiated in Halifax, the province’s capital, and became available during 2007 in Sydney, the second largest urban centre in Nova Scotia, with outreach to rural communities upon request. Despite the availability of these testing options, barriers to access for HIV testing and counselling services persist in Nova Scotia, including geographic isolation, a lack of anonymous testing sites, fear of disclosure in small communities, poverty, and continuing stigma associated with HIV testing. (11)

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