1. Transtheoretical Model (Stages of Change) Stage of Change CharacteristicsInterventions Precontemplative Doesn’t see it. No! Unaware Defensiveness Resistance Help them think about it Engagement Trust building Get a reaction, either cognitive or emotional Contemplative Maybe, but... Ambivalence, unsure Problem awareness Openness to information Explore pros and cons Help explore ambivalence Explore barriers Pass information Ready for Action (Preparation) Decided, Yes! Ready to do Experimentation Coaching; teach skills Solve it! Encourage, empower, support Emphasize options Focus on developing a step

2. Stages of Change Stage of Change CharacteristicsInterventions Action Doing it! Practice new behaviors Avoiding old behaviors Help them do it! Support, praise, recognition Focus on rewards Follow-up, reach out Problem-solving Maintenance Living it! Sustaining behavior Live it! Reinforcement Support, praise, recognition Find other supports Become a role model to others

3. Principles of Change ► Based on a variety of psychological theories of change ► A person’s relationship to changing a behavior is dynamic ► The stages of change are NOT linear ► Relapse/recycling ► People are in different stages for different behaviors ► Steps in behavior change are incremental

4. Your Role in Change   Clients are competent to make choices and changes in their lives.   Change cannot be imposed.   Reward and encouragement are more effective than punishment and judgment.   Change depends on the pros of change outweighing the cons.

5. Counseling and Testing ► HIV Test ► Counseling in Behavior Change ► Health Education ► Client-centered disclosure counseling ► Referrals

6. Tests ► Conventional HIV Testing (2 visits)  Informed Consent  Client receives counseling and gives sample  ELISA or EIA test  If positive 2x at lab, confirmed w/Western Blot  1-2 wks later, given result

7. Standardized Test Results ► HIV-positive ► HIV-negative ► Inconclusive

8. Tests ► Rapid Testing (1 visit)  Informed Consent  Oral or blood sample  OraQuick ADVAJNCE rapid HIV-1/HIV-2 antibody test  Health Education or HIV counseling  20-40 minutes

9. Results Rapid Test ► Preliminary positive ► Confirmed positive ► Negative ► Invalid

10. Notes on Testing ► Does not determine whether or not someone has AIDS ► Further testing required to understand state of immune system ► Accuracy of tests  Considered one of the most accurate medical screening tests  Positive results tested 2x, negative tested 1x

11. Further Notes on Testing ► 98% of HIV antibody tests given are negative ► 2/3rds of clients receiving positive result have previously received at least 4 negative ► HIV-positive persons offered variety of referrals ► Always make individual assessments and referrals

12. Informed Consent ► Anonymous Testing ► Confidential Testing  Differences: ► Consent forms ► Written results ► Identifiers ► HIV reporting by name

13. Window Period ► Difference between exposure and infection ► ► Window Period ► ► Incubation Period

14. Window Period

15. Practice ► ► Section 2: HIV and the Immune System ► ► 1. What is an antibody? ► ► 2. Why do you test for an antibody instead of the virus itself?

16. Practice ► ► Section 8: Rapid and Conventional HIV Testing ► ► 3. Why do I have to wait seven to 14 days for a conventional test or confirmatory ► ► positive test result? ► ► 4. Can you tell me if I have AIDS? ► ► 5. What’s the difference between conventional testing and rapid testing? ► ► 6. What does a positive test result mean? ► ► 7. What does a negative test result mean? ► ► 8. What does an inconclusive test result mean? Is an invalid test result the same thing? ► ► 9. What does a preliminary positive mean?

17. Practice ► ► Section 9: The Window Period ► ► 10. If I test negative, then I don’t have anything to worry about, right? ► ► 11. What is the window period? ► ► 12. How often should I come back for testing? ► ► Section 11: Informed Consent ► ► 13. What is the difference between anonymous and confidential testing? ► ► 14. How sure can I be that the system you have in place is completely confidential?

18. Safer Sex Demonstration Male Condom Female Condom

19. THRIVE http://thrive.preventioninstitute.org/thrive/ind ex.php http://thrive.preventioninstitute.org/thrive/ind ex.php

20. Community Mapping ► http://breeze.cce.cornell.edu/communityres ources/