Designated Medical Practitioner Handbook

Appendix IV: HIV Pre-test Counselling

Counselling will have to be age appropriate and individualized to the patient being tested.

Clarify:

confidentiality of HIV testing and counselling;
testing options available (i.e., nominal, non-nominal, anonymous);
the test is for antibodies to HIV, not a test for AIDS;
the majority of persons produce detectable antibodies within three months;
a non-reactive or negative test may mean
- no infection, or
- it is too soon to detect antibodies;
a positive test means
- infection with HIV
- person is infectious to others through unprotected sexual contact, blood or breast milk;
an indeterminate result means another test needs to be performed;
HIV is not casually transmitted through sweat, saliva or tears.

Transmission risks are:

direct blood-to-blood contact;
sharing needles or syringes;
sexual contact: anal sex (very high risk); vaginal sex (high risk); oral sex (low risk);
infected mother to child during pregnancy, at birth or via breast milk;
recipient of blood or blood products in Canada before November 1985 (elsewhere risk will vary depending on testing of donated blood).

Discuss:

specific risks, sexual and otherwise;
if pregnant: discuss availability of therapy to decrease the risk of mother-to-child transmission (decreased by 80%);
whether future testing will be necessary;
risk reduction behaviours:
- consistent use of latex condoms
- avoidance of casual, anonymous or unprotected sex;
- no sharing of needles, syringes or injection drug-use equipment.

Explore:

psychological implications of testing:
- coping mechanisms for either result; support systems available (personal, community, medical) should be known.

Explain:

the need to return for test result and schedule the post-test counselling visit
- obtain agreement for follow-up if patient fails to return;
post-test counselling procedure;
partner notification and reporting requirements for HIV infection (depends on jurisdiction and availability of anonymous testing).