The Aim of Pre-Test Counseling.
This counseling is provided to individuals who can be found to be HIV positive or negative based on the medical screening and on the possible personal, medical, social, psychological and legal implications. The information should be passed on in a manner which is easy to understand and is up-to-date. Testing is a positive act that may help in changing risk behaviour. The decision of testing is informed decision where the individual is aware of the possible implications of the test result. Some countries ask for explicit informed consent by law before test takes place, otherwise implicit consent is accepted in case of people look for health care.
The understanding about the policy and consent in every instance must be clear to the individual that when being tested there are limitations of testing. The testing should be done in such a way that minimizes the possibility of disclosure or discrimination. During the screening the individual’s right must be respected and recognized. The counselor must endorse and encourage the rights for both who are tested and who have the access to the records and result, with assured confidentiality at every instance.
Issues in Pre-Test counseling.
The pre-test counseling is based on (1) the personal history of the individual and the risk of having been exposed to HIV,(2) the client’s understanding of HIV/ AIDS with any previous experience of crisis situation.
ASSESSMENT OF RISK.
- Frequency and type of sexual behaviour specific sexual practices, high risk practices, sex without using condom, unprotected sexual relations or sex with commercial sex workers and drug abuse.
- Known to be associated with a group of HIV prevalence being with high risk life styles, injecting drugs users where using same syringes, both male and female commercial sex workers, bisexual men.
- Blood transfusion in the past, organ transplant, administering blood or body products.
- Exposing to non-sterile invasive procedures such as scarification or tattooing.
ASSESSMENT OF PSYCHOLOGICAL FACTORS AND KNOWLEDGE.
- What is the reason behind conducting test?
- The symptoms or particular behaviour of the client that need a concern.
- The knowledge of the client about the test and its uses.
- Whether the client is aware of his/her reaction for the positive test result / negative result?
- The client’s knowledge and his beliefs about HIV and its transmission and relationship to risk behaviour.
- Who could provide emotional and social support to the client family, friends or anybody else?
- Whether the client has gone for testing before if yes when, for what reason, where and the reason behind it and its result?
After this initial assessment the counselor should be able to discuss client’s understanding level:
- The meaning of positive or negative result and its consequences.
- If behaviour is changed how can it help reduce chances of transmission to others.
In pre-test counseling the counselor should make sure that the client is able to cope with the test result, and the changes he will have to make in response to it. The counselor must also encourage the client why to get tested and what purpose will that serve. While inquiring about the personal history of the client the counselor must keep in mind:
- The client might be too anxious to absorb what counselor says.
- The client may expect unrealistic expectations about the test.
- The client, does not realize the reason of questioning on private matters and so is reluctant to answer.
- Whatever may be the result the client is not willing to change behaviour.
In the pre-test counseling the counselor must tell the client that the first test may have false positive or false negative results occasionally and so supplement tests are important and reliable in case the first test is positive. These facts must bp made clear to the client along with the period when the test may be unable to
assess true infection which is called a window period.
The summery of pre-test counseling must include:
- Determining the understanding of that person about HIV/AIDS.
- To provide factual information as per the requirement.
- Discussing both positive and negative test results in advance.
- Explain and obtain informed consent.
- Review of the procedure.
- Assess how capable is the person to cope with a positive result.
- Establishing a relationship that would help to create a base for post-test counseling.