An HIV-positive diagnosis is a life-changing event. Before giving HIV-positive test results, the health worker, trained lay provider, or counsellor should keep in mind the 5 Cs of HTS, as recommended by WHO and UNAIDS, in particular correct test results.
A diagnosis of HIV infection is a life-changing event. Before giving these results, the provider should keep in mind the 5 Cs of HTS.
Once health workers or lay providers are confident of adherence to all measures to ensure correct test results, they should provide post-test health education and counselling. All post-test counselling should be “client-centred”, which means avoiding formulaic messages that are the same for everyone regardless of their personal needs and circumstances. Instead, counselling should always be responsive to and tailored to the unique situation of each individual or couple. Health workers, professional counsellors, social workers and trained lay providers can provide counselling. People with HIV who are trained in counselling may be particularly understanding of the needs and concerns of those who receive an HIV-positive diagnosis.

WHO good practice recommendation

To ensure that clients who are misdiagnosed are not needlessly placed on lifelong ART (with potential side-effects, waste of resources and psychosocial and emotional implications), WHO recommends that all clients be retested to verify their HIV diagnosis prior to enrolling in care and/or starting ART.
The information and counselling that health workers, or others, should provide to HIV-positive clients is listed below. Absorbing all of this information in one session may be very challenging, and a follow-up counselling session may be required. Indeed, the shock of learning of an HIV-positive diagnosis may make it difficult for a person to take in further information immediately.

• Explain the test results and diagnosis.
• Give the client time to consider the results and help the client cope with emotions arising from the diagnosis of HIV infection.
• Discuss immediate concerns and help the client decide who in her or his social network may be available to provide immediate support.
• Provide clear information on ART and its benefits for maintaining health and reducing the risk of HIV transmission, as well as where and how to obtain ART.
• Make an active referral for a specific time and date. (An active referral is one in which the tester makes an appointment for the client or accompanies the client to an appointment, including an appointment for co-located services, and enrolment into HIV clinical care.) Discuss barriers to linkage to care, same-day enrolment and ART eligibility assessment. Arrange for follow-up of clients who are unable to enrol in HIV care on the day of diagnosis.
• Provide information on how to prevent transmission of HIV, including information of the reduced transmission risk when virally suppressed on ART; provide male or female condoms and lubricants and guidance on their use.
• Discuss possible disclosure of the result and the risks and benefits of disclosure, particularly among couples and partners. Offer couples counselling to support mutual disclosure.
• Encourage and offer HIV testing for sexual partners, children and other family members of the client. This can be done individually, through couples testing, index testing or partner notification.
• Assess the risk of intimate partner violence and discuss possible steps to ensure the physical safety of clients, particularly women, who are diagnosed HIV-positive.
• Assess the risk of suicide, depression and other mental health consequences of a diagnosis of HIV infection.
• Provide additional referrals for prevention, counselling, support and other services as appropriate (for example, TB diagnosis and treatment, prophylaxis for opportunistic infections, STI screening and treatment, contraception, ANC, opioid substitution therapy (OST), and access to sterile needles and syringes, and brief sexuality counselling ).
• Encourage and provide time for the client to ask additional questions.