Prevention counseling

Prevention counseling is an interactive process that consists of:

• Assessing an individual’s risk for acquiring or transmitting HIV and or HCV, based on a discussion of risk behaviors.
• Developing an individualized plan to reduce these risk behaviors.

When offering HIV/HCV counselling to people who use drugs, it’s important to focus on drug-related risk behaviours, encouraging clients to identify the drug use behaviours that put them at increased risk for acquiring HIV/HCV and understand the reasons why they continue to engage in them, in order to set and reach a specific, realistic, risk-reduction goal. The counselor should also explore previous attempts to reduce these risks and support clients in their successes and efforts. Strategies for reducing the risk of sexual transmission should also be addressed among clients who use drugs.

Informed consent

Informed consent is the authorization of the patient to undergo a medical examination, after having received all the information about risks, advantages and methods of this examination. The client has to be informed of the right to refuse to take the test and of the fact that declining an HIV test will not affect his access to services that do not depend upon knowledge of HIV/HCV status. Community-based organizations (CBOs) must have a consent form that carefully and clearly explains (in appropriate language) the CBO’s responsibility and the client’s rights. Client participation must always be voluntary, and documentation of this informed consent must be maintained in the CBO’s records. Clients offered HIV testing in nonclinical settings may be under the influence of alcohol or drugs or may have chronic mental health conditions, any of which may interfere with their ability to provide informed consent for voluntary HIV testing and to understand test results. Counselors should be able to determine when clients are not competent to provide consent and understand the result.

Risk assessment

Traditionally, in the pre-test counselling, the focus is on risk assessment, in order to make the person aware of the risks encountered that might eventuality lead to having a positive result; while strategies for risk reduction is done in the post-test counselling, when providing the client with test results.

While speaking about the ways of transmission, the counsellor can check with the client what risks the client may have encountered since the last HIV/HCV test. An important aspect is also the risk behaviors of the client’s partner(s), which might affect HIV/HCV risk for the client.