HIV/AIDS Case-Finding In Family Planning Clinics

1. Midwest AIDS Training & Education Center HIV/AIDS Case-FindingIn Family Planning Clinics Health Care Education & Training, Inc.

2. Section 3: HIV Prevention and Test Counseling in Family Planning Clinics: A Client – Centered Approach

3. Objectives for Section 3 • Discuss the importance of HIV counseling for family planning clinics • Discuss the process of behavior change • Describe effective counseling formats and practices • Identify information about sexual transmission of HIV to be conveyed in counseling

4. Benefits of HIV Counselingin a Family Planning Clinic • Comfort level of staff already established in talking about sexual behavior • Clients are already concerned about preventing pregnancy and/or STIs / HIV • Clients will expect to disclose some sexual history to staff • Opportunity to reach a population that doesn’t seek other care

5. Providing HIV Counseling in a Family Planning Clinic • Establish a private area for HIV counseling • Train staff members on client-centered counseling and HIV risk reduction methods • If you only offer confidential testing, be sure to provide referral options to anonymous testing

6. Providing HIV Counselingin a Family Planning Clinic • Whenever possible, keep the same counselor for each client’s HIV counseling sessions • Establish a written policy requiring staff to offer HIV tests to ALL clients • Assess your environment and materials

7. Predictors of Successful Behavior Change Risk of harm • A Perceived • A Perceived • A Sense of Self • Social • Having a Benefit of Change Efficacy Support Plan

8. Client-Centered Counseling versus Directive Counseling • Why use Client-Centered Counseling? • It works! • A client is much more likely to act on behaviors determined by them and by someone else. • Directive counseling is based on the beliefs, skills, perceived risks & benefits, and self-efficacy of the counselor, not the client – that’s why it doesn’t work!

9. Client-CenteredCounseling Principles • The Client’s Needs Come First • The Client is in Charge / Control • Clients are responsible for their own decisions and behavior changes • Options, rather than directives, are offered • Counseling is not interviewing or educating • Focus on feelings as much as information • Behavior change is a process

10. Client-CenteredCounseling Techniques • Active Listening • Attending • Open questions • Paraphrasing • Reflecting feelings • Clarifying • Articulating non-verbal messages

11. Client-CenteredCounseling Techniques • Reframing • Third-Personing • Weighing

12. Client-CenteredCounseling Techniques • Confronting • Rehearsing / Role Playing • Giving Information (KISS) • Summarizing and Closing

13. HIV Counseling Goals • Goal  to get every client tested • Goal  to reduce the spread of HIV by: • Improving client’s perception of risk • Supporting positive behavior changes the client has made • Providing the information and suppor a client needs to make decisions • Negotiating a realistic, incremental plan to further reduce risk

14. HIV Counseling • How do you bring up HIV? • Establish RAPPORT and address the client’s presenting concern(s) first • Within CONTEXT of family planning • Explain REASON for raising the issue • Offer as a service to EVERYONE

15. HIV Counseling • Once you start, what do you talk about? • Client’s perception of risk • Efficacy of client’s birth control choice • Prevention / risk reduction • Previous experience with testing and willingness to be tested or retested • Testing decision

16. HIV Prevention Counseling • Assess client’s perception of risk • “Has anything happened that you think might have put you at risk?” • If so, “Can you tell me what happened?” • “What can you tell me about how HIV is transmitted?” • “Why do you think you could be at risk?” • “From unprotected sex / needle sharing?”

17. Transmission of HIV • Infectious Body Fluids • Blood, Semen, Vaginal Fluids, Breast milk • Routes of Transmission • Unprotected sexual intercourse (oral, vaginal, and anal) • Exchange of Blood or Blood Products (ie, sharing needles, body piercing/tattoo) • Perinatal transmission during pregnancy and delivery, or after birth through breast feeding

18. HIV PreventionCounseling • Discuss prevention / risk reduction • Assess client’s behavior • “What are you doing to protect yourself from HIV / STI’s?” • Support any positive change • “Would you like to work on reducing your risk (even more)?”

19. HIV PreventionCounseling • Discuss prevention / risk reduction • Discuss additional options • “What are some things a person can do to avoid getting HIV?” • Negotiate a plan • “What would work for you?” • “When would you like to try that?” • consider potential obstacles • rehearse the steps involved

20. HIV Test Decision Counseling • Ask about previous experience with testing and willingness to be tested or retested • “Have you been tested for HIV before?” • If Yes: • “When were you tested?” • “Where were you tested?” • “What were the results?” • “Are you interested in retesting?”

21. HIV Test Decision Counseling • “Have you been tested for HIV before?” • If no… • “How would you feel about being tested?” • “Would you consider having a test?” • “What would be good about testing?” • "What would be difficult?”

22. Typical Services for HIV-Positive Persons • Primary Care • Case Management • Dental Care • Drug Reimbursement • Legal Assistance • Substance Abuse Counseling • Rent & Utility Assistance

23. HIV Pre-Test Counseling • Explain window period / meaning of results • “Are you familiar with ‘window period’ for the test?” • “It can take 2-12 weeks for the test to show if someone has been infected.” • “What do you understand positive means?” • “Yes, it means a person has HIV and can pass it on to others.”

24. HIV Pre-Test Counseling • “What do you understand negative means?” • “Yes, it could mean that a person is not infected with HIV, or . . .” • “It could mean a person was infected recently and it’s too soon to show up on the test yet.” • “If your test is negative it might be a good idea to be retested if you have had a recent risk.”

25. HIV Pre-Test Counseling • Discuss reactions to Test Results • “How do you think you will feel while you’re waiting for results?” • “How do you think you would feel if your test came back negative?” • “How do you think you would feel if your test came back positive?” • “What would you do?” • “Whom would you turn to for support?”

26. HIV Pre-Test Counseling • Obtain written consent • “In order to do the test, I need you to sign a consent form.” • “Please read the consent form and let me know if you have any questions or concerns before you sign it.”

27. HIV Pre-Test Counseling • Plan follow-up visit for test results • Explain when and how to get results • “Your test results will be ready . . .” • “You will need to come back in person to get your test results.” • “When you come back, I will give you your results and we can talk about what they mean for you.”

28. HIV Post-Test Counseling • Negative test result • Disclose the test result • “Your HIV test was negative.” • Assess the client’s reaction • “How do you feel about that?” • Review the meaning of the result • “Can you tell me what a negative test result means?”

29. HIV Post-Test Counseling • Negative test result • Discuss possible need for retesting • “Remember, it might be good to get retested if you’ve had a recent risk.” • Review the client’s risk reduction plan • “How do you plan to stay negative?” • support the client’s intentions • review other options as needed • encourage implementation soon

30. HIV Post-Test Counseling • Positive test results • Disclose the test result • “Your HIV test was positive.” • Assess the client’s reaction • “What are your thoughts / feelings?” • Review the meaning of the result • “Can you tell me what a positive test result means?”

31. HIV Post-Test Counseling • Positive test results • Validate feelings and offer hope • “I can see you’re feeling . . .” • “There’s a lot to learn about living with HIV, but there’s plenty of time and lots of people to help you.” • Assess emotional stability and coping • “What are your plans when you leave?” • “Whom can you turn to for support?”

32. HIV Post-Test Counseling • Positive test results • Discuss disclosure to partner / others • “Have you thought about who you might share your results with?” • “We can talk about how and when you might tell them.” • Discuss need for continued risk reduction • “It’s important to avoid reinfection and other illnesses. Are there some things you can do to protect yourself?”

33. HIV Post-Test Counseling • Positive test results • Recommend follow-up medical care • “The next step is to assess your health and decide how to manage your infection.” • Schedule a return visit or make referral • “I’d like to see you again in a few days so we can develop a plan for your care.” • Offer an interim contact and written material • “In the meantime, you can reach me at…”

34. HIV Post-Test Counseling • Indeterminate test results • Disclose and explain test result • “Your HIV test was indeterminate, which means the lab couldn’t determine if you were infected with HIV.” • Assess the client’s reaction • “What are your thoughts / feelings?”

35. HIV Post-Test Counseling • Indeterminate test results • Validate feelings and offer support • “I can see you’re feeling . . .” • “This result can be very confusing and unsettling. Let’s talk about what the next step is and what kind of support you need until you get a clear result.” • Determine the client’s window period • “When was the last time you…”

36. HIV Post-Test Counseling • Indeterminate test results • Recommend retesting • “At this point, we need to retest you in order to get a clear result.” • p24 antigen • pcr for DNA • pcr for RNA (viral load) • HIV antibody test • Provide (or schedule visit for) retesting

37. HIV Post-Test Counseling • Indeterminate test results • Discuss need for continued risk reduction • “What’re you doing to protect yourself?” • Assess emotional stability and coping • “What are your plans when you leave?” • “Whom can you turn to for support?” • Offer interim contact until results are back • “In the meantime, you can reach me at…”