See also:
Harm Reduction Theory and Practice,
by Nicolas Sheon
Harm Reduction by Michael Aldrich,
California AIDS Intervention Training Center
From a panel presentation at the 1st National Conference on Harm Reduction, September, 1996
By Kristen Ochoa, Nicolas Sheon, Susan Thompson, and Ed Wolf
1) HRTC, like client-centered counseling, focuses on the client's concerns and interests and tailors the discussion to be relevant to the client's philosophy, lifestyle and resources. It relies on the client's reactions to the discussion and moves away from directive counseling. In other words, both the client and the counselor guide the discussion; the agenda is not held only by the counselor.
2) HRTC focuses on incremental, realistic changes, beginning at the client's present stage of behavior change. It prioritizes issues the client identifies as important with the input, insight, support and participation of the counselor.
3) HRTC shows the client that they are effective, and that they are capable of taking a greater degree of control in their own lives. It praises even the smallest accomplishment toward self-efficacy and validates the client's current attempts. Most importantly it prioritizes the remaining risks and points toward realistic steps to achieve the client's goals.
4) HRTC, while allowing room for flexibility, holds counselors and clients to the basic responsibilities of HIV test counseling. While the scope of the discussion is fluid, HIV risk and the Antibody Test remain the context of the discussion. Regardless of the structure of the counseling session, defining HIV, factors in transmission, hierarchy of risks, and the window period remain standard elements of the discussion.
1) While risk reduction focuses on a continuum or spectrum of HIV risk (from the low risk being oral sex to the high risk being unprotected anal receptive intercourse), harm reduction focuses us on change, not based on a spectrum or a graph, but based on the very situational, very personal goals of the client.
2) Harm reduction is more holistic than risk reduction. HRTC encompasses the whole person while addressing each part of the individual and his or her environment, possibilities and concerns, not just with regard to sexual behavior. Risk reduction in HIV test counseling focusses on sexual behavior. Harm Reduction, when used in HIV test counseling, understands that reducing HIV risk is complex, deeply personal and involves all an individual's behavior in relationships, not just what they do when they have sex.
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