| Counseling When providing pre-test counseling, assessment of risk should be made and
relayed to the person being tested. Although new oral diagnostic products can provide tested persons with results
at that particular counseling visit, the wait may be agonizing to the testee. Without downplaying a person's risk
potential, if the risk is low, this assessment should be conveyed in order to relieve some of the inherent anxiety
associated with testing. On the other hand, the test should not be accorded the relative insignificance of something
akin to a routine complete blood count. The implications are profound, and should warrant sufficient attention.
Pretest counseling provides an opportunity to teach prevention and risk reduction techniques, such as safer
sex, pregnancy planning and treatment options for substance abuse. The signs and symptoms of HIV and AIDS
should also be discussed. It should be explained to the person being counseled why the test is useful, the implications
of positive and negative results, potential problems with the test, and why it may need to be repeated. The person
should be prepared for the impending test results, and his or her ability to cope, if possible, should be assessed, with
the availability of support systems made known. Lastly, consent needs to be obtained. |
Post-Test
Counseling Negative Result
- Encourage Risk-Reduction
- Abstinence and monogamy
- Safer sex techniques
- Drug-free programs
- Avoiding needle sharing
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Regarding post-test counseling, if the test result is negative, risk reduction behavior should most certainly be
reinforced. Negative results can sometimes give high-risk persons license to continue practicing harmful habits.
Education is clearly important when counseling these persons. The patient should be told that he or she has
"dodged the bullet" but may not be so lucky next time. Risk reduction steps include abstinence
and monogamy, safer sex and barrier techniques, drug free programs and avoidance of drug-sharing paraphernalia.
Arrange for a retest if risk behavior was practiced within three months of testing. |
| If the test result is positive result, this information should be given at the beginning of the
appointment. It is likely that the result and not much else will be absorbed during this visit. The patient should be
allowed to vent his or her feelings. Learning of a positive result can have significant adverse psychological effects; as
such, positive results should not be given over the phone or on a Friday, when psychological support, if needed, is
unlikely to be available over the weekend. |
Post-Test
Counseling Positive Results
- Give results in person and listen to patient
- Reinforce difference between being HIV + and having
AIDS
- Evaluate psychosocial status and encourage
psychological testing
- Schedule follow-up testing and office visit.
- Reinforce risk-reduction
- Provide names of physicians who are familiar with
treatment of HIV
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Also, reinforce the difference between being HIV positive and having AIDS. Provide hope, which is more realistic
now than it has been in the past. Depending on how early a diagnosis is made, infected persons can potentially live
for many years with proper follow-up. Reinforce risk reduction behavior and know where to direct the person for
support. At least initially, this is probably the most important step. Many infected persons, upon learning of their
diagnosis, go into denial and delay medical follow-up for unacceptably long periods of time, possibly losing an
advantage that obtaining an early diagnosis may hold. Appropriate counseling may prevent this situation from
happening. |
Once a person is diagnosed HIV positive, he or she needs to be integrated into the system. Patients with limited
financial or social means, which is the rule rather than the exception with this disease, need to be enrolled into some
type of ongoing formal management program. Successful programs integrate staff caseworkers and physicians as
well as nutritionists, psychiatrists/psychologists, and others in helping to get these patients the care they need.
Enrollment into a management program can include contact notification, initiation of case management, health
department reporting, if indicated, and referral to support groups. |
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