Supporting Client Disclosure of HIV Status – Evaluating Provider Efficacy Before vs. After a Skills-based Training

1. Supporting Client Disclosure of HIV Status – Evaluating Provider Efficacy Before vs. After a Skills-based Training Alice Gandelman, Greg Mehlhaff, Linda DeSantis, Heather Lusk California STD/HIV Prevention Training Center ( CAPTC), California Department of Health Services, Berkeley, California Issue Objective Results, cont. Training Agenda Results • Ten trainings were conducted for a total of 174 participants between 1/28 –5/29/03 • Participant Characteristics: • 47% had bachelor’s or higher education degrees • 59% devoted 75% or more of their time to work in STD/HIV field • Discussing HIV Serostatus disclosure is a critical, yet challenging issue for both providers and patients/ clients • Disclosure Exercise: (to gain a better understanding of the challenge of disclosing something difficult) • Participants given script of a difficult issue they must disclose to a partner in the training • Followed by facilitated discussion by trainers • Stages of HIV: (examines clients at varying stages: positive test disclosure, starting treatment-experiencing side effects, ill-treatment not working) • Who might they want to disclose to at this time? • What are their issues at this stage? • How might you as provider assist them? • 4 Steps of Disclosure Planning: • Step 1: Transition • from topic at hand to partner disclosure, draw on context of current session • Step 2: Discuss Whom Client is Considering Telling • explore issues/concerns for each person considered • prioritize who will be told, discuss what else might be disclosed with serostatus (e.g., sexuality, drug use, etc), remind client of confidentiality issues • ask client to assess how person will react (if domestic violence a possibility, discouragedisclosure) • Step 3: Coach Client around Disclosure • decide when, where disclosure will occur, remind client to secure private place, ask what s/he will say, offer opportunity to practice,Provide appropriate referrals • Step 4: Summarize the Discussion • Review what has been discussed, validate client for wanting to disclose, leave the door open for further assistance • To conduct a brief (8 hour) training of an individual-level intervention for providers who work with HIV positive patients/clients to: • understand the complex client issues surrounding HIV serostatus disclosure • become familiar with a 4-step model to support patient/client disclosure • develop skills to coach patients/clients through these steps, including safer sex strategies, regardless of disclosure decision Setting Medical and non-medical settings where individual interaction occurs between HIV-positive patients or clients, and providers Methods Background • Reviewed existing literature on HIV serostatus disclosure issues • Reviewed existing PwP courses to identify what disclosure issues, if any, were covered in content • Met with HIV prevention and care providers to determine training needs • Drew from existing PCRS course conducted at the CA STD/HIV Prevention Training Center Recent studies have shown that many providers don’t discuss safer sex or serostatus disclosure issues with their clients because they feel they lack sufficient time, are being too intrusive, or do not feel comfortable discussing these issues with their patients. As a result, clients do not bring the issue up, even if they look to providers for support and guidance. Conclusions • More participants from public health depts. attended trainings than from CBOs • Interactive trainings with practice sessions to develop skills can build provider efficacy • Training participants gained confidence in their ability to assist clients with disclosure “This gives me some concrete steps for walking a client through these issues” “I have a greater comfort level because of the model, practice, and feedback” “Added to my toolbox (techniques)to empower others” “One of the best trainings I’ve been to; very useful information and skills”