When is HIV Counselling Necessary?

When is HIV Counselling Necessary? The first is Pre-test discussion. A discussion of the implications of HIV antibody testing should accompany any offer of the test itself. This is to ensure the principle of informed consent is understood and to assist patients to develop a realistic assessment of the risk of testing HIV antibody positive.

This process should include accurate and up-to-date information about transmission and prevention of HIV and other sexually transmitted infections. Patients should be made aware of the “window period” for the HIV test – that a period of 12 weeks since the last possible exposure to HIV should have elapsed by the time of the test. Patients may present for testing for any number of reasons, ranging from a generalised anxiety about health to the presence of HIV-related physical symptoms.

For patients at minimal risk of HIV infection, pre-test discussion provides a valuable opportunity for health education and for safer sex messages to be made relevant to the individual. For patients who are at risk of HIV infection, pre-test discussion is an essential part of post-test management. These patients may be particularly appropriate to refer for specialist counselling expertise. In genitourinary medicine clinics where HIV antibody testing is routinely offered as a part of sexual health screening, health advisers provide counselling to patients who have been identified as high risk for testing HIV positive. The importance of undertaking a sensitive and accurate sexual and/or injecting drug risk history of both the patient and their sexual partners cannot be overstated.

If patients feel they cannot share this information with the physician or counsellor then the risk assessment becomes meaningless; patients may be inappropriately reassured, for example, and be unable to disclose the real reason for testing. Counselling skills are clearly and essential part of establishing an early picture of the patient and his/her history and of how much intervention is needed to prepare him or her for a positive result, and to further reinforce prevention messages. It is at this stage that potential partners at risk are identified which will become an important part of the patient’s management if HIV positive.