HIV/AIDS Counselling: Post-Test Counselling

This post is part of a larger write-up on HIV/AIDS Counselling & Support - A Social Works Perspective. You may download it in one single pdf: HERE

 
POST TEST COUNSELLING

Post-test counselling helps the client understand and cope with the HIV test result. Here, the counsellor prepares the client for the result, gives the result and then provides the client with any further information required, if necessary referring the person to other services. The two usually discuss ways to reduce the risk of infection or transmission. HIV test results should always be given with counselling. The form of post-test counselling will depend on what the test result is.

The main goal is to help the client to understand and come to terms with his/her test results and to initiate adaptation to their sero-positive or sero-negative status. Post-test counselling helps the client to understand and cope with the HIV test result. Counselling for people who have recently received their results is similar to pre-test counselling, because both of them involve HIV risk assessment and the promotion of safer behaviours. The main difference is that in post-test counselling clients need to deal with the reality of their situation and not imagining it in the future. Clients also need to have a clear understanding of what their results mean and what options are available to them.

Giving results (positive) can be difficult and uncomfortable for the counsellor. Sometimes the counsellor fears they may not know what to say or do to an emotional client and fear that clients may harm themselves or others. Because of this counsellors may be tempted to make inaccurate suggestions and give inappropriate assurance so as to make the client feel better but this would be doing the client a disservice because the counsellor would be lying to the client and it is also unethical and unprofessional.

IMPORTANCE OF POST TEST COUNSELLING

Counselling after an HIV test is important for the following reasons:

For Positive test results: Post test counselling is given to convince the client about the reality and seriousness of the situation – it is often difficult for people to accept and believe that they are HIV positive based only on the results of a blood test, especially if they are feeling healthy and strong:

• To ensure understanding of the test result.
• To help client cope with the positive result, especially in the days and weeks to follow.
• To make a plan for ongoing medical care and necessary referrals
• To provide information about the dangers infecting others and getting re-infected with different strain of the virus.
• To understand the need for careful planning and importance of medical attention for client who want to have children
• To help the client with the issue of disclosure.

For negative test results

• First, because of the “window period”, a negative result may not mean absence of infection, and the client might wish to consider returning for a repeat test after 3-6 months.
• Second, counsellors need to discuss HIV prevention, providing support to help the client adopt and sustain any new safer practices.

For indeterminate test results

• To explain the need for re-testing and the reasons that the result could have been indeterminate
• To help the client develop a plan for protecting him/herself from HIV

Clients may experience a range of emotions upon learning their test results. Many of these emotions will be very strong and should be acknowledged by the counsellor. A client who is very emotional, either in a positive or negative way may be too distracted to hear information that is given to them. Therefore, it is important to help the client to explore his/her emotions and “vent” them. Once a client has released his/her feelings, s/he will be more receptive to receiving other information regarding prevention, treatment and referrals.

Reactions to results from clients can vary from happiness (negative result) to anger despair, depression, grief, anxiety, suicidal ideations, shock and denial (positive or indeterminate result). What determines people’s reactions to their result varies. One of the most important is how well-prepared the person was for the news during the pre test counselling at which the counsellor should have properly prepared the client for the result and also have studied the client and be able to determine the pre-test psychological condition of the client which would help in anticipating how the client would react to the result.

IMPORTANT POINTS FOR POST TEST COUNSELLING

Post test counselling must begin the session by asking how the client has been feeling since having the test and what has been going through his/her mind since taking the test. They should also give the test result in a neutral tone of voice which shows no emotions to reflect what the result is. State the result clearly and simply.

• It is important to begin the post-test session by asking how the client has been feeling since having the test and what has been going through his/her mind since taking the test.
• Ask the client if they have any questions but by this time most clients are anxious to receive their result and might not be ready to ask any questions.
• Give the test result in a neutral tone of voice which shows no emotions to reflect what the result is. State the result clearly and simply.
• Make sure that the client has understood the test result and that the client is emotionally and psychologically ready for more information to be provided
• Assess the clients understanding of the test result. Ask the client to explain what the test result means to him/her and check for any misperceptions or misinformation.
• Assess emotional understanding by asking the client how he or she is feeling at that moment, and allow the client to express the emotions

Once the client is emotionally able to cope start to help the client to plan what the next steps will be. This is called behavioural integration. Behavioural integration requires that the client make an immediate plan (ask ‘what are you planning to do when you leave here today?’) as well as plans for partner notification (disclosing HIV status to partner), modifying the risk-reduction plan or other behavioural changes depending on their test result and the clients Situation.