Harm Reduction HIV Test Counseling Checklist
-- pdf version (This can be viewed and printed using the Adobe Acrobat
Nicolas Sheon, March, 1997
Here is one example of a checklist for an anonymous test counseling session prepared by Nicolas Sheon, Berkeley Free Clinic. This checklist is especially useful for new counselors to take with them into the session. This checklist is only a rough guide. The client's own situation, their narrative, stage of behavior change, and level of knowledge should guide how the counselor prioritizes the items on this list. However, no matter how many prior tests they have had, it is important never to assume that a client is informed or familiar with the procedure to the extent that it need not be covered in the pre-test session. Clients often present themselves as over-educated about HIV, but nevertheles they can always learn a thing or two and will be glad that you took the time to explain it to them. Never assume that all these items were covered in the pre-test when you are disclosing a result.
Harm Reduction HIV Test Counseling Checklist
-- pdf version
(This can be viewed and printed using the Adobe
Acrobat
1. Greet the client and make eye contact, especially for
disclosure sessions.
Introduce yourself and specify immediately whether they should feel
free to diclose their name (i.e. anonymous testing).
2. Obtain client's verbal consent for HIV testing.
This can be done just by asking, "So, are you here for the HIV
test?"
3. Explore client's motivations for testing using open ended questions.
In order to open up discussion, assure client that people get tested for
a lot of reasons besides a risk of exposure and that the test has many possible
functions in people's lives, relationships, life changes.
4. Explain procedures used to maintain anonymity or confidentiality.
Explain the difference between anonymous and confidential tests.
5. Explain testing procedure and accuracy of the test results
Explain purpose of Pre and Post test counseling, encourage them to
ask questions. Explain return date, and the difference between ELISA (sensitive
screening test) and Western Blot (specific confirmatory test)
6. Explain antibodies and window period using date's of
client's last possible exposure.
Antibodies are produced in 2-12 weeks but very rarely can take up
to six months.
7. Assess need for follow-up testing based on last possible
exposure.
Make sure the client is not getting retested because they don't understand
the window period.
8. Proceed with Risk Assessment Form.
Use client's answers to form questions to elicit more information
on their safer sex strategies. Intersperse open ended questions with the
question from the rik assessment form.
9. Explore relationship between substance use and risky
behavior
If they are a current user, discuss how and when they use. People
generally like to talk about the details of their substand use with someone
they trust. Avoid framing the discussion in terms of recovery, unless the
client brings this up. Discuss ways to reduce the risk without advocating
that they stop using altogether. Always validate steps to they have taken
to reduce harm.
10. For heterosexual and bisexual clients, explore relationship
between client's birth control method and risky behavior.
If the client is getting tested with their lover discuss how the
results of their tests will affect their decisions to use protection. Discuss
their history of herpes and warts.
11. Explain the relationship between STD's and HIV transmission.
Review symptoms of Herpes, HPV, yeast, NGU, GC, Syphilis, Vaginitis,
PID, etc. Offer referrals for STD screening.
12. Assess client's practical understanding of modes of
HIV transmission (relevant to client's practices) and suggest techniques
to reduce risk.
Make sure they understand the hierarchy of risk among their activities
and why they are more or less risky.
13. Explore client's past experiences with condom use and
offer suggestions on lube and condom styles.
I find that the best probe for this is "Have you or your partner
ever had any problem with condoms feeling uncomfortable or breaking?"
14. Demonstrate different ways to put on a condom correctly
using a dildo.
Dildos are essential for good condom demonstrations. Good
Vibrations sells silicone ones for around $8 each. The rolldown and
stocking methods. Personalize your recommendations, for example "I
like these" or "these are very popular." This is where you
can show the client that they don't actually know everything there is to
know about safer sex. Demonstrate lube in tip and pinch out air bubbles.
Remind them to hold the base when pulling out.
15. Offer condoms, lube, dental dams, gloves, bleach, etc.
16. Reinforce positive risk-related changes participant
has already made.
Emphasize where the glass is half full rather than half empty. Never
dwell on past lapses. Focus on the future.
17. Problem solve and prioritize areas where risk reduction is needed.
18. Formulate a risk reduction plan focusing on small, realistic changes.
19. Discuss preparedness to receive either positive or negative results and client's willingness to return.
20. Allow client to have all of their questions asked and
answered
Watch your body language here (shuffling papers, filling out the
lab slips, tapping your pen) so that you do not rush the client before they
are able to ask delicate questions.
21. Offer referral sheet and mark appropriate referalls.
22. Discuss client's needs and desires for further testing.
If client says "every six months" assess if further testing
is appropriate, for example if routine testing appears to be hindering needed
behavior change.
23. Explain the blood draw.
Determine if you can help make the blood draw less stressful for them by
either staying with them or explaining what the procedure will be.
24. Give the client a test counselor evaluation form to complete if they want.
24. Check over the risk assessment form and lab slips to make sure that they are complete and the person disclosing the result will have all the relevant information.
25. Do whatever you need to do to take care of yourself before taking another client.
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