Testing, testing, testing - MUCHO emphasis on HIV testing these days. There has been MUCHO debate around the role of counseling in the HIV testing context - is it a barrier to care, does it have any value to any of the participants (like the person getting tested), and what would happen if it disappeared? One of the LGBTI Health Movement's most wonderful, steady leaders, Stewart Landers, mused over the issues and shares some of his thoughts here for LifeLube.
Please leave a comment if so inclined.
Jim
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I think it's not a coincidence that the move to reduce or eliminate counseling as part of HIV testing comes at the same time many are pushing for "routine" or other forms of expanded HIV testing.The main barrier to widespread HIV testing has been providers' discomfort or lack of willingness to "go there." That is many do not want to talk to their patients about a stigmatized disease that may suggest behaviors they (the provider) are uncomfortable discussing or providing counseling or other information about.
Removing counseling requirements and requiring only opt-out consent procedures potentially allows many providers to check off the HIV test box when they draw blood and never mention it to the patient. Docs who would do this (and I really do love most docs I've known in my life) are also the ones who are least likely to want to deliver a positive test result in person to a client but leave it to their staff, phone or even, heaven help the newly infected person, mail.
While there may be anecdotal information and some pretty good research that most negative people don't change behavior based on negative results, there is pretty good research that positive people do change behavior after receiving positive test results and those changes are in the direction of risk reduction. Whether those changes are the results of counseling or the well taught human trait to avoid harming others is hard to separate, because up until recent times, almost all people received counseling with their HIV test results.
I had to give out 2 or 3 positive test results in my time as an HIV counselor (in the late 80s with virtually no treatment and much more stigma), and I agree people don't hear or absorb much information at the time of a test result. However, a good HIV counselor knows that it is also the affective behavior of a counselor that is important - empathy, patience, a willingness to listen (though many clients seek to "disappear" as quickly as possible after getting a positive test result.) There are also techniques that are used such as making plans with a client about who they were going to talk to next, what they were going to do over the next 4-24 hours, the next week and even month, just so they understood that their life would go on.
Each positive test result is somewhat unique, so it's hard to describe exactly the strategy
counselors employ. With the current emphasis on moving people directly from a positive test result into care, people who give test results are often situated at the same location where people receive medical or case management services. In those cases, when the client is not anonymous, a counselor can make appointments for medical or case management services and someone (usually not the counselor, but in some cases it is the counselor) will follow-up with the client to make sure they show up to get those services. Getting a positive test result for HIV is still a shocking piece of news for most people. It changes the course of their lives - how they think about partnering, parenting, sexuality, survival, work and much more. While I'm all for the mainstreaming of AIDS care and the de-stigmatization of the illness, I often find myself in a quandary about how we do that and still acknowledge all the life changing aspects of the illness.
---Stewart
BIO - Stewart Landers, JD, MCP, has been a senior consultant at John Snow, Inc. (JSI) since 1994. He consults on issues related to HIV/AIDS, substance abuse treatment and lesbian, gay, bisexual, transgender and intersex (LGBTI) health. Mr. Landers has also been an activist for LGBTI rights and health, and was co-convener of the 2004 National LGBTI Health Summit. In addition to his consulting duties, Mr. Landers serves as an associate editor of the American Journal of Public Health for LGBT Health, HIV/AIDS, community planning and evaluation studies. He has recently launched his own blog: Landers Health Report.
