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Counselling in HIV
Dr.Balan Stephen
The Major Issues
The major issues in counselling persons about HIV serum testing are :
Who should be tested.
Why a particular person should or should not be tested.
What do the test results signify
What are the implications 
Although specific groups of persons are at high risk for contracting HIV and should be tested, any person who wants to be tested should be tested.

Indications for HIV Testing
  1. Patients who belong to high risk group
  2. Persons have multiple sexual contacts (including homosexual contacts)
  3. Intravenous drug abusers
  4. Patients who have received blood or blood products without screening for HIV
  5. People with cuts, wounds, sores whose lesions have had direct contact with HIV infected blood.
  6. Patients with symptoms of AIDS
  7. Blood, semen, organ donors.
  8. Women belonging to high-risk groups planning for pregnancy.

Counselling both before and after testing should be done in person and not over phone.
The reason for requesting a test should be ascertained to detect unspoken concerns and motivation that may merit psychotherapeutic interventions.

Pre-test HIV Counselling
  1. Discuss the meaning of a positive result and clarify distortions (e.g) the test detects exposure to the HIV virus. It is not a test for AIDS.
  2. Discuss the meaning of a negative result. (e.g.) sero-conversion requires time; recent high risk behaviour may require follow-up testing.
  3. Be available to discuss the patients fears and concerns( unrealistic fear may require appropriate psychological intervention)
  4. Discuss why the test is necessary. (Not all the patients will admit to high risk behaviours).
  5. Explore the patient's potential reaction to a positive result. Take appropriate necessary steps to intervene in a potentially catastrophic reaction.
  6. Explore past reaction to severe stresses.
  7. Discuss the confidentiality issues relevant to the testing situation. Inform the patient of other possible testing options where the counselling and testing can be done completely anonymously. Discuss who has access to the test results.
  8. Discuss with the patient how being  sero positive can potentially affect social status
  9. Explore high risk behaviours and recommend risk reducing interventions.
  10. Document discussions in the chart.
  11. Allow the patient time to ask questions.

Post-Test HIV Counselling
  1. Interpretation of test result.
            Clarify distortion. (e.g.) a negative test still means you could contract the virus at a future time. It does not mean you are immune from               AIDS. Ask questions about the patients understanding and emotional reaction to the test result.
  1. recommendations for prevention of transmission like high risk behaviours
  2. Recommendations on the follow up of sexual partners and needle contacts.
  3. If a test result is positive, recommendations against donating blood, sperms, or against sharing razors tooth brushes or anything that may have blood on it.
  4. Referral for appropriate psychological support. HIV positive people may often need access to a mental health team. Assess the need for inpatient versus outpatient care.
  5. Consider need for individual or group supportive therapy.
  6. Common themes include the shock of the diagnosis, the fear of death, and social consequences, grief over potential losses, and dashed hope for good news.
  7. Also look for depression, hopelessness, anger, frustrations, and guilt feelings. Activate support available to the patient (e.g.) family, friends, and community services.

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