Risk Assessment

Risk assessment is a strategy used within individual counseling as part of the behavior change process (risk assessment can also be used for other purposes—see EngenderHealth’s online Sexually Transmitted Infections course). During risk assessment, health care workers use a client’s responses to questions about the client’s behaviors and partners in order to gauge the client’s risk for HIV infection.

Questions about risk often focus on, for example:

• Age (less than 20)
• Partnership status (in some cultures)
• New sexual partners
• Multiple partners
• Partners with multiple partners
• Partner who often travels
• History of an STI, pelvic inflammatory disease (PID), reproductive tract infection (RTI)
• Partner with symptoms of an STI
• Current symptoms or signs

Risk assessment is sometimes done using a brief checklist, which is more appropriate for screening purposes than behavior change purposes. It can also be done by providing the client with information about risks in general, and asking the client to self-assess whether or not he or she is at risk without revealing specific information. This approach is often used where it is deemed culturally inappropriate to probe for more specific information about sexual practices and partnerships. Another approach is for a counselor or provider to encourage a client to discuss his or her specific practices and circumstances as part of an interactive, exploratory counseling process. This approach is likely to be more effective in assisting a client to perceive his or her risk for infection than the former.

Many people have difficulty perceiving their own risk for infection, even if they know, in general, what places a person at risk. When a counselor or provider understands the individual risks of a client, he or she can apply information to that client’s particular circumstances, which makes the risks more apparent and assists in improving risk perception.

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