Pre-test discussion

In the past, HIV testing was usually preceded by lengthy pre-test counselling, but this is no longer considered necessary in the UK, unless someone requests or needs it.^{1 2}

One disadvantage of requiring pre-testing counselling is that a significant number of health professionals do not feel confident in providing it (or do not have the time to do so), thus limiting the number of people who get tested. Moreover, as it is a procedure that patients do not experience with other medical tests, it marks HIV out as being essentially different from other medical conditions. It may add to the fear and stigma associated with HIV, thus discouraging people from getting tested.³

The main purpose of discussion before testing is for the healthcare worker to obtain consent. In order to do this, discussion should address any other issues of concern to the person being tested, including providing further information about HIV and about the test.

It is also important to make clear arrangements for how test results will be communicated. Positive results (or those which need to be verified) may be given in a different way to negative results.

For some people who are at a higher risk of HIV infection, a pre-test discussion could provide a useful opportunity to talk in a confidential environment about sexual health needs or other high-risk behaviour.

Moreover, a discussion can include:

• Explaining why a test is being recommended on this occasion.
• Providing information on the benefits of HIV testing.
• Providing information on how HIV is transmitted and how to reduce the risk of infection.
• Taking a sexual history.
• Assessment of the window period and whether repeat testing may be needed.
• Discussing risk reduction.
• Making referrals to other services, e.g. counselling, help with addictions, etc.
• Explaining testing procedures and guarantees of confidentiality.

Further advice on the pre-test discussion is given by the Society of Sexual Health Advisers.⁴