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close this bookTB/HIV: a Clinical Manual (WHO - OMS, 1996, 135 p.)
close this folderChapter 5 - Diagnosis of HIV in adults with tuberculosis
View the document5.1 Clinical recognition or HIV infection in TB patients
Open this folder and view contents5.2 HIV Testing
View the document5.3 HIV Counselling

5.3 HIV Counselling

Confidential counselling is essential before and after HIV antibody testing. The patient gives explicit informed consent to have the test, i.e. he understands what the test involves and the implications of testing. The counsellor provides support. Counselling is a dialogue between patient and counsellor.

Counsellors

With suitable training, anyone who works with patients and families can be a counsellor. Counsellors may be members of the community or health workers. Many health workers have had counselling training. In the course of their duties they have the opportunity to counsel patients for HIV testing. Doctors and other clinicians are often in a good position to counsel patients for HIV testing. This is because clinicians have already established a relationship with the patient, who usually trusts the clinician.

Pro-test counselling

The aim is to enable the patient to make an informed decision to have the test or not. The patient needs to know what the test involves and what are the implications of the result. The main issues for discussion are assessments of the following: a) the patient’s likelihood of having acquired HIV infection, b) his knowledge about HIV, and c) his ability to cope with a positive result.

PRACTICAL POINT

In sub-Saharan Africa, anyone with TB is in a high risk group for HIV.

a) Assessment of risk of having acquired HIV infection

· multiple sex partners


· sex with commercial sex workers


· for men, sex with other men


· non-sterile skin piercing, e.g. scarification, tattooing


· previous blood transfusion


· intravenous drug use


· sexual partner/spouse of person at risk

b) Assessment of knowledge about HIV

· what does the test involve and mean?


· how does HIV transmission occur?


· what is high risk behaviour?

c) Assessment of ability to cope with result

· patients expected reaction to result


· who will provide emotional support?


· impact of a positive result on



- relationships



- social issues, e.g. employment



- future health

PRACTICAL POINT

The HIV test does not become positive until usually 6 weeks, and up to about 3 months, after infection (the “window period”).

Post-test counselling

The content of post-test counselling depends on the HIV test result. The aims are to discuss the result, share information, provide support, and encourage future safe sexual behaviour. Always ensure confidentiality. Break the news openly and sympathetically. When someone has a positive HIV test result, common reactions at different times may include shock, anger, guilt, grief and depression. Patients will need continuing support.

Issues for discussion when the HIV test result is negative.

· A negative result does not mean that the patient definitely does not have HIV infection (the test could be in the seroconversion “window period”).

· Avoidance of unsafe sexual behaviour.

· Promotion of healthy behaviour.

Issues for discussion when the HIV test result is positive.

· General health (good diet, balance of rest and exercise, avoiding infections, when to seek advice about symptoms of other HIV-related illnesses).

· Awareness of possible anti-TB drug side-effects.

· Safe sexual behaviour.

· Avoidance of blood or organ donation.

· The patient’s reaction to the test result.

· Emotional and psychological support for the patient.

· How to tell friends, family and lovers.

· Counselling partner(s) if possible.

· Referral to local community services and support groups, if available.

· Social implications, e.g. employment, life insurance.

SUGGESTIONS FOR FURTHER READING

WHO. AIDS in Africa: a manual for physicians. Geneva, 1992.

WHO. Weekly Epidemiological Record. 1992; 67: 145-149.

WHO. Guidelines for HIV Surveillance Among Tuberculosis Patients. Geneva, 1994.

WHO. Global Programme on AIDS. Source Book for HIV/AIDS Counselling Training. GE, 1994.

WHO. Global Programme on AIDS. Counselling for HIV/AIDS: a key to caring. GE, 1995.

WHO. Global Programme on AIDS. living with AIDS in the community. GE, 1992.