1. BY GINO JOSE FUNDAMENTS OF STD/HIV/HCV COUNSELING

2. GUIDELINES FOR HIV/HCV COUNSELING Pre-Test Counseling Provide information on potential test results Welcome client and discuss what is going to happen in the session Establish rapport Engage client in risk reduction counseling. Educate client on conditions they are being tested for. Assess client’s risk and readiness for testing. Provider information on testing.

3. Describe test and results and clear indicate what those results mean. Review risk reduction plan and highlight goals for behavior change. Provide referrals as necessary. Provide recommendations for continual testing if client's continues to have risky behaviors. Annual testing may be suggested if the client is not planning to modify risk behaviors. GUIDELINES FOR HIV/HCV COUNSELING Post- Test Counseling

4. COMMUNICATION IS THE KEY  Establishing rapport.  Listens effectively.  Uses open-ended questions (Who, What When Where, Why How)  Communicate at the patient’s level of understanding.  Give factual information.  Uses reinforcement.  Use appropriate nonverbal communication.

5. 6 STEPS TO HIV/HCV COUNSELING Step 1. Introduction Step 2. Identify Client’s Personal Risk Behavior(s) and Circumstances. Step 3. Identify Safer Goal Behaviors. Step 4. Develop a Personalized Action Plan. Step 5. Make Referrals and Provider Support. Step 6. Summarize and Close Session.

6. 6 STEPS TO HIV/HCV COUNSELING Step 1. Introduce and Orient Client to Session. Goal: Introduce Yourself. Describe purpose of session. Confer with client that the session is something they will participate in. Suggested Open Ended Questions: Why did you come to the clinic today? What would you like to know before you leave here today? What have you heard about HIV and hepatitis?

7. 6 STEPS TO HIV/HCV COUNSELING Step 2. Identify Client’s Personal Risk Behavior(s) and Circumstances. Goal: Identify the specific behaviors that place him or her at risk for HIV.  Build from reasons that brought the client into the clinic  For Example: Tell me about the exposure incident that brought you to the clinic today; What makes you believe that you might be at risk for HIV?

8. 6 STEPS TO HIV/HCV COUNSELING What are you doing in your life that might be putting you at risk for HIV and/or HCV? Have you been tested before? If so, when and why? What were the results? How many different people do you have sex with? How often? What is your experience with shooting up drugs? How often do you do this? What was happening then? When do you have sex without a condom? What are the riskiest things that you are doing? What are the situations in which you are most likely to be putting yourself at risk for HIV and/or HCV? How often do you use drugs or alcohol? How does this influence your HIV and/or HCV risk behaviors? Step 2. Identify Client’s Personal Risk Behavior(s) and Circumstances.

9. 6 STEPS TO HIV/HCV COUNSELING Step 3. Identify Safer Goal Behaviors Goal: Reinforce the client’s previous HIV and HCV risk- reduction efforts. Identify specific safer goal behaviors that the client is willing to try to adopt. Suggested Open Ended Questions:  What are you presently doing to protect yourself?  Is there a specific time that you remember where you were able to practice safer sex (use needles safely)?

10. 6 STEPS TO HIV/HCV COUNSELING Step 4. Develop a Personalized Action Plan. Goal: Establishing a personal plan to reduce his/her risks of HIV/STDs/Hepatitis. Include client’s previous attempts, perceived personal barriers and perceived personal benefits to reducing risk Discuss existing barriers

11. 6 STEPS TO HIV/HCV COUNSELING Step 4: Develop a Personalized Action Plan Is there a specific time that you remember when you were able to practice safer sex? What did you do? What are you presently doing to protect yourself? What would you like to do to reduce your risk of HIV? What one thing can you do to reduce your risk right now?

12. 6 STEPS TO HIV/HCV COUNSELING Step 5. Make Referrals and Provide Support Goal: Identify community support and referral to professional services. We’ve talked about a lot of issues today. Which of the things we’ve talked about would you like more help with? Would you like to talk with an individual counselor about... (issue that has been raised)? Would you be interested in a support group? Is there a particular kind of support or service that you would be willing to consider?

13. 6 STEPS TO HIV/HCV COUNSELING Step 6. Summarize and Close Session Goal: Summarize and Identify next steps. Re-emphasize the importance of Risk Reducing goals you both have discussed Applaud the effort it took to get tested and information of safer sex practices or risk reduction Provide the proper resources need for on going care (if needed)

14. SUMMMARY COUNSELING: DO’S & DONT’S Do’s Reinforce their risk reduction plan by praising their efforts in getting tested & preventing disease Allow patient to be comfortable with disclosing personal information they may share by identifying that any information shared will not be shared outside of healthcare settings. Negotiate realistic plans for risk reduction Help patient understand the risk of not changing high risk behavior Dont’s Guilt the patient with his/her current risk behavior(s) Complete session without offering informational resources blame god, fate, luck for patient’s infection Use optimism about any preliminary positive due to the confirmatory still needing to be done

15. QUESTIONS? Gino Jose HIV / Quality Management Coordinator Office: 701-328-1059