HIV/AIDS Counselling: Pre-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

 
1. PRE-TEST COUNSELLING

HIV counselling is often given in connection with a voluntary HIV test. Such counselling helps to prepare the client for the HIV test, explains the implications of knowing that one is or is not infected with HIV, and facilitates discussion about ways to cope with knowing one’s HIV status. It also involves a discussion of sexuality, relationships, possible sex- and drug-related risk behaviours, and how to prevent infection. It helps correct myths and misinformation around the subject of AIDS. Whenever resources permit, pre-test counselling should be made available to those who desire it.

People who do not want or do not have access to pre-test counselling should not be prevented from taking a voluntary HIV test, however. In contrast, informed consent is always required before an HIV test where the individual’s name will be linked to the result. To allay anxieties while awaiting the test result, some individuals may seek support not only from their own families or a knowledgeable community worker.

Pre-test counselling simply refers to counselling given to an individual prior to taking an HIV test. It is given to prepare the person for the HIV test and the implications of taking the test. Pre test counselling has certain core objectives which are:

• To explain the test and clarify its meaning;
• To also explain the limitations of test results and to caution the client about potential misuse of results.
• To help the client to think about possible reactions to the test result and who should be told. If the test result is positive, who could be informed and who could provide emotional support
• To help the client understand why the test is required and to make a decision about the test.
• To review the client’s risk of infection which is also called risk assessment. HIV/AIDS risk assessment requires discussion of personal sexual lifestyle of the client, with far-reaching implications.
• Correct myths and misinformation about HIV
• Review the test procedure, including issues related to false positive and false negative and also “window period”
• Explain and obtain informed consent Discuss potential implications (personal, medical, social, psychological and legal) of a negative or positive result; discuss and demonstrate condom use

1.1 IMPORTANT POINTS FOR PRE TEST COUNSELLING

Pre-test Counselling is usually the first point of contact of the client with counsellor/health facility that is providing the testing service so it is important to establish a good rapport. If you prepare your client well during the pre-test session, you may encounter fewer difficulties during the post test.

• Identify yourself and clarify your role as a counsellor.
• Emphasize confidentiality of everything that will be discussed.
• Ask if relevant why he/her opted to come for counselling and/or testing or clarify why he was referred for counselling.
• Obtain relevant medical history (past and present) e.g. serious illness in the past, blood transfusion; cough and diarrhoea, STD's etc;
• Ask about personal habits such as smoking, drinking, drugs etc. This helps with assessing risk behaviour
• Ask about sexual history. Does the individual have a steady partner, wife/husband, boy/girlfriend, other partners outside relationship, etc;
• Assess client's knowledge on HIV/AIDS. This enables the counsellor the opportunity to correct misconceptions /misunderstandings; Also to cover such issues as modes of transmission, prevention etc.
• Assess the client’s understanding of getting tested for HIV and what the test entails
• Explain what the result will mean if positive or negative including the window period and explore the personal implications of having the test, and what a positive or negative result will mean to him/her and their family and/or significant others;
• Educate the individual on safer sex practices and healthy lifestyle practices.
• Discuss with the client what will be required in the area of behaviour change to reduce the risk of contracting HIV irrespective of whether the result will be positive or negative;
• Help identify how the client will protect their sexual partner/s
• Explore clients support mechanisms. Who they will tell or talk to about their results? Where they will get support? Explore areas of strength e.g. faith and/or other support systems (supportive husband/wife, relatives, or work-mates);
• Explain the procedure for the HIV test and what it entails
• Provide an opportunity for the client to ask questions
• If the client decides to test, obtain informed consent. Explain the informed consent form and allow the client time to read a leaflet on HIV testing where feasible

1.2 RISK ASSESSMENT

Risk assessment refers to conducting a review of clients’ risk of HIV infection. It is important to remember that this is a very sensitive subject and the client is expected to share information that he/she may never have shared with any other person. To assess the client’s personal risk, the counsellor should continue to explore with him/her the following areas:

• Current and past client’s sexual behaviour
• Current and past sexual behaviour of the client’s sexual partner(s)
• Current and past drug usage pattern of both the client and clients partner
• Has client’s ever had a blood transfusion done?
• Client’s exposure to non-sterile invasive procedures

Based on the information gathered from the risk assessment, the counsellor can help the client identify any behaviour that leaves the client open to risk of acquiring or transmitting HIV. The essence of exploring risk with the client is not only to show the client that he/she is open to risk of infection but also to help the person examine ways in which he/she can reduce the chances of getting infected. This means helping the client to develop a risk reduction plan.

1.3 EXPLAINING HIV TESTING AND THE MEANING OF TEST RESULTS

Clients considering testing for HIV must be provided with appropriate information they need to make an informed decision and this should include the method for testing used in the organization. This is very important because some people have a fear of needles and need a lot of psychological preparation before taking an injection so the counsellor may have to prepare the individual as well answer questions the client will have about the testing procedure.

It is important that the counsellors be sufficiently knowledgeable about HIV testing procedures as clients will often have concerns about the accuracy of the test and have specific questions about the laboratory procedures used and the counsellor has to be able to show familiarity with the testing procedure so as to convince the client. The client should also be assured of the confidentiality of the whole testing procedure.

The counsellor should also take time and ensure that the client understands the meaning of a negative or positive HIV result. The counsellor should never assume that the client understands the meaning of the negative/positive test result because the meaning of negative/positive in the English language may confuse some clients.

1.4 CONSENT FOR HIV TESTING

Counsellors should always ensure that a client’s consent is given and depending on the organization maybe in written format. It is the client’s right to have or refuses to have an HIV test carried out and they should not be coerced.

It is the counsellors duty is to ensure that client understands the meaning and possible implications of HIV testing and to ensure that the client does not feel pressured to make a decision but rather that the client makes the decision to test at their own pace.

Finally it is important to reassure the client that the test result will be held in the confidence, to reinforce reasons why the client may benefit from knowing his/her HIV sero-status, and provide an appointment to return for test results.