24.7.1  Delivering the result and post-test counselling when the result is HIV-positive

During post-test counselling, you should cover the following points:

• Inform the person of the result simply and clearly, and give him or her time to consider it. You could ask ‘Are you ready to hear the result?’, allowing the person an opportunity to ask additional questions before you give the result. Most people are ready to hear their result and this should be delivered without undue delay.
• Ensure that the person understands the result. Avoid using technical language such as ‘reactive’ and ‘non-reactive’.
• Allow the person time to ask questions.
• Help the person to cope with emotions arising from the test result. The emotional response to an HIV-positive result can include confusion, anger, denial, sadness, loss, uncertainty, fear of death, shame (embarrassment), fear of stigma and discrimination.
• Discuss any immediate concerns, and assist the person to determine who in their social network may be available and acceptable to offer immediate support.
• Describe follow-up services that are available in the health facility and in the community, focusing on the available treatment, prevention of mother-to-child transmission, and HIV care and support services.
• Provide information on how to prevent transmission of HIV, including provision of male and female condoms and guidance on their use (Study Sessions 25 and 29).
• Provide information on other relevant preventative health measures, such as good nutrition, cotrimoxazole (for prophylactic chemotherapy of opportunistic infections) and, in malarious areas, insecticide-treated bed nets.
• Discuss possible disclosure of the positive result, when and how this may happen, and to whom.
• Encourage and offer referral for testing and counselling of current and former partners, and children who may be at risk.
• Assess the risk of violence or suicide, and discuss possible steps to ensure the physical safety of people with an HIV-positive test result, particularly women.

You should also arrange a specific date and time for a follow-up visit or referral for treatment, care, counselling, support, and other services as appropriate, e.g. tuberculosis screening and treatment, prophylaxis for opportunistic infections, treatment for other sexually transmitted infections (STIs), family planning and antenatal care.