This document provides guidelines for HIV pre-test and post-test counseling. The pre-test counseling guidelines outline establishing rapport, assessing the client's knowledge and risk level, explaining the testing process, and discussing potential results. The post-test counseling guidelines differ based on negative, positive, or indeterminate results, but generally involve discussing the client's reaction, providing information and support, and making a follow-up appointment. The overall aim is to properly inform and support clients before and after HIV testing.

1. HIV COUNSELLING
Clinical Skills NRMSM 2012

2. HIV PRE-TEST COUNSELLING
GUIDELINES
AIM: To make sure that the client has sufficient
information to make an informed decision about
having an HIV test

3. PRE-TEST COUNSELLING
GUIDELINES
 Identify yourself and clarify your role.
 If appropriate, explain what counselling is and
why it is done.
 State how much time is available for counselling.
 Stress confidentiality – (some institutions have
the policy of allowing clients to use a pseudonym
if they wish.)
 Reduce the client’s anxiety by having a relaxed,
calm manner.
 Establish why the client has come in for testing or
counselling. What is different about today that
prompted him/her to come in?

4. PRE-TEST COUNSELLING
GUIDELINES
 Establish the client’s understanding of HIV/AIDS.
Correct misinformation and supply missing
information.
 Identify the client’s risk activities and try to establish
whether he/she is in the window period or not.
 Assess the client’s understanding of what the test
entails. Assist the client in understanding the test and
what the results mean.
 Discuss the personal implications of having test, what
a negative or positive result will mean to his/her family
or significant other.
 Discuss the practical implications of having the test,
what a negative or positive result will mean to him/her
in terms of sexual relationships, work situation, life
insurance and medical follow-up.

5. PRE-TEST COUNSELLING
GUIDELINES
 Identify how the client will protect his/her
sexual partners in the interim. (i.e. explore with
your client how he/she can implement safer
sex practices.)
 Discuss with the client what a negative result
would mean to him/her.
 Discuss with the client what effect an
indeterminate result would have on him/her.
 Explore how he/she can cope with a positive
result.

6. PRE-TEST COUNSELLING
GUIDELINES
 Explore: Client’s coping mechanisms. How has he/she
coped with the crises in the past? What family support
does he/she have? What other support does he/she
have?
 Discuss who the client would tell about his/her
results?
 Explore potential support from loved ones, family or
close friends.
 Discuss the procedure for having blood taken and
how long it will take for the results to be available.
 Inform the client where testing is done. Give details of
how to go through the system.
 Discuss who the client may contact whilst waiting for
results.

7. HIV POST-TEST COUSELLING
GUIDELINES
 Informing the client of the result
 It is important that the result of the test,
whether it is positive or negative, be given in
person.
 The results should only be given if the
counsellor has proof (a laboratory report) in
front of him/her. This is important for two
reasons:
 To avoid confusion/mix-ups arising
 As proof to the client who may wish to see the
result in the written form

8. HIV POST-TEST COUSELLING
GUIDELINES
 Deal with the feelings arising from the result
1) A negative test result
 Feelings such as relief, happiness, continued
worry, disbelief etc may be present.
 It is necessary to permit time for ventilation of
feelings.
 The counsellor needs to stress to the client that a
negative result does not mean the client is
immune to HIV infection.
 Discuss if appropriate the issues around re-
testing.
 Check what the client understands by the results.

9. HIV POST-TEST COUSELLING
GUIDELINES
2) A positive test result:
 Feelings such as shock, anger, disbelief, guilt
etc may be present and will need to be dealt
with.
 SHOCK: Due to implications of being infected
– i.e. facing illness and possibility of untimely
death.
 ANGER: At being infected, at past high risk life
style and activities, at inability to overcome the
virus, at health and lifestyle implications
 GUILT: Over past high-risk behaviour, over

10. HIV POST-TEST COUSELLING
GUIDELINES
DEPRESSION
 Helplessness over physical decline
 Hopelessness due to the fact that there is no cure,
and limits imposed by ill health
 Reduced quality of life
 Self-blame and recrimination for past behaviour
ANXIETY
 About reactions from others
 About isolation, abandonment and rejection
 About risk of infecting others
 About partner’s ability to cope with their infection
 About loss of cognitive, physical, social and work
abilities
 About possible disfigurement and disability

11. HIV POST-TEST COUSELLING
GUIDELINES
OBSESSIVE DISORDERS
Persistent probing, relentless searching for new diagnostic
evidence on body
Pre-occupation with death and decline , faddism over health
and diets
3) An indeterminate test result:
Feelings such as blame, anger, confusion and
anxiety are common with this type of result and
need to be dealt with.
BLAME, The counsellor, the lab staff
ANGER: At counsellor, at lab staff
ANXIETY AND CONFUSION: What does the result
mean?

12. HIV POST-TEST COUSELLING
GUIDELINES
 A full explanation of the meaning of an indeterminate
result is necessary.
 The reasons for this type of result need to be clarified.
 The issue of the re-test needs to be discussed with
the client.
 Identify the client’s immediate concerns.
 Who will the client tell?
 What will the client say?
 When should others be told?
 How to tell others?
 Discuss how the client plans to spend the next few
hours and days.

13. HIV POST-TEST COUSELLING
GUIDELINES
 Identify what support the client has.
 Who are the “significant others” in the client’s
life?
 Identify what difficulties the client foresees and
how he/she might deal with them.
 Encourage the client to ask questions.
 At some point the client needs information on
the following:

14. HIV POST-TEST COUSELLING
GUIDELINES
 Lifestyle: Health, rest, exercise, diet
 Safer sex
 Infection control in the home and workplace
 Medical follow-up: Health monitoring
 Prompt identification and treatment of symptoms
 Local support systems
 Offer a follow-up counselling session approximately 48 hours after
the post-test counselling session.
 Give the following handouts:
 - Leaflet on safer sex
 - Leaflet on condom use
 - Telephone number of ATIC (031300 3104), LIFELINE
(0313122323) and AIDS HOTLINE (08000 12322 – toll free) or
appropriate local agencies

15. HIV POST-TEST COUSELLING
GUIDELINES
 SECOND APPOINTMENT
 Repeat the information as not too much will be
remembered from the first session.
 Encourage the client to ask questions.
 Stress the need to develop a support system.
 Look at problem solving.
 Discuss a future strategy
-Medical
-Psychological
- Social

16. References
 Department of Obstetrics and Gynaecology
protocol NRMSM