Counselling before and after HIV testing in pregnancy
Pre- and post-test counselling are essential elements of the
management of HIV in pregnancy. Pre-test counselling enables women and men to
make informed decisions about an HIV test. Post-test counselling is an integral
part of the management of the HIV-positive person, and provides an important
opportunity for risk-reduction messages for those found to be HIV-negative.
Pre-test counselling
HIV testing should be accompanied by the provision of pre-test
information and by informed consent to the test by the woman (see Table 5).
Pre-test counselling implies explanation of both the test and the illness to the
woman in a non-directive manner, and answering any questions prior to the
performance of the test. The woman should be given time to decide on the test
and, if unsure, should be counselled to take more time to think about the test
and return at a later stage. Information about HIV testing can be incorporated
into the health education and promotion activities of antenatal clinics and need
not be too time consuming within maternity services319. Various
models have been tried, including group counselling, video education,
incorporating information on HIV into the first visit interview by midwives and
the use of lay counsellors344,345. An appropriate model should be
developed for the circumstances of each service, based on the prevalence and the
level of prior awareness of the women in the community.
Table 5 : Pre-test counselling
[Based on guidelines
from the Johannesburg Community AIDS Centre]
|
Take client to private setting for counselling
Assure the
client of confidentiality
Explain or determine the reasons for HIV
testing
Elicit information about the person's current and previous risk
behaviour in a sensitive manner
Provide information about HIV and
AIDS
Provide information about the HIV antibody test, including information
about the "window period" of infection
Review the implications of a positive
test result for the client
Discuss the person's possible responses to a
positive test result
Discuss the implications of a negative test
result
Provide information about test procedures
Obtain informed consent
|
Post-test counselling
The essential elements of post test counselling for HIV positive
women are illustrated in Table 6. Counselling implies more than merely giving a
positive result, and continued care and advice will be necessary as part of the
management throughout the pregnancy and beyond344,346,347. The choice
of appropriate counsellor will depend upon the circumstance of the practice or
health service: counsellors ideally should have personal qualities, which equip
them for the job, but many of the skills can be acquired during training.
Wherever possible, counselling should be provided in the woman's home language
and within the same cultural background. The involvement of peer counsellors -
women who are themselves HIV-infected, who are able to counsel and to share
their own experiences, fears and successes may be very valuable and should be
encouraged. The integration of peer counsellors and support groups into the work
of health services can be a very valuable addition to the available services.
Table 6 : Post-test counselling
[Based on
guidelines from the Johannesburg Community AIDS Centre]
|
See the client personally to give result - no telephonic
results, preferably not before a weekend
Give the result as soon as possible
after the test is done
Inform the client of the test result
Deal with the
feelings arising from a negative result and explore prevention of infection and
the window period
Deal with the feelings arising from a positive
result
Identify the person's immediate concerns
Discuss how the client
plans to spend the next few hours and days
Identify what support the client
has
Discuss who the client may want to tell about the result and risks to
sexual partners
Identify what difficulties or problems the client foresees
and how to deal with them
Encourage the client to ask questions
Provide
information on a healthy lifestyle, medical follow-up, local support
systems
Refer for follow-up care and counselling |
The delay between taking the test and giving the result should
be as short as possible, as the woman may be very concerned about the test and
the implications of the result. Women who test positive should be encouraged to
bring their male partner(s) for counselling and testing wherever possible.
Post-test counselling should also be provided for HIV-negative
women, with a focus on providing information to enable them to avoid infection.
This could be provided on a group basis, or by individual health workers,
depending on the
circumstances.
