Barriers to VCT despite 13 years of community-based awareness campaigns in a peri-urban township in northern Limpopo [letter]

An estimated 5.7 million people in South Africa live with HIV/AIDS. In 2008, it was estimated that 12.5% of the Limpopo population aged 15 - 49 was HIV-positive, while the national HIV prevalence estimate was 18.8%. Over the past 8 years, the South African government has supported prevention campaigns, expanded voluntary counselling and testing (VCT) sites, and increased the access to antiretroviral therapy (ART) to decrease the burden of the epidemic. VCT was offered at 87% of primary health care facilities in Limpopo Province in 2003. By 2007, 42% of the people in need of ART in South Africa had commenced it. Despite VCT's benefits and the increased number of testing sites, many South Africans remain untested for HIV for various reasons. In Bela-Bela, the HIV/AIDS Prevention Group (HAPG) has been active since 1996, providing VCT and care and support to people with HIV/AIDS. Its activities include prevention campaigns, free VCT and ART, home-based care and orphan care. Each year, 39.4 - 42.2% of the HAPG VCT attendees test HIV-positive. In 2005, 254 HIV/AIDS prevention activities were organised, reaching 15 570 participants (73% women). We studied motivations for, and barriers to, VCT uptake among black South Africans living in Bela-Bela, a peri-urban town with a population of 55 844 and an unemployment rate of 21%