HIV COUNSELLING

Clinical Skills NRMSM 2012

HIV PRE-TEST COUNSELLING GUIDELINES

AIM: To make sure that the client has sufficient information to make an informed decision about having an HIV test

PRE-TEST COUNSELLING GUIDELINES Identify yourself and clarify your role.  If appropriate, explain what counselling is and

why it is done.  State how much time is available for

counselling. Stress confidentiality – (some institutions have

the policy of allowing clients to use a pseudonym if they wish.)

Reduce the client’s anxiety by having a relaxed, calm manner.

Establish why the client has come in for testing or counselling. What is different about today that prompted him/her to come in?

PRE-TEST COUNSELLING GUIDELINES Establish the client’s understanding of HIV/AIDS.

Correct misinformation and supply missing information.

Identify the client’s risk activities and try to establish whether he/she is in the window period or not.

Assess the client’s understanding of what the test entails. Assist the client in understanding the test and what the results mean.

Discuss the personal implications of having test, what a negative or positive result will mean to his/her family or significant other.

Discuss the practical implications of having the test, what a negative or positive result will mean to him/her in terms of sexual relationships, work situation, life insurance and medical follow-up.

PRE-TEST COUNSELLING GUIDELINES Identify how the client will protect his/her

sexual partners in the interim. (i.e. explore with your client how he/she can implement safer sex practices.)

 Discuss with the client what a negative result would mean to him/her.

Discuss with the client what effect an indeterminate result would have on him/her.

Explore how he/she can cope with a positive result.

PRE-TEST COUNSELLING GUIDELINES Explore: Client’s coping mechanisms. How has he/she

coped with the crises in the past? What family support does he/she have? What other support does he/she have?

Discuss who the client would tell about his/her results? Explore potential support from loved ones, family or

close friends. Discuss the procedure for having blood taken and how

long it will take for the results to be available. Inform the client where testing is done. Give details of

how to go through the system.  Discuss who the client may contact whilst waiting for

results.  Arrange date and time for follow-up interview

HIV POST-TEST COUSELLING GUIDELINES Informing the client of the result  It is important that the result of the test,

whether it is positive or negative, be given in person.

 The results should only be given if the counsellor has proof (a laboratory report) in front of him/her. This is important for two reasons:

To avoid confusion/mix-ups arising As proof to the client who may wish to see

the result in the written form

HIV POST-TEST COUSELLING GUIDELINES Deal with the feelings arising from the result1) A negative test result Feelings such as relief, happiness, continued

worry, disbelief etc may be present. It is necessary to permit time for ventilation of

feelings. The counsellor needs to stress to the client that a

negative result does not mean the client is immune to HIV infection.

Discuss if appropriate the issues around re-testing. Check what the client understands by the results. Use the session to emphasise prevention of

infection.

HIV POST-TEST COUSELLING GUIDELINES

2) A positive test result: Feelings such as shock, anger, disbelief, guilt

etc may be present and will need to be dealt with.

SHOCK: Due to implications of being infected – i.e. facing illness and possibility of untimely death.

ANGER: At being infected, at past high risk life style and activities, at inability to overcome the virus, at health and lifestyle implications

GUILT: Over past high-risk behaviour, over possibly having spread infection to others

HIV POST-TEST COUSELLING GUIDELINES

DEPRESSION  Helplessness over physical decline Hopelessness due to the fact that there is no cure,

and limits imposed by ill health Reduced quality of life Self-blame and recrimination for past behaviour ANXIETY About reactions from others About isolation, abandonment and rejection About risk of infecting others About partner’s ability to cope with their infection About loss of cognitive, physical, social and work

abilities About possible disfigurement and disability  

HIV POST-TEST COUSELLING GUIDELINES

OBSESSIVE DISORDERS Persistent probing, relentless searching for new diagnostic evidence on bodyPre-occupation with death and decline , faddism over health and diets

3) An indeterminate test result: Feelings such as blame, anger, confusion and anxiety are common with this type of result and need to be dealt with.BLAME, The counsellor, the lab staffANGER: At counsellor, at lab staffANXIETY AND CONFUSION: What does the result mean?

HIV POST-TEST COUSELLING GUIDELINES A full explanation of the meaning of an

indeterminate result is necessary. The reasons for this type of result need to be

clarified. The issue of the re-test needs to be discussed with

the client. Identify the client’s immediate concerns.  Who will the client tell? What will the client say? When should others be told? How to tell others? Discuss how the client plans to spend the next few

hours and days.

HIV POST-TEST COUSELLING GUIDELINES Identify what support the client has. Who are the “significant others” in the

client’s life? Identify what difficulties the client

foresees and how he/she might deal with them.

 Encourage the client to ask questions.  At some point the client needs

information on the following: 

HIV POST-TEST COUSELLING GUIDELINES Lifestyle: Health, rest, exercise, diet Safer sex Infection control in the home and workplace Medical follow-up: Health monitoring Prompt identification and treatment of symptoms Local support systems  Offer a follow-up counselling session approximately 48

hours after the post-test counselling session.  Give the following handouts: - Leaflet on safer sex - Leaflet on condom use - Telephone number of ATIC (031300 3104), LIFELINE

(0313122323) and AIDS HOTLINE (08000 12322 – toll free) or appropriate local agencies

HIV POST-TEST COUSELLING GUIDELINES SECOND APPOINTMENT Repeat the information as not too much will

be remembered from the first session. Encourage the client to ask questions. Stress the need to develop a support

system. Look at problem solving. Discuss a future strategy - Medical - Psychological - Social

References Department of Obstetrics and

Gynaecology protocol NRMSM