Posttest counseling

All individuals who are tested for HIV antibodies should have access to a posttest counseling and education session at the time they are given the test results. This session will help both the health care provider and the client assess the client’s understanding of the results of this test. Test results should be given as soon as possible so that the client has time to absorb this information. When giving negative test results, remind clients that the results may not be accurate if the client has engaged in behaviors that put him or her at risk during the three months before testing or since the test was done. If appropriate, clients should be offered a repeat test at an appropriate time in the future.

When disclosing a negative test result, the counselor should explain what the test result means, answer any questions, address the client’s emotional response, and discuss strategies for remaining HIV-negative. This could include further discussion of the client’s risk-reduction plan.

Talking with clients about positive test results
If the test is positive for HIV, the counselor should  begin to help empower the client to participate in the many difficult decisions that HIV infection poses by providing clear, honest, factual information in terms the client can easily understand.

If a client tests HIV-positive, the counselor should explain what a positive result means, address the client’s emotional response, answer any questions, discuss treatment options (if they exist) and self care, and discuss how the client can avoid transmitting the virus to others. Providers should refer HIV-positive clients to care and support services, wherever feasible, and should address issues of stigma, disclosing HIV status to partners, and any personal safety concerns or threats of violence or abandonment that those testing positive may face. Women who test positive should be counseled on options available to prevent mother-to-child transmission (MTCT) of HIV.

Recognizing clients’ anxieties
Most clients who test positive for HIV are likely to have a high degree of anxiety, even before learning of the diagnosis. Many people at high risk for infection have friends or acquaintances who are currently living with HIV infection or who have already died from AIDS, and many may have misperceptions about the facts of HIV infection. Even clients who already have a good level of information about HIV infection in general will require personalized information about the infection regarding the specifics of their own individual case.

While giving information, health care providers should be aware that the anxiety and emotion that accompany a positive result are likely to have a profound effect on the client, and the client may need some time to come to terms with the results before being able to deal with more detailed information. For many clients, it might be more appropriate to wait for a little while to discuss treatment options, perhaps with the supportive presence of a friend or family member.

Talking about clients’ prognoses
When discussing HIV infection with newly diagnosed clients, health care providers must walk a very thin line between the clients’ simultaneous needs for honesty, factual information, practical information, advice, and hope for the future.

Many clients are likely to ask difficult questions, such as “How long will I live?” after learning of the diagnosis. Honesty and realism are essential tools for health care providers when discussing a client’s prognosis, but a realistic optimism should be applied whenever appropriate.

While recognizing the seriousness of the diagnosis, providers should avoid speculating about a client’s survival time, stressing that each individual case is different and that strategies to extend survival and new treatment therapies are being developed and tested at a rapid pace; however, this may offer little comfort in settings where treatment options are not readily available.

Referral for counseling and services
Newly diagnosed clients may require immediate assistance in attaining additional counseling for emotional distress, peer support, or assistance with financial concerns, future planning, child care issues, housing, or other practical concerns. Such clients also may require referrals to services related to the prevention of MTCT and to family planning services. Where available, providers should refer clients to appropriate community organizations, social agencies, peer support groups, and other resources.

Clients who test negative may also require referrals to family planning, health care, counseling, or social services. All clients, positive and negative, should be provided with condoms, counseling on prevention, and information about where to obtain additional condoms.

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