HIV Education and Counseling
1. Twelve Questions and Answers about HIV/AIDS:
Center for Health Training, Region IX (13 pages)
2. The Six Steps of an STD/HIV Risk Reduction
Counseling Session:
Centers for Disease Control and Prevention revised by
Center for Health Training, Region IX (6 pages)
Tab
7
3. HIV Prevention Materials: Family Planning Council*
a. Definitions of HIV-related Services 2008 (2 pages)
b. Prevention Counseling Observation & Coaching Tool (5 pages)
c. HIV Education, Information & Counseling Guide (1 page)
* From the HIV Prevention Counseling Chapter of Family Planning
Council, TRAINING 3, Region III, HIV Tool Kit
4. Questions to Support Behavior Change –
English and Spanish:
Center for Health Training, Region VI (2 pages)
5. Disclosing Reactive (Positive) Rapid HIV Test Results:
Center for Health Training, Region IX (3 pages)
6. How to Make an Effective Referral:
Center for Health Training, Region IX (1 page)
About Making Client Referrals:
TRAINING 3, Region III (1 page)
7. Client-Centered Care/Communications
Observation Form:
Development Systems, Inc., Region VII (4 pages)
RELATED MATERIALS
• Checklist for HIV Prevention Education & Counseling
(see Tab 3)
· • HIV Knowledge Survey
(see Tab 4)
• Resources for HIV Prevention and Risk Reduction
(Tab 15, page 6)
ROADMAP TO INTEGRATION:
HIV Prevention in Reproductive Health
A collaborative
effort between
CDC SMART team
and the Regional
Training Centers
2009
Tab 7: HIV Education and Counseling
Twelve Questions & Answers about HIV and AIDS1
1.
WHAT IS HIV? WHAT IS AIDS?
HIV stands for Human Immunodeficiency Virus. This is the virus that causes AIDS. There are
two common strains of the virus (HIV 1 & HIV 2) but only HIV 1 is common in the U.S.
Viruses are microscopic infectious agents that cannot “live” or replicate outside other cells.
HIV is different from most other viruses because it attacks the immune system. The immune
system gives our bodies the ability to fight infections. HIV finds and destroys a type of white
blood cell (T cells or CD4 cells) that the immune system must have to fight disease. People
can live a long healthy life with HIV without symptoms, even without medications. Once the
immune system begins to break down over time, and the person develops more symptoms, this
often means they have progressed to AIDS.
AIDS stands for Acquired Immuno Deficiency Syndrome. AIDS is the final stage of HIV
infection. It can take many years for a person infected with HIV, even without treatment, to
reach this stage. Having AIDS means that the virus has weakened the immune system to the
point at which the body has a difficult time fighting infection. When someone has one or more
specific infections, certain cancers, or a very low number of T cells, he or she is considered to
have AIDS. HIV chooses CD4+ cells and other lymphocytes as its host. Lymphocytes are
white blood cells that are important in the synthesis of antibodies and help protect the body
from disease.
Origin of AIDS: Scientists identified a type of chimpanzee in West Africa as the source of HIV
infection in humans. The virus most likely jumped to humans when humans hunted these
chimpanzees for meat and came into contact with their infected blood. Over several years, the
virus slowly spread across Africa and later into other parts of the world.
AIDS is a medical diagnosis given by a medical doctor when a person meets the criteria. Often
this includes a positive HIV test results plus any of several conditions (more information in
Question #2). An AIDS diagnosis is used by the Centers for Disease Control and Prevention
(CDC) for statistical purposes to track the epidemic. This diagnosis is not necessarily a
reflection of an individual’s current health status. The diagnosis remains with the individual
even after he or she no longer meets the AIDS-defining criteria. Before the development of
protease inhibitors and combination therapies, virtually all people with HIV infection
eventually developed AIDS. These new therapies are currently delaying progression toward
AIDS, and the health of many people who have an AIDS diagnosis has improved dramatically.
2.
HOW DOES HIV DAMAGE THE IMMUNE SYSTEM?
HIV infects the body through several different cells of the immune system. As more of these
cells become infected, fewer are available to fight off diseases. Diseases that a healthy immune
system can prevent become more dangerous and even life-threatening as they overpower the
immune system of a person with HIV disease.
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When HIV enters a person’s CD4 cells, it uses the cells to make copies of itself. This process
destroys the CD4 cells and the CD4 count goes down. As a person with HIV loses CD4 cells,
their immune system becomes weak. A weakened immune system makes it harder for the body
to fight infections and cancer.
People with HIV disease may have one of several different manifestations of infection. For
example, a person can be infected with HIV, have no physical symptoms, and have healthy
results on tests of immune function. Or a person can have no physical symptoms but show
some signs of immune system damage on medical tests of the immune system. A person can
also have mild or more severe symptoms of HIV disease.
About 30% of people newly infected with HIV disease will show an “acute stage” of infection
shortly after becoming infected, with flu-like symptoms lasting one or two weeks. Then the
person may have no physical symptoms for several years. Mild symptoms can develop, and
then, as time passes, more severe symptoms may appear. This range of presentations is often
called “the spectrum of HIV disease.” The phrase indicates that there are many possible
manifestations of HIV infection.
There are several indicators of more severe HIV (which occur in the presence of HIV infection
and the absence of any reason for immune suppression). These conditions also define an AIDS
diagnosis, which is used for epidemiological statistics and to meet the requirements for some
government benefits and services. Among the conditions are:
a.
CD4+ count of less than 200 cells per microliter or CD4+ cell percentage of less than
14
b. Recurrent pneumonia, more than one episode in a one-year period*
c. Kaposi’s sarcoma (KS)
d. Cervical cancer, invasive
e. Pneumocystis carinii pneumonia (PCP)
f. Coccidioidmycosis, disseminated
g. HIV encephalopathy (HIV dementia)
h. Histoplasmosis, disseminated
i Lymphoma (certain types)
j.
Other non-Hodgkin’s lymphoma of B-cell or unknown phenotype
k. Any mycobacterial disease caused by mycobacteria other than disseminated Mycobacterium tuberculosis
l. Recurrent Salmonella (non-typhoid) septicemia
m. HIV wasting syndrome (emaciation)
n. Herpes Simplex (severe infection)
o. Tuberculosis (TB)
p. Chronic Candidiasis
*Bold font highlights those conditions most likely to show up in a health clinic.
3.
HIV HAS BEEN FOUND IN WHICH BODY FLUIDS?2
HIV has been isolated in many different body fluids. The Centers for Disease Control
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recommends precautions be taken with the following fluids.
a. Blood (including menstrual blood, which can have a high concentration of the virus).
b. Any bodily fluid containing visible blood.
c. Semen (including pre-ejaculation)
d. Vaginal secretions.
e. Cerebrospinal fluid (surrounding the brain and spinal cord).
f. Synovial fluid (surrounding joints).
g. Pleural fluid (surrounding membranes of lungs and thoracic cavity).
h. Peritoneal fluid (in membranes lining abdominal/pelvic walls).
i. Pericardial fluid (surrounding the heart).
j. Amniotic fluid (surrounding the fetus).
k. Human breast milk (neonatal transmission).
In addition, although HIV has been detected in other fluids, unless there is visible blood
present, viral concentrations are not sufficient to transmit HIV. Among these fluids are tears,
saliva, urine, feces, vomit, sputum, and nasal secretions. Sweat is not considered a risky fluid.
Remember that there must be an exchange of fluids to transmit the virus, contact alone
does not cause infection.
4.
HOW IS HIV TRANSMITTED FROM ONE PERSON TO ANOTHER? HOW
CAN THIS TRANSMISSION BE PREVENTED?
HIV Transmission: The ways that you get infected with HIV have not changed since the
beginning. “Infection” means that HIV has invaded the body and will multiply and produce an
injurious effect. Upon infection, a person can transmit the virus to others through a variety of
routes.
“Exposure” means that an individual has come in contact with an HIV-infected person’s body
fluid. During a given exposure, the virus may not necessarily have found a “host cell” in the
uninfected person. Hence, not every exposure leads to transmission, although statistics have
shown that it is possible to become infected from only one exposure.3
It is important to remember that behaviors put people at risk for HIV, not membership in any
particular “risk group.” The ways in which HIV is transmitted are:
a. Unprotected sexual intercourse with an infected partner. This includes vaginal, anal, or
oral sex or other sex that involves the exchange of body fluids. Receptive anal sex is the
most risky activity because the anus has only one mucosal membrane. The vagina has 2
layers of mucosal membrane and is therefore less risky than anal sex. The mouth has 3
layers of mucosal membranes and therefore oral sex is the least risky of the three.
Engaging in unprotected oral sex with someone who is infected with HIV can lead to HIV
infection.4 The relative risk of transmission through unprotected oral sex is extremely
low, and oral sex is safer than other insertive forms of sex.
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b.
Sharing of needles and injection paraphernalia (“works,” including needles, syringes,
cookers, and other injection equipment) with an infected partner. Remember people
use needles for drug use, hormones, vitamins, medical purposes and for tattooing and
piercing.
c.
From an infected woman to her fetus (vertical or perinatal transmission) or through
her infected breast milk (neonatal transmission).
d.
Through other direct exposure to infected blood or needle sticks (occupational
transmission), open cuts or sores, or other breaks in the skin that would facilitate
direct blood to blood exposure. Though infection with HIV through a blood
transfusion is very rare in the U.S., it is still common in other developing countries.
e.
Through other direct exposure to semen. (i.e. Sperm banks and alternative
insemination using unscreened semen).
Tattoos and Piercing: Instruments that are intended to penetrate the skin (tattooing,
acupuncture, piercing) should be used once and disposed of or thoroughly cleaned and
sterilized. The CDC knows of no instances of HIV transmission through tattooing or body
piercing, although hepatitis B has been transmitted.
Kissing: Because of the potential for contact with blood during “French” or open-mouth
kissing, CDC recommends against engaging in this activity with a person known to be
infected. However, the risk of acquiring HIV during open-mouth kissing appears to be
extremely low. The CDC has investigated only one case of HIV transmission that may be
attributed to open-mouth kissing.
Insects (or other animals): Studies conducted by researchers at CDC and elsewhere have
shown no evidence of HIV transmission through insects. When an insect bites a person, it does
not inject its own or a previously bitten person’s blood into the next person. Rather, it injects
saliva, which acts as a lubricant or anticoagulant so the insect can feed efficiently. HIV lives
for only a short time inside an insect or other animal and therefore does not reproduce in them.
All reported cases suggesting new or potentially unknown routes of transmission are
thoroughly investigated by state and local health departments with the assistance of the CDC.
HIV Prevention:
People can prevent HIV by:
a.
Abstaining from sex or exchange of bodily fluids—never having sexual intercourse
with anyone under any circumstances.
b.
Abstaining from needle sharing activities including drug use—never sharing works
or using needle exchange programs.
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c.
Having sex only with partners known to be uninfected with HIV.
d.
Practicing safer sex, which might include mutual masturbation, massage, and body
rubbing, and using a latex or polyurethane barrier use for all forms of intercourse:
vaginal, oral, anal. These barriers include condoms, dental dams, Reality or “female”
condoms. To reduce the potential risk of transmission through oral sex, participants
should avoid causing trauma to the mouth and throat, and abstain from oral sex when
infections or abrasions are apparent on the genitals, mouth, or throat.
e.
Cleaning injection works with bleach before sharing. Cleaning needles involves
using the bleach, and flushing with water afterwards and repeating this 3 times. For
cleaning needles used for hormones, since the fluid (silocone) is oil-based, you must
you dishwashing detergent instead of bleach.
f.
Keeping a clear head: avoiding the use of alcohol or other drugs that might impair
judgment or resolve to follow safer sex activities.
g.
Using universal precautions for all health care interactions to prevent needle stick
exposure.
5. WHAT DOES THE HIV TEST MEASURE?
WHAT ARE THE NAMES OF COMMONLY USED HIV TESTS?5
The HIV test measures the presence of antibodies to HIV in the blood. After a person becomes
infected with HIV, the body will produce antibodies (usually in two to 12 weeks but it can take
up to six months). The presence of HIV antibodies indicates that the individual is infected with
HIV and is capable of passing the virus on to others through usual routes of transmission.
Samples to be tested for the HIV antibody can be obtained from:
• Blood drawn from arm or finger stick
• Mucosal membranes from the mouth (not saliva)
• Urine testing
The gold standard for conventional HIV testing is to use blood because the test results are
more accurate. The HIV antibody tests are all looking for antibodies to HIV and not for the
actual virus.
Generally there are two layers of HIV testing needed to be sure of results, whether you are
doing conventional or rapid testing. The first sample or layer of testing is called screening.
Once the samples have been collected, the most commonly used HIV antibody test in the
United States today is the ELISA (enzyme-linked immunosorbent assay, also referred to as
“EIA”). If this test is negative, the second layer of confirmatory testing is not needed. If the
ELISA is reactive or positive, the second layer of tests used to confirm the results at a
laboratory are either the Western Blot, the RadioImmunoPrecipitation Assay (RIPA) and the
ImmunoFluorescence Assay (IFA). These are referred to as confirmatory tests. The world of
testing is changing so it may be that a combination of rapid tests will soon replace these more
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conventional methods of confirming the initial test result.
Several other assays for HIV antibody are being tested in different settings in the United States
and elsewhere, but the ELISA and its confirmatory assays are still the most commonly used
with conventional testing. These tests require two sessions since the specimens are usually sent
to an off-site lab and the results can take 1-2 weeks. If the ELISA is negative, there is no
confirmatory testing done. If the ELISA result is positive, confirmatory tests are automatically
performed.
Rapid Testing: There are many rapid HIV tests that have been approved by the FDA. The
rapid HIV test takes 10-20 minutes and the client can get their test and results in one visit.
However, the rapid test is only a screening test (an ELISA), and therefore requires a reactive or
preliminary positive result to be followed up with an additional confirmatory test. Rapid tests
are usually done using either a finger stick or an oral swab. Because it is a screening test, it can
have false positive or false negative results. In some areas, the initial reactive result is getting
confirmed with additional rapid tests instead of the Western Blot or IFA/RIPA.
HIV-2: In 1986 a second type of HIV called HIV-2 was isolated in AIDS patients in West
Africa. HIV-2 is very similar to HIV-1 but seems to develop more slowly and be milder than
HIV-1. Not all of the HIV tests are able to detect HIV 2 as well. The most common rapid test
(OraQuick Advance) also tests for HIV-2. HIV-2 infections have been predominantly found in
Africa.6
6.
WHAT ARE THE POSSIBLE HIV TEST RESULTS AND WHAT DO THEY
MEAN? WHAT IS THE WINDOW PERIOD?
HIV Results: An HIV antibody test can be positive, negative, or inconclusive or
indeterminate. A confirmed positive result means that your body produced antibody and you
have HIV. A negative test either means that you are not infected OR you are infected but it is
too soon after infection and your body hasn’t had time to produce the antibody to HIV yet. An
inconclusive or indeterminate test can happen either because something in the blood triggered
a positive test in the first layer of screening tests but could not be confirmed OR you may be in
the process of seroconverting from negative to positive. Some things that can cause an
indeterminate result include auto immune disorders, multiple subsequent pregnancies, or a
current syphilis infection. In instances where a person repeatedly gets an indeterminate result,
it would be recommended to get a viral load test which tests for the virus and not the antibody.
Window Period: The window period is the time between getting infected with HIV and the
body producing antibodies which are detectable with testing. Statistics show that many
infected people develop antibodies within 2-12 weeks. It can take as long as 6 months. In
California, most professionals in the field of HIV still say that the window period is 3-6
months and allow the client to determine whether they want to test after 3 or 6 months or both.
This means that if possible, clients are encouraged to get tested for HIV 3-6 months after their
last risky contact.
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7.
WHAT IS THE DIFFERENCE BETWEEN CONFIDENTIAL AND
ANONYMOUS HIV TESTING IN CALIFORNIA?
Confidential testing: In confidential testing programs, the client has a chart and their name can
be matched with their test result. In confidential testing programs, clients must give informed
verbal consent before they can be tested. As of January 2008, in California a separate HIV
consent form is not needed. HIV testing can be included in a general medical consent form. If
a test result is positive, the clients name will get reported to the health department and the State
Office of AIDS. In a confidential setting, where a client’s name and address are usually
known, it is possible to offer follow-up after HIV antibody testing with further counseling and
intervention. Confidential testing programs are part of larger service agencies (for example,
family planning clinics, rural health clinics, maternal-child health clinics, STD clinics, Jails,
drug and alcohol treatment, and Indian Health Service facilities). Clients come to the agency
for many different reasons, and HIV antibody testing is rarely the concern that brings them
there.
Anonymous testing: At anonymous test sites, no identifying information —only a number—
can be matched with a client’s test result. Consent for the HIV test is informed but not written
(written consent would violate anonymity). In both settings, clients should be 12 years or older
(13 years if using an oral test (OraSure)) and of sound mind, should fully understand the risks
and benefits of the test, and should choose to be tested freely, not through coercion. If a test is
done anonymously and is positive, there is no reporting of the result to the state. Follow-up is
more difficult with anonymous testing because there is no locating information on the client,
and anonymous sites are usually not funded to provide follow-up services.
Alternative test sites (ATS) are “dedicated” facilities and their main or only reason for existing
is to provide the HIV antibody test anonymously. Clients come to the test site voluntarily and
specifically to be tested for the HIV antibody. Anonymous testing is not available in most
states and may not be available in California in the future.
8.
WHAT IS THE CONNECTION BETWEEN DRUG AND ALCOHOL USE AND
HIV RISK BEHAVIORS?
Exposure to HIV-infected blood through the sharing of needles in injection drug use is one of
the most common causes of HIV transmission in the U.S. today.
Other kinds of recreational drug use can also lead to HIV risk behaviors. For example, when a
person has used alcohol or other drugs, he or she may be
• less inhibited and more likely to engage in unsafe sex or unsafe needle use. This
may include exchanging drugs for sex.
• less capable of using condoms for safer sex or lose resolve to abide by safer sex
guidelines.
Alcohol is often considered a “soft drug” and has not traditionally been seen as an HIV-related
drug. However, alcohol is known to have a disinhibiting effect, even in relatively small
amounts. Alcohol also impairs fine motor coordination and judgment. As with recreational
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drug use, these factors can lead to attitudes, beliefs, or disabilities that contribute to the
practice of HIV risk behaviors: feeling like it won’t matter if you engage in a risk; believing
there is no chance of becoming infected; finding it difficult to use condoms or other safer sex
techniques; changing previously made decisions not to engage in risky activities; or finding it
easier to “slip” into risky behaviors.
It is important to remember that social, environmental and cultural factors may also contribute
to the intensity and type of disinhibition a person feels when using alcohol or drugs. The
likelihood that a mildly inebriated person will take HIV-related risks can be significantly
increased by these factors.
9.
WHAT IS THE CONNECTION BETWEEN SEXUALLY TRANSMITTED
DISEASES (STDS) AND HIV? WHAT ABOUT TB AND HEPATITIS C?
Sexually transmitted diseases: A sexually transmitted disease (STD) is any disease acquired
through sexual contact. Since HIV is a virus that can be transmitted through sexual contact, it
is a sexually transmitted disease. If an individual has a sexually transmitted disease other than
HIV, he/she is at increased risk for HIV infection. If you have chlamydia, you are 3-5 times
more likely to get infected with HIV. In addition, the sores, blisters, rashes or other tissue
changes that result from infection with an STD may provide a way for HIV to enter the body.
In women, STDs other than HIV increase the number of HIV target cells (CD4+ cells) in
cervical secretions and thus increase HIV susceptibility in women who have HIV-infected sex
partners.
Tuberculosis7: An estimated 10-15 million Americans are infected with TB bacteria, with the
potential to develop active TB disease in the future. About 10% of these infected individuals
will develop TB disease. Tuberculosis (TB) is an infectious disease that is spread from person
to person through bacteria in the air. TB usually affects the lungs, sometimes causing the
following symptoms: a bad cough that lasts longer than two weeks a pain in the chest, or the
coughing up of blood or sputum (phlegm from deep inside the lungs). People infected with
HIV are more likely to get infections such as tuberculosis because HIV infection weakens the
immune response to other viruses, bacteria, and fungi. People dually infected with HIV and TB
have a 100 times greater risk of developing active TB disease and becoming infectious than
those who are not HIV-infected. Individuals co-infected with HIV and TB often face the
complications that can occur when taking HIV medications with the drugs commonly used to
treat TB.
Hepatitis C (HCV)8, 9 is another virus found in the blood that is transmitted mostly through
blood to blood contact. Some people will recover from HCV within about 6 months after
getting infected but most people will remain infected. These people have what is referred to as
chronic HCV which over time will cause serious damage to the liver. HCV is found in 80
percent of people with HIV who have ever injected drugs and is similar in several ways to
HIV. Both viral diseases can have long periods between infection and the appearance of
clinical symptoms. Like HIV, HCV is spread through blood products, sharing needles, and the
failure to use precautions in medical settings to prevent exposure to blood and other potentially
infectious fluids. Unlike HIV, HCV can live a longer time outside of the body. Some studies
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say it can live up to 4 hours outside the body and others say up to 3 weeks. While HCV can be
sexually transmitted, this appears to be an unlikely route unless there is an exchange of blood.
It has been suggested that people co-infected with HIV and HCV have a more rapid
progression to liver disease. Co-infection of HIV and HCV can be challenging because the
HIV medications can be difficult for the liver to process.
10. WHAT IS THE IMPORTANCE OF DISCUSSING DOMESTIC VIOLENCE IN AN
HIV COUNSELING SESSION? WHAT ABOUT SEXUAL ABUSE?
Domestic Violence: Abuse in a relationship, or domestic violence, is any pattern of behavior
that is used to dominate, coerce, or control another person. Domestic violence occurs in all
communities, regardless of race, class, ethnicity, ability/disability, age, sexual orientation,
religion, education or lifestyle.
a. In California, in 2006 alone, there were 176,299 domestic violence related calls for
assistance to law enforcement agencies. 80,946 of the calls involved weapons.10
b. It is estimated that every year, spousal assault occurs in one out of six families in the
United States.
c. It is estimated that one million women per year are assaulted by their intimate
partners.11
d. On average, more than three women are murdered by their husbands or boyfriends in
this country every day.12
e. There were 3,319 reports of domestic violence in LGBT relationships in 2007.13
For some batterers, HIV disease may be used as an excuse for domestic violence. In addition,
violence may occur when a lover, family member, or roommate finds out about a person s HIV
status. The user may threaten to reveal the victim’s HIV status to others, threaten to leave a
partner who is sick, refuse to wear a protective barrier during sex, force or withhold sex based
on HIV status of the partner, or humiliate or blame the partner for HIV infection.
In assessing the impact of an individual’s HIV status on violence in a relationship, it is
important to consider: the abuse survivor’s knowledge and feelings about his or her own HIV
status; the abuser’s knowledge and feelings about his or her HIV status; the health status of the
abuse survivor; and the health status of the abuser.
Identifying whether a client is a victim or perpetrator of domestic violence impacts on many
aspects of the counseling session, such as:
a.
Whether or not the client will be compliant with the counselor’s recommendations,
e.g., notifying the partner if the clients tests HIV positive, or having the ability and
making the choice to engage in safer sex.
b.
The client’s life may be more at risk from domestic violence than from testing HIV
positive. The counseling session is a good opportunity to screen for possible partner
abuse that may be associated closely with the client’s HIV status. If the client is at
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risk for being a victim of severe abuse, an appropriate referral can be made that could
possibly save the client’s life.
c.
If the client is an abuser to a partner, the client could be receptive to getting help in
dealing with anger over the client’s or the partner’s HIV status and associated issues.
So this situation presents an opportunity to refer the client to an anger management
group or a batterer treatment program.
In sum, asking the client about domestic violence can provide the client with the opportunity to
discuss form of battering or sexual abuse which may impact on the client’s behavior when
he/she leaves the counseling session. It also impacts on how the counselor might approach risk
reduction and partner notification and to the referrals provided. And it could save a life.
Childhood Sexual Abuse:
Having a history of childhood sexual abuse puts someone at 6 times the risk for HIV. People
who have suffered sexual trauma are more likely to abuse drugs and/or alcohol and they are
more likely to engage in high risk sex (multiple partners, sex addiction, under the influence,
etc.). If reviewing a client’s sexual history, it is important to ask about past childhood sexual
abuse.
11. WHAT IS IMPORTANT TO KNOW ABOUT HIV+ WOMEN WHO ARE
PREGNANT?
This is the best news in the HIV epidemic: Perinatal HIV transmission is Avoidable! From the
beginning of the epidemic, women with HIV who were pregnant would infect their babies
about 25% of the time. Now, there are treatments available for pregnant women and for the
infants after birth which bring this statistic(25%) down to less than 1%.
Perinatal transmission can occur in three ways:
• In the uterus during pregnancy (blood)
• During birth (blood and genital secretions)
• After birth (breast milk)
Rates of HIV transmission from mother to infant in the U.S.:
• 25% without any treatment during or after pregnancy
• 9-13% with treatment only during labor or at birth
• 0.9% or less with antiretroviral therapy during pregnancy and labor, and the AZT
given to the newborn, if maternal viral load <1000 at delivery.
In the United States, perinatal transmission is extremely rare….but it still happens more
frequently in developing countries where treatments are not available and breastfeeding is
safer than other food sources, despite risk of transmission.
Factors that increase the likelihood of perinatal transmission of HIV include:
• Low CD4 count in mother
• High viral load in mother
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•
•
•
•
•
•
Drug use by mother
Active genital herpes or other sexually transmitted infection during labor
Prolonged rupture of membranes.
Infected “bag of water” during labor and delivery
Premature delivery
Breastfeeding
Pregnancy does not increase the viral load of the woman. Often though the CD4 count may be
slightly lower in pregnancy but this is a result of increased blood volume which is a
physiologic change of pregnancy.
If a mother’s viral load is less than 1000 at the time of the delivery, the rate of HIV
transmission is the same with a vaginal delivery as with a cesarean delivery.
In California, it is mandatory to offer HIV testing to a pregnant woman. In some other states,
mandatory testing is required of all pregnant women.
12.
IF SOMEONE TESTS POSITIVE FOR HIV, WHAT HAPPENS NEXT?
A positive HIV antibody test is scary news but it’s not a death sentence. As better therapies
continue to be developed, it’s entirely possible to live out a normal lifespan after testing
positive. The key to living a long life with HIV is seeking out the different types of health care
and suitable therapies. A positive result is an important medical message that may help you
save and extend your life. Whether you took the test or not, sooner or later you would have
learned of your HIV status. Here are some messages to give to clients testing positive:
o
o
o
o
o
o
o
o
o
HIV has become a chronic manageable disease
People can live healthy with HIV, many take medications
It is important to have medical follow-up with a doctor knowledgeable about HIV.
We will help you get connected to the best HIV doctors and support systems in the area
Your first appointment with an HIV doctor will involve more tests to see what shape
your immune system is in, and see how much HIV is in your body.
There is support for you. We can provide referrals of groups and organizations that
serve people living with HIV.
Many people are living with HIV and living happy, healthy lives. You are not alone.
We have referrals and other written materials for HIV+ people available in case you
want more information.
It will be important to identify people in your life who can provide emotional support
in the journey ahead living with HIV.
After testing positive for HIV, one of the first things a person should do is go see a doctor who
specializes in HIV care. The HIV specialist will do a variety of tests to determine how much
virus is in the body, and what shape the immune system is in. The following tests are the most
common tests used to assess the health of the immune system:
CD4+ cell count: This test measures the number of CD4+ cells present in a specific amount of
blood (test result expressed as a number value), and is correlated to some extent with
Center for Health Training/California 2009
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 7: HIV Education and Counseling
progression of disease in HIV infection. A “normal” CD4+ cell count is in the range of 500 to
1500 per micro liter of blood. People with illness, including HIV infection, might have lower
readings. Many treating physicians will start antiviral and anti-opportunistic condition
prophylaxis treatments at a CD4+ cell count of 300. A CD4+ cell count below 200 alone
results in an AIDS diagnosis
Viral load test: This test measures the amount of virus in the bloodstream. Results are strongly
associated with the rate of HIV disease progression and can indicate a continuum of increased
progression risk. HIV viral load levels appear to be more predictive of progression than does
CD4+ count, particularly in asymptomatic patients.
It is important to offer culturally appropriate resources for those testing positive for HIV. This
means paying attention to the gender, ethnicity, sexual orientation, etc of each client. It is
recommended that a resource list be available. There are many forms of HIV treatment that are
culturally appropriate and offer support to those living with HIV. It is key to check
periodically to make sure that the services are still accurate. It is also important to ensure
confidentiality when referring someone for services.
•
•
•
•
Don’t disclose the name of the client without prior consent.
Talk to the client and let him/her know what to expect when they go to a place
you refer them, (e.g. what kind of documents are they going to need to bring,
details about the process, languages spoken, hours of operation, etc.)
If possible, make the appointment for the client and/or help them think through
how they would get to the agency where they are being referred.
Try to help client identify who they could talk to for support and guidance once
they leave your clinic (friends, family, teacher, counselor, etc.).
Remember, everyone is different and will have a different way that their body responds to HIV
and a different way that they want to take care of their physical, spiritual, and mental health.
Reference Materials
1
Adapted from: “Building Quality HIV Prevention Counseling Skills: The Basic 1 Training A training
Curriculum for Counselors working in the context of HIV Counseling and Testing Trainer’s Manual” (1st Draft of
Sixth Edition, The AIDS Health Project at UCSF in collaboration with the Centers for Disease Control and The
California Department of Health Services, State Office of AIDS, HIV Education and Prevention Services Branch.
August 9, 2004.
2
Centers for Disease Control and Prevention. “Update: Universal precautions for prevention of transmission of
Human immunodeficiency Virus, hepatitis-B, and other blood borne pathogens in health-care settings”. MMWR
1988; 37:377-382387- 88.1.
3
HIV and Its Transmission CDC HIV/AIDS Fact Sheet -National Center for HIV, STD and TB Prevention,
9/22/03
4
Centers for Disease Control and Prevention, Department of HIV/AIDS. “Human Immunodeficiency Virus Type
2 Fact Sheet.” October 2009.
5
A Rapid Review of Rapid HIV Antibody Tests, Greenwald et al. Current Infectious Disease Reports 2006,
Center for Health Training/California 2009
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 7: HIV Education and Counseling
8:125-131
6
HIV and Its Treatment: What you should know, Health Information for Patients, September 23, 2005 Fact
Sheets AIDS INFO, A service of the U.S. Department of Health and Human Services.
7
Centers for Disease Control and Prevention, Department of HIV/AIDS. “The Deadly Intersection Between
Tuberculosis and HIV: Fact Sheet.” November 1999.
8
The Deadly Intersection Between TB and HIV, CDC HIV/AIDS Fact Sheet, 11/99
9
Co infection with HIV and Hepatitis C Virus, CDC HIV/AIDS Fact Sheet 11/05
10
California Partnership to End Domestic Violence, “DVAM 2007 Statewide Press Release.” September 2007.
www.cpedv.org/docs_2007/DVAM_2007_STATEWIDE_PRESS_REALEASE.pdfe
11
Bureau of Justice Statistics Data Brief. “Intimate Partner Violence 1993-2001.” February 2003.
12
Bureau of Justice Statistics Data Brief. “Intimate Partner Violence 1993-2001.” February 2003.
13
. “National Coalition of Anti-Violence Programs. “Lesbian, Gay, Bisexual and Transgender Domestic Violence
in the United States in 2007.” 2008.
http://www.avp.org/publications/reports/documents/2007NCAVPDVREPORT.pdf
Center for Health Training/California 2009
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 7: HIV Education and Counseling
The Six Steps of an STD/HIV Risk Reduction
Counseling Session
1. Introduce and orient client to session
2. Identify client’s personal risk behaviors and
circumstances
3. Identify safer goal behaviors
4. Develop client action plan
5. Make referrals and provide support
6. Summarize and close session
Definitions
Risk Behaviors: Transmission
These are the sex or drug-related actions that in and of themselves can result in
transmission of STDs, HIV or viral Hepatitis.
Safer Goal Behaviors: Prevention
These are specific actions that in and of themselves directly prevent or greatly
reduce STD/HIV transmission and that the client is willing to try to adopt.
Action Steps:
Specific incremental (baby) steps a client can take to help adopt a safer goal
behavior
Adapted from Fundamentals of HIV Prevention Counseling; CDC 1998 – Center for Health Training 2004
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 7: HIV Education and Counseling
Step 1: Introduce and Orient Client to Session
The purpose of Step 1 is very basic: to introduce yourself and describe the purpose and
duration of the session and respective roles.
Introduce yourself as a health counselor. Describe the purpose of the session, the
expected duration, and what you hope to achieve in the session. Seek consensus from
the client as to the objectives of the session and agreement to maintain this focus
throughout the session. Some clients may be at the clinic specifically requesting an
STD/HIV test, while others may not be aware of their risk.
During the session, be polite, professional, and display respect, empathy, and sincerity
to the client. Become involved and invested in the process and convey an appropriate
sense of concern and urgency about the client’s STD/HIV risk behaviors. Seek to deal
with the client’s concerns.
Suggested introductory statements or open-ended questions:
• Hi, my name is ____________and I will be your ____ counselor today.
• We will spend about ______ minutes together talking about _____________
• How are you doing today?
• What has been your experience with testing for STDs or /HIV in the past?
Informed Consent Issues:
• Before we start, I want to talk to you about our policy on confidentiality.
• What have you heard about anonymous vs. confidential testing?
• What do you know about this test? (tests for antibodies and not virus)
• A positive means that HIV was found in your blood, a negative means that it was not
found at this time- explain the window period.
• Explain your agency testing procedure (i.e. type of test, how long for results, etc.)
• I have a form that I have to fill out for our funding so I may ask you some questions
at the end of our session
Adapted from Fundamentals of HIV Prevention Counseling; CDC 1998 – Center for Health Training 2004
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 7: HIV Education and Counseling
Step 2: Identify Client’s Personal Risk Behaviors and Circumstances
With the client, identify the specific behaviors that place him or her at risk for STD or
HIV. Some clients may need to be informed of their risk. Focus the client on specific
behaviors, situations, and partner encounters that contribute to his or her risks. Attempt
to build from the problem (symptoms, referral, etc.) and the reasons that brought the
client to the clinic. Establish an atmosphere that conveys a collaborative and creative
exploration of the relevant issues.
Risk behaviors and their context:
Identify the sex or drug-use behaviors that can result in transmission of STD or HIV.
Identify the circumstances of those risk behaviors.
Suggested open-ended risk assessment questions:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
What brought you to the clinic today?
What makes you believe that you might be at risk for STD/HIV? What are you doing
in your life that might be putting you at risk for STD/HIV? When was the last time
that you put yourself at risk for STD/HIV?
When you have sex, do you generally have sex with men, women or both?
When you have sex, do you generally have anal sex, oral sex, vaginal sex or a
combination?
How many different people do you have sex with? How often?
When was the last time you had unprotected sex? What types of sexual behaviors
are you engaging in? Are your partner(s) men, women or both?
When do you have sex without a condom?
Have you been tested before? If so, when and why?
What were the results?
If you were infected in the past, how do you think you may have been infected?
How often do you use drugs or alcohol? How does this influence your STD or HIV
risk behaviors?
What is your experience with shooting up drugs? How often do you do this?
Do you ever share needles? When was the last time?
What was happening then?
What are the riskiest things that you are doing?
What are the situations in which you are most likely to be putting yourself at risk for
HIV or STD?
Adapted from Fundamentals of HIV Prevention Counseling; CDC 1998 – Center for Health Training 2004
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 7: HIV Education and Counseling
Step 3: Identify Safer Goal Behaviors
Behaviors that directly prevent or reduce transmission of STD/HIV.
Reinforce the client’s previous STD or HIV risk-reduction efforts, if any.
Identify specific safer goal behaviors that the client is willing to try to adopt.
Suggested open-ended questions to explore participant STD/HIV risk-reduction
attempts and safer goal behaviors:
•
•
•
•
•
Is there a specific time that you remember where you were able to practice
safer sex (used needles safely, used a condom)? What did you do? What
made it possible for you to do it? How was that for you?
What are you presently doing to protect yourself?
What could you imagine doing to reduce your risk of HIV or STD?
What do you see as advantages or good things about adopting __________ (the
safer behavior)?
What do you see as disadvantages or bad things about adopting ___________ (the
safer behavior)?
ABCD approach:
•
•
•
•
•
•
•
•
•
•
•
What has your experience been being abstinent in the past?
What would it be like for you to consider abstinence again?
Given that you are sexually active right now, how do you handle the issue of
monogamy or having more than one partner?
What would it be like for you to talk to your partner about monogamy or reducing
the number of other partners?
What would it be like to talk to your partner(s) about getting tested?
What is your agreement with your current partner about having other partners?
What has been your experience having only one partner?
What has been your experience using condoms with your partners?
What would it be like for you to only have sex using condoms with partners?
What has been your experience with using needles?
What would help you to use needles more safely?
Suggested statements reinforcing positive change already made:
•
• It’s great that you are here!
• You’ve taken the first step; which is a significant piece.
The fact that you are concerned about STD/HIV is important.
• It is important that you recognize that you’ve really been thinking about
reducing your STD/HIV risk.
• Look at how much you’ve already done to protect yourself (be specific).
Adapted from Fundamentals of HIV Prevention Counseling; CDC 1998 – Center for Health Training 2004
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 7: HIV Education and Counseling
Step 4: Develop a Personalized Action Plan
Help the client establish a personal plan to reduce his/her risks of STD/HIV. The plan
should be realistic yet challenging, and should address the specific behaviors identified
by the client during the risk assessment phase of the session. It should incorporate the
client’s previous attempts, perceived personal barriers, and perceived personal benefits
to reducing STD/HIV risk.
Discuss existing barriers to adopting the new behavior and what benefits there are.
Identify concrete, incremental steps the client can start to take to achieve his/her goals.
Discuss how the client will put the plan into operation, using specific and concrete steps.
Establish a back-up plan. Confirm that this plan is personalized and acceptable to the
client. Solicit questions and reinforce the client’s initiative in agreeing to negotiate a
risk-reduction plan.
Suggested open-ended questions to explore STD/HIV risk reduction attempts and
questions to explore personal barriers and benefits to adopting safer behaviors:
• What makes it easy (what situations make it easier for you) to ___________ (the
safer behavior)?
• Who (individuals or groups) would approve or support you in adopting ___________
(the safer behavior)?
Suggested open-ended questions to use when assisting the client to develop a personal
risk-reduction plan:
• What one thing can you do to reduce your risk now?
• What can you do that would work for you now?
• What could you do differently now? In the future?
• How would your sexual/drug use practices have to change for you to stay safe?
• Now that you’ve identified these steps that you could take, how can you go about
making these things happen?
• What could you do to make it easier to take these steps?
• Who would help to support you in taking these steps?
• When do you think you will have the opportunity to first try this?
• How realistic is this plan for you?
• What will be the most difficult part for you?
• What might be good about changing this?
• What will you need to do differently?
• How will things be better for you if you __________?
• How will your life be easier or safer if you change __________?
• How would your drug practices have to change to stay safe?
Suggested statements supporting and reinforcing the client:
• You have really done something good for yourself in putting this plan into place.
• You’ve taken very positive steps today to help meet some important personal goals.
Adapted from Fundamentals of HIV Prevention Counseling; CDC 1998 – Center for Health Training 2004
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 7: HIV Education and Counseling
Step 5: Make Referrals and Provide Support
Identify client peer and community support for STD/HIV risk reduction, as well as
provide referral to professional services directed at addressing specific issues the
patient may have identified.
Steps for Effective Referrals
•
•
•
•
•
•
•
Help client define priorities
Discuss and offer options
Offer referrals
Refer to known and trusted services
Assess client response to referral
Facilitate active referral
Develop a follow-up plan
Suggested questions:
• We’ve talked about a lot of issues today. Which of the things we’ve talked about
would you like more help with?
• Would you like to talk with an individual counselor about __________ (issue that has
been raised)? Would you be interested in a support group?
• Is there a particular kind of support or service that you would be willing to consider?
Step 6: Summarize and Close Session
Briefly summarize issues and plans that have been discussed and identify the
next steps that the client has agreed to take. Assist with any necessary followup appointments. Encourage and support client in progress.
•
•
•
Identify major points, including feelings that have been discussed, and tie
them together.
Formulate a concise statement of client’s issues and decisions, including
content, feelings, and connection between them.
Check that client “owns” the summary.
Signs of ineffective summarizing, closure:
•
•
•
Client balks, says you have missed the main or major point(s)
Client does not leave
Client leaves without acknowledging an understanding of what has been discussed
Adapted from Fundamentals of HIV Prevention Counseling; CDC 1998 – Center for Health Training 2004
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 7: HIV Education and Counseling
FAMILY PLANNING COUNCIL – Definitions of HIV Related Services 2008
Prevention Counseling
Prevention
Counseling
Servicessession is a discussion with a client that focuses on the
A Prevention
counseling
client’s own unique circumstances and needs. Its goal is to assist the client in
A Prevention
Counseling
sessionthat
is aput
discussion
a client
thatunintended
focuses on the
client’s own
identifying
behaviors
her/himwith
at risk
for an
pregnancy
andunique
circumstances and needs. Its goal is to assist the client in identifying behaviors that put her/him at risk for an
acquiring an STD or HIV. In addition, prevention counseling should assist the
unintended pregnancy and acquiring an STD or HIV. In addition, prevention counseling should assist the
client in supporting positive health behaviors in which she/he is already
client in supporting positive health behaviors in which she/he is already engaged (e.g.; the use of
engaged
(e.g.;
the use monogamous
of contraception,
condoms,
abstinence,
monogamous
contraception,
condoms,
abstinence,
relationship,
seeking routine
reproductive
health care).
relationship, seeking routine reproductive health care).
A prevention counseling session can be delivered at each client visit and should be coded each time that it is
A Prevention
prevention
counseling
session
bedocumented
delivered in
at aeach
client
and
should of the
provided.
counseling
should
also becan
clearly
client’s
chart visit
so that
continuity
be
coded
each
time
that
it
is
provided.
Prevention
counseling
should
also
be
behavior-based counseling can be addressed.
clearly documented in a client’s chart so that continuity of the behavior-based
You have
counseling
provided a Prevention
can be addressed.
Counseling Session when all 3 of the following criteria have been met:
1.
risk assessment,
including
a discussion
of Client
YouDiscussed/updated
have provided aa client
Prevention
Counseling
Session
when allof3the
of ABCs
the following
Centered
Disease
Prevention
and
the
identification
of
client
personal
risk
behaviors
and
criteria have been met:
circumstances. Assessment questions can include: “Have you abstained from having sex as a way
of preventing
STDs, HIV and unintended
pregnancy?”
“Howthrough
many partners
have you had in the
1. Discussed/updated
a client risk
assessment
the identification
last 3 months?”
“Did
you
use
condoms
the
last
time
you
had
sex?”
“What
do
you want to do to
of client personal risk behaviors and circumstances. Assessment
protect yourself from HIV, STD’s and unintended pregnancy?”
questions can include: “What do you want to do to protect yourself
from HIV, STD’s and unintended pregnancy?” “Did you use condoms
2. Explored what the client would like to do to:
the last time
you had
sex?”
“How
many partners
have
a. Continue
to support
positive
health
behaviors
(eg.; existing
useyou
of had in the
last
3
months?”
contraception/condoms)
2. Reduce
Explored
what the
would at
like
to(eg.;
do to:
b.
behaviors
thatclient
put her/him
risk
multiple sexual partners, not using
a.
Continue
to
support
positive
health
behaviors (eg.; existing use of
contraception/condoms)
contraception/condoms)
b. Reduce
that
her/him
at risk (eg.;
3. Discussed with
client thebehaviors
development
of put
specific
and concrete
steps multiple
to achievesexual
or maintain
using
contraception/condoms)
positive healthpartners,
behaviorsnot
(e.g.:
abstaining
from sex, use of birth control and condoms, mutually
and b,c,d and
and econcrete
as needed: steps
monogamous
relationship).
This
should
include
a. always
3. Discussed with client the development
of specific
a. Client
identifies
least 1 way
she/he can
continue
to support
positive
behaviors or to
to achieve
or at
maintain
positive
health
behaviors
(e.g.:
usehealth
of birth
reduce
behaviors
that
put
her/him
at
risk
right
now
(e.g.;
limit
their
number
of
sexual
control and condoms, mutually monogamous relationship). This should
partners,
contraception/condoms)
and b,c,d and e as needed:
includeuse
a. always
b. Client
requests/receives
factual
information/education
a. Client identifies
at least
1 way she/he can continue to support
c. Clients chooses
to
be
tested
for
STDs/HIV
pregnancy
positive health behaviors or toorreduce
behaviors that put her/him
d. Client chooses to be provided with contraception/condoms, emergency contraception
at risk right now (e.g.; limit their number of sexual partners, use
e. Client requests/receives referrals or follow-up appointment
contraception/condoms)
f. Others as identified by client or counselor
b. Client requests/receives factual information/education
c. Clients
chooses
to be tested for STDs/HIV or pregnancy
Related Prevention
Counseling
Codes:
d.
Client
chooses
to
be provided
HIV Prevention Counseling:
941 with contraception/condoms,
HIV Resultsemergency
Counseling contraception 943
e. Prevention
Client requests/receives
referrals
Pregnancy
Counseling:
946 or follow-up appointment
f.
Others
as
identified
by
client
or counselor
STD Prevention Counseling:
918
Prevention Counseling Codes:
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 7: HIV Education and Counseling
FAMILY PLANNING COUNCIL – Definitions of HIV Related Services 2008
HIV Testing
HIV Prevention Counseling: 941
Pregnancy Prevention Counseling: 946
STD Prevention Counseling: 918
HIV Test Codes:
HIV - 1 Rapid Test (blood)
821
HIV Testing
- 1 Rapid Test
(oral swab)is a prerequisite
822
Note: HIV
Prevention
Counseling
to providing HIV Testing
HIV - 2 Rapid Test (oral swab)
HIV - 2 Rapid Test (blood)
HIV -Test
Codes:
HIV
1 OraSure
Test (oral swab)
HIV 1 - Serum:
HIV - 1 Conventional
Serum871
HIV - 2 Conventional
Serum
HIV 1 - Oral:
824
823
820
824
871
872
HIV 1 - Rapid (Blood): 821
HIV Results Counseling
HIV antibody test results must be provided to a client in person. Knowledge of HIV status is important
information that a client can use to explore behaviors that enable them to stay HIV negative or manage an HIV
positive test result. HIV Results Counseling minimally includes:
1.
2.
3.
4.
Determination of client readiness to receive test result
Explanation of Test Result and ensure that client understands what result means
Renegotiation or reinforcement of existing plan for reducing risk, considering client’s HIV status
Linkages to HIV Case Management Services, partner management and other related services as needed
HIV Results Counseling Code:
943
Documentation of the Provision of “Prevention Counseling” Services
Details of a Prevention Counseling Session should be clearly documented in a patient’s chart each time that it is
provided. This will help to ensure that continuity of the behavior-based counseling can be addressed. Examples
of chart documentation include:
1. Discussed/updated a client risk assessment, including a discussion of the ABCs of Client Centered
Disease Prevention
a. Patient states uses condoms for protection against STD’s/HIV and unintended pregnancy but did
not use a condom last time she had sex
b. Patient has had 2 sexual partners in last 3 months, inconsistently uses condoms
c. Patient has been in a mutually monogamous relationship for 1 year
2. Explored what the client would like to do to:
a. Continue to support positive health behaviors
• Patient would like to continue to use Depo-Provera
b. Reduce behaviors that put her/him at risk
• Patient would like to use condoms with Depo-Provera
3. Discussed with client the development of specific and concrete steps to achieve or maintain
positive health behaviors
a. Patient will continue use of Depo-Provera and will use condoms consistently with sexual partners
b. Patient plans to reduce their number of sexual partners
c. Patient requests
emergency
contraception
and birthincontrol
pills Health
Roadmap
to Integration:
HIV Prevention
Reproductive
Tab 7: HIV Education and Counseling
Family Planning Council / TRAINING 3 – August, 2009
Prevention Counseling Observation/Coaching Tool
Site: ________________________________
Date: _________________________
Staff Name: ________________________
Evaluator: _____________________
Visit Type: __________________________
Step 1: Introduction
• Introduce him/herself and role and purpose of session
• Identify client’s reason for visit
• Identify client’s primary needs and concerns for visit
YES
YES
YES
NO
NO
NO
PARTIALLY N/A
PARTIALLY N/A
PARTIALLY N/A
Step 2: Help Client Identify Personal Risk Behaviors and Circumstances
• Obtain/update client sexual history
YES NO
PARTIALLY N/A
• Identify client risk factors for potential needs related to:
o Unintended Pregnancy
YES NO
PARTIALLY N/A
o Acquiring an STD/HIV
YES NO
PARTIALLY N/A
• Discuss the ABCs of Client Centered Disease Prevention
YES NO
PARTIALLY N/A
• Identify the circumstances that lead the client to engage in behaviors that put them at risk for: (i.e.,
with whom, where, how and when risk behaviors occur)
o Unintended Pregnancy
YES NO
PARTIALLY N/A
o Acquiring an STD/HIV
YES NO
PARTIALLY
• Provided client with information as needed on:
o Birth Control
YES NO
PARTIALLY N/A
o STDs
YES NO
PARTIALLY N/A
o HIV
YES NO
PARTIALLY N/A
Step 3: Help Client Identify Goal Behaviors to Prevent Unintended Pregnancy and STDs/HIV
• Identify and support client’s previous risk reduction efforts to
o Avoid unintended pregnancy
YES NO
PARTIALLY
o Avoid acquiring STDs/HIV
YES NO
PARTIALLY
• Identify and explore ways client can reduce their risk of:
o Unintended Pregnancy
YES NO
PARTIALLY
o Acquiring STDs/HIV
YES NO
PARTIALLY
Step 4: Develop Client Risk Reduction Plan to Achieve Goals
• Help the client develop specific and concrete steps to reduce their risk of:
o Unintended Pregnancy
YES NO
o Acquiring STDs/HIV
YES NO
• Confirm with client that the steps are reasonable and acceptable as they relate to:
o Unintended Pregnancy
YES NO
o STDs/HIV
YES NO
• Offered the following services to client as appropriate:
o Birth Control
YES NO
o STD Testing
YES NO
o HIV Testing
YES NO
Title X HIV Prevention Project
Roadmap to Integration: HIV Prevention in Reproductive Health
N/A
N/A
N/A
N/A
PARTIALLY N/A
PARTIALLY N/A
PARTIALLY N/A
PARTIALLY N/A
PARTIALLY N/A
PARTIALLY N/A
PARTIALLY N/A
1-08
Tab 7: HIV Education and Counseling
Family Planning Council / TRAINING 3 – August, 2009
Step 5: Make Follow-up Appointment and Referrals as Needed
• Assessed need for
o Follow-up Appt.
o Referrals
YES
YES
NO
NO
PARTIALLY N/A
PARTIALLY N/A
Step 6: Summarize and Close Session
• Summarize and close session
YES NO
PARTIALLY N/A
• Reviewed/Updated client contact information (may occur at beginning or end of session)
YES NO
PARTIALLY N/A
Demonstration of Counseling Skills and Concepts
•
•
•
•
•
•
•
Offering options, not directives
Open ended questioning
Giving Information Simply
Attending
Focus on Feelings
Setting boundaries
Manage own discomfort
HIV Counseling and Testing
• Client was offered HIV Prevention Counseling
• Client was offered HIV Testing
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
PARTIALLY
PARTIALLY
PARTIALLY
PARTIALLY
PARTIALLY
PARTIALLY
PARTIALLY
N/A
N/A
N/A
N/A
N/A
N/A
N/A
YES
YES
NO
NO
PARTIALLY N/A
PARTIALLY N/A
Evaluator’s General Comments:
_______________________________________________________________________________________
_______________________________________________________________________________________
Areas of Strength:
_______________________________________________________________________________________
_______________________________________________________________________________________
Recommended Area(s) of Improvement:
_______________________________________________________________________________________
_______________________________________________________________________________________
Were comments discussed with staff member YES
NO
Title X HIV Prevention Project
Roadmap to Integration: HIV Prevention in Reproductive Health
1-08
Tab 7: HIV Education and Counseling
Family Planning Council / TRAINING 3 – August, 2009
Prevention Counseling Observation/Evaluation for Family Planning Clinic Staff
Instructions for Family Planning Staff Members
The goal of this exercise is to assess the skill level of family planning staff in the delivery of a prevention counseling
session to a client according to Family Planning Council guidance (see attached “Prevention Counseling” definition). It
is also an opportunity to assess the use of some very basic counseling concepts and skills that should be employed
during a prevention counseling session.
An evaluator will observe a session between a client and a family planning staff member (nurse, clinician, counselor)
with the patient’s consent. The evaluator will use the “Prevention Counseling Observation Tool” attached to assess
staff performance related to the concepts listed on the tool. Feedback will be provided to the staff member at the close
of the session. Feedback should include the positive elements of the session as well as comments on specific areas that
may need to be strengthened.
The performance appraisal is observed and assessed with a NO, YES or PARTIALLY response:
NO: This rating applies to a counseling step, skill or concept that was not demonstrated.
YES: This rating applies to a counseling, skill or concept that was demonstrated.
PARTIALLY: This rating applies to a counseling step, skill, or concept that was observed, but could be improved.
N/A= Not Applicable: This rating applies to a limited number of behaviors within the counseling steps, when they are
inappropriate to attempt, are unnecessary, or do not apply to the counseling session’s progress.
Additionally, please find on the back of this document a description of counseling concepts and skills that will be
observed during the prevention counseling session.
Title X HIV Prevention Project
Roadmap to Integration: HIV Prevention in Reproductive Health
1-08
Tab 7: HIV Education and Counseling
Family Planning Council / TRAINING 3 – August, 2009
Prevention Counseling Observation/Evaluation for Family Planning Clinic Staff
Instructions for Evaluators
Observation and evaluation of clinic staff in the provision of prevention counseling services to clients is a valuable
way to assess performance. The goal of this exercise is to assess the skill level of family planning staff in the delivery
of a prevention counseling session to a client according to Family Planning Council guidance.
The observation form is designed to be completed after the evaluator has observed a session between a client and a
staff member. When you provide feedback to the staff member you may want to identify the positive elements of the
session as well as comment on specific areas that may need to be strengthened.
To complete this form, circle a single rating for each item by indicating:
NO: This rating applies to a counseling step, skill or concept that was not demonstrated.
YES: This rating applies to a counseling, skill or concept that was demonstrated.
PARTIALLY: This rating applies to a counseling step, skill, or concept that was observed, but could be improved.
N/A= Not Applicable: This rating applies to a limited number of behaviors within the counseling steps, when they are
inappropriate to attempt, are unnecessary, or do not apply to the counseling session’s progress.
Additionally, please find on the back of this document a description of counseling concepts and skills that will be
observed during the prevention counseling session.
Title X HIV Prevention Project
Roadmap to Integration: HIV Prevention in Reproductive Health
1-08
Tab 7: HIV Education and Counseling
Family Planning Council / TRAINING 3 – August, 2009
The 6 Steps of Prevention Counseling
1. Introduce and orient client to session
2. Identify client’s personal risk behaviors and circumstances.
3. Identify safer goal behaviors
4. Develop client risk reduction plan
5. Make referrals and provide support
6. Summarize and close session
Description of Counseling Concepts and Skills
Counseling Concepts:
Focus on Feelings
Bring up, listen to, and respond to client’s feeling-level reactions, beliefs, and issues.
Manage Your Own Discomfort
Manage our own values when assisting clients I behavior change. Recognize our discomfort so that we keep it from
becoming a barrier between our clients and us.
Set Boundaries
Set boundaries between our own roles and responsibilities and our clients’. Do not feel responsible for a client’s
behavior and decisions or because we want to solve all of their problems.
Counseling Skills:
Open-Ended Questioning
Questions that require more than a “yes” or “no” answer.
Attending
Physically showing the client that we are listening, which requires using positive nonverbal behavior.
Offering Options, Not Directives
Giving the client firm control over change decisions – by offering options rather than issuing directives.
Giving Information Simply
Use simple, non-technical words – be brief and to the point – address client needs specific to their concerns – saying,
“I don’t know” is OK. We do not need to volunteer information about “HIV 101” if it is not appropriate to the client’s
circumstances.
Title X HIV Prevention Project
Roadmap to Integration: HIV Prevention in Reproductive Health
1-08
Tab 7: HIV Education and Counseling
HIV EDUCATION / INFORMATION / COUNSELING GUIDE
Type
When to use
Routine (screening)
Enhanced (risk-based)
When a client receives a test as part of an annual
routine screening, assuming the client has not
been exposed to the HIV virus by having sex
without a condom or by sharing needles, i.e., has
not engaged in risky behavior.
When a client has engaged in behaviors that
put them at risk for HIV infection (e.g., having
sex with someone without using a barrier
method or sharing needles).
Pre-Test
Discuss:
• The voluntary, confidential nature of testing
– including written consent.
• The test procedure.
• How client will receive the result and method
of follow up if client does not return for
result.
• How HIV is transmitted and risk factors,
including ABCs of prevention.
• The meaning of test result and “window
period” (time for which a client who is
actually HIV positive could still receive a
negative test result).
Discuss:
• Personal risk behaviors.
• How HIV is transmitted.
• The voluntary, confidential nature of
testing – including written consent.
• The test procedure.
• The meaning of test result and “window
period” (time for which a client who is
actually HIV positive could still receive a
negative test result).
• How client will receive the result and
method of follow up if client does not
return for result.
• Risk reduction and infection prevention
information, including ABCs of
prevention.
Post-Test
Negative Test Result - discuss:
• The meaning of a negative test result.
• Reinforcement of healthy behaviors.
• When to return for another test.
• Referral services, if needed.
Negative Test Result - discuss:
• The meaning of a negative test result.
• Reinforcement or re-negotiation of risk
reduction plan.
• When to return for another test.
• Referral services, if needed.
Positive Test Result - when client receives a
preliminary positive or confirmed positive HIV
test result:
• Determine the client’s readiness to receive
a result.
• Interpret the result and ensure that the
client understands what the result means.
• If the result is a preliminary positive,
discuss and arrange for a confirmatory test.
• Assess the client’s immediate needs for
medical, psychological and social
supports.
• Provide appropriate referrals for medical
evaluation or treatment, and for other
identified needs.
• Discuss measures for the prevention of
transmission of HIV
• Discuss partner notification issues.
• Schedule follow up appointment, if
appropriate.
Positive Test Result - when client receives a
preliminary positive or confirmed positive HIV
test result:
SAME AS >>>>>>>>>
Written
materials
Routine HIV Education / Information /
Counseling may be supplemented by written
materials that are culturally sensitive, appropriate
to the client’s reading level, and in languages
served at the site.
Enhanced HIV Education / Information /
Counseling may be supplemented by written
materials that are culturally sensitive,
appropriate to the client’s reading level, and in
languages served at the site.
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 7: HIV Education and Counseling
Questions to Support Behavior Change
•
•
•
•
•
•
•
•
•
•
•
•
What do you think about your risks for HIV?
You seem nervous talking about this.
Who do you know that's been tested for HIV?
Based on what you’ve told me, you are at some risk for
HIV.
How can you bring this up with your partner?
What's the first thing you'll say to your partner?
Who can support you with this decision?
Good for you! You’ve really given this some thought.
So how has it been to use condoms some of the time?
What would it be like to talk to your friends about this?
How are you rewarding yourself for making this change?
Who can help you stick with this change?
centerforhealthtraining.org
Questions to Support Behavior Change
•
•
•
•
•
•
•
•
•
•
•
•
What do you think about your risks for HIV?
You seem nervous talking about this.
Who do you know that's been tested for HIV?
Based on what you’ve told me, you are at some risk
for HIV.
How can you bring this up with your partner?
What's the first thing you'll say to your partner?
Who can support you with this decision?
Good for you! You’ve really given this some thought.
So how has it been to use condoms some of the time?
What would it be like to talk to your friends about this?
How are you rewarding yourself for making this change?
Who can help you stick with this change?
centerforhealthtraining.org
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 7: HIV Education and Counseling
Preguntas para respaldar los cambios de comportamiento
·
·
·
·
·
·
·
·
·
·
·
·
¿Qué piensa sobre sus riesgos de VIH?
Se lo ve nervioso al hablar sobre esto.
¿A quién conoce que le hayan hecho un análisis de VIH?
En base a lo que me dijo, usted corre cierto riesgo de VIH.
¿Cómo podría contarle esto a su pareja?
¿Qué sería lo primero que le diría a su pareja?
¿Quién lo puede apoyar con esta decisión?
¡Lo felicito! Usted de verdad lo ha estado pensado.
¿Cómo le ha ido con el uso de condones por un tiempo?
¿Qué le parecería hablar sobre esto con sus amigos?
¿Cómo se recompensa o premia a sí mismo por haber hecho este cambio?
¿Quién le puede ayudar a mantener este cambio?
centerforhealthtraining.org
Preguntas para respaldar los cambios de comportamiento
·
·
·
·
·
·
·
·
·
·
·
·
¿Qué piensa sobre sus riesgos de VIH?
Se lo ve nervioso al hablar sobre esto.
¿A quién conoce que le hayan hecho un análisis de VIH?
En base a lo que me dijo, usted corre cierto riesgo de VIH.
¿Cómo podría contarle esto a su pareja?
¿Qué sería lo primero que le diría a su pareja?
¿Quién lo puede apoyar con esta decisión?
¡Lo felicito! Usted de verdad lo ha estado pensado.
¿Cómo le ha ido con el uso de condones por un tiempo?
¿Qué le parecería hablar sobre esto con sus amigos?
¿Cómo se recompensa o premia a sí mismo por haber hecho este cambio?
¿Quién le puede ayudar a mantener este cambio?
centerforhealthtraining.org
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 7: HIV Education and Counseling
Disclosing Reactive Rapid HIV Results:
1. Disclose reactive/positive rapid test result
State result in a direct and neutral tone “your rapid test result was reactive, which means
something in your blood caused a reaction.”
Note: Some people prefer to use the word positive or preliminary positive, however, keep
in mind that for many clients, the word “positive” means you have HIV, and can be
confusing.
2. Remind client of what this test result could mean
o
o
o
o
o
o
o
o
o
o
o
This is a screening test, which is the first layer of HIV testing
We now need to do another blood test to confirm whether this result is accurate
We send this blood sample to a lab. This second test is called a confirmatory test.
This result may mean that you have HIV but we won’t know until the
confirmatory test result is back.
The confirmatory result sometimes comes back negative, sometimes comes back
positive at this clinic (NOTE: tailor this message to your clinic and experience)
If the confirmatory result is positive, it means you have HIV.
If the confirmatory result is negative, it means that you do not have HIV, but
something in your blood reacted with this first test.
This is a screening test and one way to explain it is “its like getting called back on
a mammogram, or like setting off the metal detector at the airport with your cell
phone.” (doesn’t mean you have breast cancer, or that you have weapons)
If the client is really anxious, review the percentage that might be false positives
or negatives (know the statistics for the rapid test(s) you are using).
Some clients will want to know what can trigger a discordant result or false
positive. A few things that can trigger the test include multiple consecutive
pregnancies, auto-immune disorders, and active syphilis.
Review how long it takes to get back confirmatory results. Offer to make the
client an appointment to come back in and get the confirmatory test results. Make
sure you have current contact information incase they do not return.
3. Be prepared to discuss “What if I am really positive, then what”?
Messages to give to the client:
o
o
o
o
o
o
o
o
HIV has become a chronic manageable disease in the last few years.
People can live healthy with HIV, many take medications
It is important to have medical follow-up with a doctor knowledgeable about HIV.
We will help you get connected to the best HIV doctors and support systems in the area
Your first appointment with an HIV doctor will involve more tests to see what shape your
immune system is in, and see how much HIV is in your body.
There is support for you. We can provide referrals of groups and organizations that serve
people living with HIV.
Many people are living with HIV and living happy, healthy lives. You are not alone.
We have referrals and other written materials for HIV+ people available in case you want
more information.
Center for Health Training 2007 Adapted from Building Quality HIV Prevention Counseling Skills: The Basic 1 Training UCSF AIDS Health
Project and California State Office of AIDS 2004
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 7: HIV Education and Counseling
4. If appropriate, talk about the most recent HIV risk behaviors
o Ask about recent sexual/drug related HIV risk behaviors
o Explain that if there has been recent risk, they may be in the process of
seroconverting from negative to positive
o Ask about sexual partner(s).
o Ask about needle sharing, and other drug and alcohol related activity
o Ask about the number of partners in the past year.
o Ask about how often and what type of protection (if any) was used during sex.
5. Discuss strategies to reduce or avoid HIV risk behavior
o
o
o
o
o
Until confirmatory result is back, encourage clients to act as if they are positive
What does this mean for the client?
What behaviors would they want to change, if any?
What is realistic for this client to change for the next week or two
Ask whether the client has questions about how to reduce their HIV risk related to
sex and drug or alcohol use.
6. Assess the client’s emotional state and feelings
o Does the client seem anxious, relaxed or indifferent about this test result?
o Check in: “How are doing with all of this”?
o “What would be most helpful to you right now”?
o Ask if they have anyone that they can share this information with. If not, do they want #
to HIV hotlines or counselors?
o Give them a card with your clinic phone # and write HIV Coordinator or your name on
the card for direct contact name. Tell them to call if they have any questions.
7. Explore information and thoughts
o Assess the client’s understanding of the test result again and clarify misconceptions.
o You may need to repeat the information again
o Review the possibility of the confirmatory coming back negative about it probably being negative, and
the possibility that it may be positive.
o Ask about other information that might be helpful while waiting for the confirmatory results.
o Explain that you will be drawing blood today for the confirmatory test, and the result will take
one week (whatever your clinic turnaround time is).
8. Identify sources of support
o
o
o
o
o
Assess the strength of the social support for this client
Explore plans for and consequences of disclosure to others
“Who knows that you are here today?”
Help client decide who they might want to talk to about this
Let them know what your/your staff availability is if they want to call you or your clinic
again.
Center for Health Training 2007 Adapted from Building Quality HIV Prevention Counseling Skills: The Basic 1 Training UCSF AIDS Health
Project and California State Office of AIDS 2004
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 7: HIV Education and Counseling
9. Review strategies for coping with the result- short and long term
o Explore how they have handled stressful situations in the past- what are their coping
mechanisms- talking to people, seeking spiritual counsel, being in nature, etc.
o Assess what the rest of their day/night looks like: “What is your plan for later today after
leaving here? Where are you going to go, how are you getting there, etc.
o “How are you feeling about this week while you are waiting for your confirmatory
result?”
o Explain your availability during the waiting time, if applicable.
o Ask what they will do if they are feeling anxious.
o Assess who is in their support system that can be helpful during the wait.
o Give out support numbers (AIDS hotline, suicide prevention, etc.)
10. Provide referrals and closure:
o Provide reassurance and grounding to the client before they leave the session.
o Provide any referrals for support while waiting for results
o Provide other referrals related to HIV medical care and emotional support as needed.
11. Draw blood for the confirmatory test
o Emphasize how important it is to come back for the confirmatory result.
o Make an appointment for the result (if possible with you for continuity).
Center for Health Training 2007 Adapted from Building Quality HIV Prevention Counseling Skills: The Basic 1 Training UCSF AIDS Health
Project and California State Office of AIDS 2004
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 7: HIV Education and Counseling
How to Make an Effective Referral
1. Create a one-page listing of local agencies that you know and trust. Try to update this
list every six months so that it is current. Try to give clients options on this list. This list
might include information about safer sex groups, recovery groups, and HIV hotlines.
2. Stress the importance of a referral appointment. Explain how the referral can help the
client. If the client just learned they have HIV, they may be in shock and need more
assistance. Help them to understand the importance of medical follow up and emotional
support.
3. Personalize the referral. Explain as much as you can about what to expect at the
appointment. Give the client a clear idea of what will happen, who she will see, etc.
Clients who speak languages other than English will need to know which agencies have
staff that is bilingual. Review what questions will be asked and how long it will take.
(E.g. “The first medical appointment after testing positive can take ____ because they are
____.”
4. Relieve the client's anxiety. Take the time to accept the person's fears, ask if there's
anything that they are particularly concerned about. Encourage the person to call if there
are any questions or further concerns that should arise.
5. Explain what costs the client can expect. This requires keeping your referral files up to
date about fees and whether Medicare patients are accepted.
6. Explain how to prepare for the referral visit (if appropriate). Review any documents
needed for the visit, special preparations needed, etc. Also tell clients what to say when
they arrive for the referral appointment (I was referred to you by...).
7. Protect the client's confidentiality. Ask the client's permission to send medical records,
etc. if needed. Only send information that is necessary to the referral problem and nothing
more.
8. Repeat the referral information or provide written information. Write down the
address, phone number and contact person's name. Write it down and ask the client to
repeat it to you. If having a written referral might threaten a client’s safety (i.e. domestic
violence), make sure you give them easy to remember information.
9. Document the referral in the client's record. Client was referred to...
10. Ask client for feedback about the referral. Sometimes we inadvertently send clients to
places that have just recently changed services and the referral agency is different than
what we have described to clients. Make sure you tell clients to come back if there is any
problem with the referral you gave.
11. Follow-up on referrals given. Ask the client about the referral when they come back for
their next visit. If you don’t ask follow up questions on the client’s next visit, you may
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 7: HIV Education and Counseling
never get feedback.. HIV organizations get funded and lose funding regularly so it is
really important to do this follow up with clients.
NOTE: Identify staff who can call referrals every six months to make sure they are current.
If the task is shared, it doesn’t take a lot of time. It is worth it not to send clients to a bad
referral which will reflect poorly on you or your agency.
ABOUT MAKING CLIENT REFERRALS
Making needed and appropriate referrals for clients, particularly those who are HIV positive, is
an essential component of HIV prevention services. As applicable to their individual needs,
clients should have access to medical, prevention and social support services. Additionally, these
services should be gender, culturally, linguistically and age appropriate
HIV referral services can include:
• Medical care and treatment
• Partner counseling and referral
• Family planning/reproductive health services
• Substance abuse prevention and treatment
• Mental health services, case management
• Peer counseling and support
• STD screening and treatment
Key elements of the referral include:
• Evaluating and prioritizing the client’s needs
• Planning the referral
• Facilitating Access to the referral service(s)
• Documenting, tracking and following up to ensure that the client has accessed the needed
service(s).
It is essential that providers have a working knowledge of the referral resources in their
community and develop collaborative relationships with organizations that are able to offer client
support services. Most family planning providers are well acquainted with the resources in their
community.
Roadmap to Integration: HIV Prevention in Reproductive Health
Roadmap to Integration: HIV Prevention in Reproductive Health
Who, what, when, how, how many, where, tell me.
Avoid technical terms and jargon.
Demonstrate accurate and up-to-date information to limits
of ability. Clearly state when information lacking, but
offer to find out.
Using open-ended
questions
Communicating at clients
level
Giving factual information
Adapted from Center for Health Training Materials
By Development Systems, Inc; 10/2006
Explore further, provide information, make referrals, and
/or note on chart when issues / problems arise.
What to Look For
Addressing significant
problems
Comments
Development Systems, Inc.
Grant #U65/CCU724366-02
Take advantage of opportunities to affirm, such as “I’m
glad you asked that,” “You’re on the right track.”
Name
Affirming client
Name
Display respect, empathy and sincerity. Polite. Seek out
and deal with client concerns.
Name
Establishing rapport
Name
Display self-confidence, competence, dependability,
preparation, integrity, appropriate seriousness.
Convincingly convey commitment to confidentiality.
Non-judgmental, objective about behavior and lifestyle.
Name
Demonstrating
professionalism
Communication Skills
Activity
Name
SCALE: V = Very Good; G = Good; F = Fair; N = Not Observed; NA = Not Applicable
Date: _________________________________________________________________________________
Clinic: ________________________________________________________________________________
Agency: _______________________________________________________________________________
Client – Centered Care / Communications Observation Form
Tab 7: HIV Education and Counseling
Roadmap to Integration: HIV Prevention in Reproductive Health
Reinforcing healthy
behaviors
Helping client determine
what risk-reduction
behaviors she will make
Increase client’s
awareness of ability to
change
Increase client’s
awareness of support
systems
Exploring options for
alternative behaviors
Helping client assess own
needs
Adapted from Center for Health Training Materials
By Development Systems, Inc; 10/2006
Acknowledge small steps.
Invite client to describe what she can / will do.
Determine who client can talk with, where she can find
support.
Elicit from client her feelings about competencies and
skills.
Elicit ideas and thought from client regarding her willing
ness to take steps.
Ask open-ended questions to elicit client’s awareness of
risk-taking behaviors.
Assesses client’s current status, i.e., pre-contemplation,
contemplation, preparation, action & maintenance.
Body language and other communication skills do not
alter when sexuality is discussed; open non-judgmental
regarding range of sexual behaviors, values.
Acknowledge client: uh-huh,, I see, really, head nods.
Using non-committals
Demonstrating comfort openly discussing
sexuality issues
Client - Centered
Behavior Change
Communication Skills
Staging clients according
to behavior change model
/ theory
Pause, relax, don’t rush the client.
Friendly, open gestures and facial expressions. Nonverbal
and verbal communication congruent.
Using appropriate
nonverbals
Using silence
appropriately
Restate client’s ideas, plans. Use active listening to check
out feelings.
Development Systems, Inc.
Grant #U65/CCU724366-02
Reflecting content and
feeling
Client – Centered Care / Communications Observation Form
Tab 7: HIV Education and Counseling
Uses print materials, reproductive modes, birth control
samples to emphasize information given verbally.
Frequently encourages client to restate new information.
Avoid overwhelming the client with information, focus on
main points, offer information to client which is specific
to individual client’s needs and situation.
Build on previous discussion.
Using support materials
Checking out clients
understanding
Providing information
specific to the client
Providing information in a
logical order
Roadmap to Integration: HIV Prevention in Reproductive Health
How to perform BSE correctly.
Checks out client’s awareness of chosen method, pro’s
and con’s.
What to expect, clinic flow.
What tests will be performed; how, why; and when to get
results
Simple clear information on how HIV/STDs are
transmitted and how they are not.
Simple, clear information on behaviors that the client can
practice which will reduce the risk of infection.
Breast self exam
BC method overview
Clinic information
Lab work
STD/HIV transmission
STD/HIV prevention
behaviors
Adapted from Center for Health Training Materials
By Development Systems, Inc; 10/2006
Basic understanding of how reproduction occurs; what
body parts are affected by method usage. If nonreproductive, what is being affected by illness or injury.
Anatomy and Physiology
Information Provided
Paint big picture first, then specifics. No rambling.
Focussed.
Development Systems, Inc.
Grant #U65/CCU724366-02
Organizing session
Giving Information
Client – Centered Care / Communications Observation Form
Tab 7: HIV Education and Counseling
Roadmap to Integration: HIV Prevention in Reproductive Health
Simple and clear information
Specific information about sexual behaviors, and their
relative risk
Assess for D.V. or sexual coercion. Accurate, up-to-date
information on community resources.
Discuss family involvement with adolescents. Review
benefits and concerns.
Effects of HIV infection
on the human body
Human sexual behavior as
it relates to risk-taking
behavior
Domestic Violence
Family Involvement
Adapted from Center for Health Training Materials
By Development Systems, Inc; 10/2006
What the test is, where to get tested and what to expect.
Development Systems, Inc.
Grant #U65/CCU724366-02
HIV antibody testing
Client – Centered Care / Communications Observation Form
Tab 7: HIV Education and Counseling