April 2003

Guidelines for Counseling and Referral for Persons with Newly Identified HIV Infection

This appendix summarizes key points for counseling and referring to services persons with newly diagnosed HIV infection, as outlined in the Revised Guidelines for HIV Counseling, Testing, and Referral (CDC. MMWR 2001;50(No. RR-19):1-54.)

Basic information and support

• Ensure that the client receives and understands the meaning of the test result.
• Provide psychological support and make referral for additional psychological support if indicated.
• Ensure that the client knows where and how to obtain further information and services.

Medical assessment and care

• Provide, or make referral for, medical evaluation, care, and treatment (including sexually transmitted disease [STD] screening and care, screening and treatment or vaccination for viral hepatitis, and reproductive health services).

Prevention

• Advise client to refrain from donating blood, plasma, or organs.
• Ensure that the client has sufficient accurate information about how HIV is transmitted and how transmission can be prevented.
• Explicitly point out and explain misconceptions regarding HIV transmission risk associated with specific sexual behaviors or the sharing of drug-use equipment.
• For sexually active clients, address strategies for preventing other STDs or bloodborne infections (e.g., gonorrhea, syphilis, hepatitis B virus, hepatitis C virus).
• Provide, or make referral for, HIV prevention counseling that focuses on the client’s personal circumstances and risk and helps the client set and reach explicit behavior-change goals to reduce the chance of transmitting HIV.
• Assess need for, and provide, or make referral for, other HIV prevention services (e.g., individual or group prevention counseling, prevention case management).
• Provide, or make referral for, partner counseling and referral services, in accordance with all applicable laws and regulations.

Special issues for pregnant women

• Provide information regarding the risk for perinatal HIV transmission, ways to reduce this risk, and the prognosis for infants who become infected.
• Provide, or make referral for, specialty care from providers who are knowledgeable about perinatal HIV prevention.
• Provide, or make referral for, nondirective counseling regarding all reproductive options.

Other support needs

• Assess need for, and provide, or make referral for, other support services (e.g., drug or alcohol prevention and treatment; mental health services; legal services; assistance with housing, food, employment, transportation, and child care; and domestic or partner violence services).

Follow-up

• Consider scheduling a follow-up appointment 3 to 6 months after diagnosis to assess whether clients were able to initiate medical care, minimize transmission risk to uninfected partners, and access other needed services (e.g., partner counseling and referral services).

Strategies for making effective referrals

• Consult with the client to identify essential factors that (a) are likely to influence the client’s ability to adopt or sustain behaviors to reduce risk for HIV transmission or (b) promote health and prevent disease progression.
• Match service referrals to the client’s self-identified needs and priorities.
• In consultation with the client, assess and address any factors that make completing the referral difficult (e.g., lack of transportation or child care, work schedule, cost).
• Provide information necessary to access the referral service (e.g., contact name, eligibility requirements, location, hours of operation, telephone number).
• Provide or arrange assistance when indicated (e.g., schedule the appointment, address transportation needs).
• Obtain the client’s consent to share identifying information to help complete and verify the referral.
• Document referrals made, the status of those referrals (i.e., whether the referral service was accessed), reasons referrals were not accessed, and the client’s satisfaction with the referrals.