Pre-HIV antibody testing--too much fuss?

Abstract

Does the apparent mystique surrounding pre-test counselling deter some doctors from talking to patients about an HIV test? Does pre-test counselling sometimes deter people from coming forward for testing? Does pre-test counselling exacerbate difficulties with patient management? We do not have conclusive data to provide answers to any of these questions. Since the HIV antibody test became available in 1985, approaches to diagnosis, treatment and care have shifted, and there are moves towards more widespread HIV testing. It is timely now to reconsider the place and purpose ofpre-test counselling. Is there indeed too much fuss being made in providing it? Information and advice about preparing patients for and obtaining consent to HIV testing were included in the Department of Health'.(1985) and General Medical Council2 (1988) guidelines for doctors. As with all tests and investigations doctors are expected to ensure that each patient is fully informed about the procedure and that consent to carrying out a procedure is obtained. The importance of consent to HIV testing was emphasised because of the serious social, personal and financial consequences that may ensue from a positive test result. Pretest counselling is also the basis from which to take a detailed sex and risk behaviour history from the patient and an opportunity to attempt to minimise transmission ofHIV through health education.