Historically, HIV counselling has been provided both before and after HIV testing. Before the introduction of RDTs, same-day results were not feasible, so counsellors included comprehensive information in the pre-test session in case the client did not return for their test results. Moreover, in the pre-treatment era pre-test counselling often focused on providing a risk assessment, preparing clients to cope with an HIV-positive diagnosis in the absence of treatment and encouraging clients to return to receive their test results.
With the widespread use of HIV RDTs, most people receive their HIV test results – at least results of the first test – and often a diagnosis on the same day. Therefore, intensive pre-test counselling is no longer needed and may create barriers to service. Individual risk assessment and individualized counselling during the pre-test information session is no longer recommended. Depending on local conditions and resources, programmes may provide pre-test information through individual or group information sessions and through media such as posters, brochures, websites and short video clips shown in waiting rooms. When children and adolescents are receiving HTS, information should be presented in an age-appropriate way to ensure comprehension.
Offering or recommending HIV testing to a client or a group of clients includes providing clear and concise information on:
- the benefits of HIV testing
- the meaning of an HIV-positive and an HIV-negative diagnosis
- the services available in the case of an HIV-positive diagnosis, including where ART is provided
- the potential for incorrect results if a person already on ART is tested
- a brief description of prevention options and encouragement of partner testing
- the fact that the test result and any information shared by the client is confidential
- the fact that the client has the right to refuse to be tested and that declining testing will not affect the client’s access to HIV-related services or general medical care
- potential risks of testing to the client in settings where there are legal implications for those who test positive and/or for those whose sexual or other behaviour is stigmatized
- an opportunity to ask the provider questions.