Counseling Procedures Research Articles

Understanding the Psychosocial Effects of WES Test Results on Parents of Children with Rare Diseases.

The use of whole exome sequencing (WES) for diagnostics of children with rare genetic diseases raises questions about best practices in genetic counselling. While a lot of attention is now given to pre-test counselling procedures for WES, little is known about how parents experience the (positive, negative, or inconclusive) WES results in daily life. To fill this knowledge gap, data were gathered through in-depth interviews with parents of 15 children who underwent WES analysis. WES test results, like results from other genetic tests, evoked relief as well as worries, irrespective of the type of result. Advantages of obtaining a conclusive diagnosis included becoming more accepting towards the situation, being enabled to attune care to the needs of the child, and better coping with feelings of guilt. Disadvantages experienced included a loss of hope for recovery, and a loss by parents of their social network of peers and the effort necessary to re-establish that social network. While parents with conclusive diagnoses were able to re-establish a peer community with the help of social media, parents receiving a possible diagnosis experienced hurdles in seeking peer support, as peers still needed to be identified. These types of psychosocial effects of WES test results for parents are important to take into account for the development of successful genetic counselling strategies.

Orientação no processo de reabilitação de crianças deficientes auditivas na perspectiva dos pais

RESUMO Objetivo: analisar o procedimento de orientação familiar realizado em serviços públicos de reabilitação de crianças deficientes auditivas considerando-se a perspectiva dos pais. Métodos: a amostra do estudo foi composta por vinte e um responsáveis de menores com déficit auditivo que realizam terapia fonoaudiológica em serviços públicos. Para a coleta de dados, aplicou-se um questionário contendo perguntas relativas ao processo de aconselhamento fonoaudiológica e sobre os principais temas explorados no mesmo. As respostas foram categorizadas e organizadas em uma planilha digital, a fim de realizar a análise descritiva por meio dos resultados em porcentagem. Resultados: 100% dos pais afirmaram receber orientações, sendo estas fornecidas semanalmente (90,5%). Entre os temas explorados, 90,5% dos genitores referiram receber informações acerca dos aspectos relacionados ao desenvolvimento de linguagem, fala e comunicação; quanto ao uso, funcionamento e manutenção do dispositivo eletrônico utilizado pela criança, 81%; a respeito do processo escolar de seus filhos, 47,6% e, sobre audição e perda auditiva, 52,4%. 95,2% dos pais também referiram não sentir dificuldades em compreender os esclarecimentos realizados pelos profissionais, e 100% relataram que aplicam as mesmas em ambiente familiar. Conclusão: o procedimento de orientação realizado nesses serviços foi considerado eficiente, uma vez que propicia aos genitores informações sobre os temas mais comumente reportados na literatura, além de serem fornecidas em todas as sessões realizadas. O mesmo também possibilita que os responsáveis apliquem as recomendações recebidas, sendo possível dar continuidade às estratégias aplicadas durante o processo terapêutico em ambiente familiar, potencializando o desenvolvimento da criança deficiente auditiva.

The impact of an interventional counselling procedure in families with a BRCA1/2 gene mutation: efficacy and safety.

Background: Predictive genetic testing has high impact on cancer prevention for BRCA carriers and passing this information in BRCA families is important. Mostly, this is proband-mediated but this path is defective and denies relatives lifesaving information. Objective: To assess the efficacy/safety of an intervention, in which relatives are actively informed. Design: Sequential prospective study in new BRCA families. The proband informed relatives about predictive testing (phase I). After 6 months, a letter was sent to adult relatives who had not been reached (phase II). Then a phone call was made to obtain a final notion of their wishes. All subjects received psychometric testing (State-Trait Anxiety Inventory, STAI), an interview and routine counselling. Results: Twenty families were included. Twenty-four of the relatives could not be reached, 59 were ‘decliners’, 47 participated by the proband and 42 by the letter. Predictive testing was performed in 98 % of the participants of which 30 were mutation carriers. The intervention is psychologically safe: the 95 % CI for the estimated mean difference in STAI DY1 between phase II/I subjects (mean difference −1.07, 95 % CI −4.4 to 2.35, p = 0.53) shows that the mean STAI DY1 score (measured at first consult) for phase II is no more than 2.35 units higher than for phase I, which is not relevant. Conclusions: A protocol directly informing relatives nearly doubles the number of relatives tested and is psychologically safe. This should lead to a change in counselling guidelines in families with a strong germline predisposition for cancer.Electronic supplementary materialThe online version of this article (doi:10.1007/s10689-015-9854-4) contains supplementary material, which is available to authorized users.

GYNECOLOGICAL LAPAROSCOPIC SURGERY: LEARNING CURVE

AbstractA study was conducted to review the learning curve of gynecological laparoscopic surgery from January 2012 to December 2014. Total 310 cases were included in the study. These patients had pelvic surgery including hysterectomy either total laparoscopic hysterectomy or laparoscopic assisted vaginal hysterectomy and Ade-nexal surgery (cystectomy, oophorectomy or adhesionolysis). After preoperative evaluation counseling and consent procedures were performed. Data was collected regarding patients profile variables, indications for surgery, intraoperative findings, intraoperative time, post operative recovery findings, analgesia requirements and discharge time from the hospital. Regarding the intraoperative time, comparison was made for duration of surgery in the 2012 and at the end of study period 2014.Results:Results of the study showed that there was no significant increase in complication either minor or major related to urinary tract or bowel injury. Operative time was decreased with time. Most common indication for hysterectomy was fibroid uterus or dys-functional uterine bleeding. Most common indication for adenexal pelvic surgery was ovarian cyst and in most cases cystectomy was done. Patient recovery was smooth and post operative analgesia was much less as compared to the routine. Patient hospital stay was less as compared to the routine procedures for hysterectomy. It is concluded from the study that laparoscopic surgery is safe procedure with the clear advantages for the patient. With appropriate surgical training & skills, the surgical time is reduced. In the study complication rate, operating time was comparable to the already published studies. With proper training it is acceptable alternate to open abdominal procedures with clear advantages for the patient.Key words:Laparoscopic surgery, Learning curve.

Factors Militating Against Effective Implementation of the 6-3-3-4 Education Policy in Nigeria: A Case Study in Policy Failure

This paper is on the factors militating against effective implementation of the 6-3-3-4 education policy in Nigeria, using Esan North East Local Government Area of Edo State as a case study. Its objective was to find out factors that militated against the effective implementation of the policy. To achieve this objective, ten (10) schools were randomly selected in the local government area. This study adopted the survey method and structured questionnaire were administered in eliciting information from the respondents and fifteen respondents were selected from each of the ten schools. The technique of data analysis was simple percentage. The findings revealed that lack of manpower, lack of equipment, inadequate guidance and counseling procedure, absence of legislation, etc were the bane of the implementation of the 6-3-3-4 education policy. Based on the result, the study draws the conclusion that the policy itself was not bad, but failed as a result of poor implementation. On this basis, the study recommends that for the 6-3-3-4 system to succeed, there is need for gradual and systematic approach towards the implementation of the policy and also ensure that the goals and objectives set be periodically evaluated to create opportunity for innovations aimed at solving the emerging problems and so on. This will ensure a better standard of education in Nigeria. Keywords: Policy, Public Policy, Implementation, Vocation, Skills, Curriculum, Innovation, Education

Antenatal Counseling Regarding Resuscitation and Intensive Care Before 25 Weeks of Gestation.

The anticipated birth of an extremely low gestational age (,25 weeks) infant presents many difficult questions, and variations in practice continue to exist.Decisions regarding care of periviable infants should ideally be well informed,ethically sound, consistent within medical teams, and consonant with the parents' wishes. Each health care institution should consider having policies and procedures for antenatal counseling in these situations. Family counseling may be aided by the use of visual materials, which should take into consideration the intellectual, cultural, and other characteristics of the family members. Although general recommendations can guide practice, each situation is unique; thus, decision-making should be individualized. In most cases, the approach should be shared decision-making with the family, guided by considering both the likelihood of death or morbidity and the parents' desires for their unborn child. If a decision is made not to resuscitate,providing comfort care, encouraging family bonding, and palliative care support are appropriate.

Improving the Quality of Voluntary Medical Male Circumcision through Use of the Continuous Quality Improvement Approach: A Pilot in 30 PEPFAR-Supported Sites in Uganda.

BackgroundUganda adopted voluntary medical male circumcision (VMMC) (also called Safe Male Circumcision in Uganda), as part of its HIV prevention strategy in 2010. Since then, the Ministry of Health (MOH) has implemented VMMC mostly with support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) through its partners. In 2012, two PEPFAR-led external quality assessments evaluated compliance of service delivery sites with minimum quality standards. Quality gaps were identified, including lack of standardized forms or registers, lack of documentation of client consent, poor preparedness for emergencies and use of untrained service providers. In response, PEPFAR, through a USAID-supported technical assistance project, provided support in quality improvement to the MOH and implementing partners to improve quality and safety in VMMC services and build capacity of MOH staff to continuously improve VMMC service quality.Methods and FindingsSites were supported to identify barriers in achieving national standards, identify possible solutions to overcome the barriers and carry out improvement plans to test these changes, while collecting performance data to objectively measure whether they had bridged gaps. A 53-indicator quality assessment tool was used by teams as a management tool to measure progress; teams also measured client-level indicators through self-assessment of client records. At baseline (February-March 2013), less than 20 percent of sites scored in the “good” range (>80%) for supplies and equipment, patient counseling and surgical procedure; by November 2013, the proportion of sites scoring “good” rose to 67 percent, 93 percent and 90 percent, respectively. Significant improvement was noted in post-operative follow-up at 48 hours, sexually transmitted infection assessment, informed consent and use of local anesthesia but not rate of adverse events.ConclusionPublic sector providers can be engaged to address the quality of VMMC using a continuous quality improvement approach.

Impact of Contraceptive Counseling in Clinical Settings: A Systematic Review.

This systematic review evaluated the evidence on the impact of contraceptive counseling provided in clinical settings on reproductive health outcomes to provide information to guide national recommendations on quality family planning services. Multiple databases were searched during 2010-2011 for peer-reviewed articles published in English from January 1985 through February 2011 describing studies that evaluated contraceptive counseling interventions in clinical settings. Studies were excluded if they focused primarily on prevention of HIV or sexually transmitted infections, focused solely on men, or were conducted outside the U.S., Canada, Europe, Australia, or New Zealand. The initial search identified 12,327 articles, of which 22 studies (from 23 articles) met the inclusion criteria. Six studies examined the impact of contraceptive counseling among adolescents, with four finding a significant positive impact on at least one outcome of interest. Sixteen studies examined the impact of counseling among adults or mixed populations (adults and adolescents), with 11 finding a significant positive impact on at least one outcome of interest. Promising components of contraceptive counseling were identified despite the diversity of interventions and inability to compare the relative effectiveness of one approach versus another. The evidence base would be strengthened by improved documentation of counseling procedures; assessment of intervention implementation and fidelity to put study findings into context; and development and inclusion of more RCTs, studies conducted among general samples of women, and studies with sample sizes sufficient to detect important behavioral outcomes at least 12 months post-intervention.

Psychological Aspects in Children and Adolescents With Major Thalassemia: A Case-Control Study.

Background:Thalassemia is an inherited blood disease. It is a serious public health problem throughout the Mediterranean region, the Middle East and the Indian subcontinent, as well as in Southeast Asia.Objectives:Thalassemia is an inherited blood disease. It is a serious public health problem. In this study we assessed psychological aspects in Iranian children and adolescents with thalassemia major.Patients and Methods:In this case-control study sixty healthy subjects aged 7-18 years and Sixty Patients with confirmed diagnosis of major thalassemia were enrolled. After obtaining informed consent from parents of all participating thalassemia patients and healthycontrols, we assessed psychological aspects and quality of life by Pediatric Quality of LifeTM (PedsQL™), Strengths and Difficulties Questionnaires (SDQ), State and Trait Anxiety, Children's Depression Inventory (CDI). Results:The results of this study indicate that there are significant changes in depression, anxiety, QOL and behavioral screening between children with thalassemia major compared with healthy subjects by means of both parents and children reports. According to the results, children with thalassemia major have more psychological problems than healthy ones. Patients with thalassemia have a lower QOL than their peers (P = 0.001), the rate of depression is higher in this group (P = 0.015), Also behavioral problems in these children are more than healthy subjects (P = 0.009).Conclusions:We recommend appropriate treatment and counseling procedures in addition to specific treatment of thalassemia. According to the results we suggest to establish pediatric psychiatric clinics beside thalassemic clinics to cure psychological aspects of the disease.

“Prefacing the Script” as an ethical response to state-mandated abortion counseling

Background: Laws governing abortion provision are proliferating throughout the United States, yet little is known about how these laws affect providers. We investigated the experiences of abortion providers in North Carolina practicing under the 2011 Woman's Right to Know Act, which mandates that women receive counseling with specific, state-prescribed information at least 24 hours prior to an abortion. We focus here on a subset of the data to examine one strategy by which providers worked to minimize moral conflicts generated by the counseling procedure. Drawing on Erving Goffman's work on language and social interaction, we highlight how providers communicated moral objections and layered meanings through a practice that we call prefacing the script. Methods: We conducted semistructured interviews with 31 physicians, nurses, physician assistants, and clinic managers who provide abortion care in North Carolina. Audio-recorded interviews were transcribed verbatim and analyzed using an inductive, iterative analytic approach, which included reading for context, interpretive memo-writing, and focused coding. Results: Roughly half of the participants (14/31) reported that they or the clinicians who performed the counseling in their institution routinely prefaced the counseling script with qualifiers, disclaimers, and apologies that clarified their relationship to the state-mandated content. We identified three performative functions of this practice: (1) enacting a frame shift from a medical to a legal interaction; (2) distancing the speaker from the authorial voice of the counseling script; and (3) creating emotional alignment. Conclusions: Prefacing state-mandated abortion counseling scripts constitutes a practical strategy providers use to balance the obligation to comply with state law with personal and professional responsibilities to provide tailored care, provide emotional support, and serve the patient's best interests. Our findings suggest that language constitutes a powerful resource for navigating and minimizing moral conflicts in health care.

Explore the Role of Cultures in Influencing the Dynamics of Counseling among the First Years in Institutions of Higher Learning. The Case of 2012-2014 Freshmen Study in Two Former Black Universities

Despite the abundance of counseling centres in most higher education institutions as a strategy to assist students who are experiencing social-psychological problems that inhibit their learning and retention, there seem to be concern that most of the students do not make use of this service. The aim of the study was to seek the role of culture in influencing students’ consumption of counseling services. The study adopted mixed methods design employing qualitative and qualitative approaches. Specifically the study used a case study design and mini survey. However the qualitative approach was more dominant. An interview guide and a questionnaire as research instruments were also used. Document analysis, focus group discussions and interviews gathered qualitative data while a questionnaire was used to gather quantitative data. The sample consisted of 220 conveniently sampled first year students drawn from two former black Universities. These students were largely coming from rural and semi-urban parts of South Africa. Findings indicate that culture was more influential to students’ dispositions to use counseling services. It emerged that more than half of the first year students who participated in the study had not used counselling services even though they were aware of its existence. Reasons for non use included stigma from fellow students who associated counseling with failure for one to solve their own problems. Also viewed from African cultural lenses, students felt that counselors were not members of the clan or immediate family for one to share their problems. These findings therefore support the view that African traditional cultures may not adequately fit into the western centric counseling counseling services. The paper recommends that counselling co-ordinators strengthen their marketing of counselling services to allay the fears and distrust students have. Also culturally sensitive counselling procedures may be required to build confidence among those students who make use of the services. DOI: 10.5901/mjss.2014.v5n27p1050

Hearing Assistance Technology: Collaborating with Teens to Get It Right

The benefits of hearing assistance technology (HAT) to enhance speech and other desired auditory inputs for listeners with compromised auditory and listening skills are known. However, the best designed and fitted technology is only as effective as its utilization. Benefit is realized when the HAT device is used as prescribed, is used consistently, is working properly, and achieves the desired listening goals for the individual. Therefore, proper selection and management of HAT is critical to achieving the desired outcomes associated with HAT use. Even when benefit is demonstrated, and the HAT is well managed, there are other reasons why users opt not to use the devices. For teens, social identity and the desire to be like their peers complicate the use of HAT. Audiologists should do their part by collaborating with the HAT candidate to assure appropriate selection, fitting, counseling, and orientation and training procedures have occurred.

Impact of an interventional counseling procedure in BRCA families: Efficacy and safety.

1552 Background: Predictive genetic testing has high impact on cancer prevention for BRCA carriers. Passing information in BRCA families on the availability of testing is important. In most countri...

Chronic non-healing sinus manifesting in episiotomy scar: hidden fistula-in-ano

A non-healing sinus manifesting in an episiotomy scar after it has healed is rare. We report one such woman. There were no underlying risk factors like third- or fourth-degree tear or inflammatory bowel disease. In spite of previous attempted exploration the problem had persisted. Examination of the case under anaesthesia revealed it to be a low fistula-in-ano. The methodical evaluation and management of the case is detailed. Fistulectomy completely cured the patient. Most of these patients present to obstetricians and gynaecologists. Awareness and a high index of suspicion of communication with the anorectal canal are important. A team approach with the colorectal surgeon would help in better preoperative counselling, planned evaluation and definitive procedure to completely cure the patient.

The Five Factor Model of Personality and Stuttering

The present study investigated the five personality domains of Neuroticism, Extraversion, Agreeableness, Conscientiousness and Openness, as measured by NEO Five Factor Inventory (NEO-FFI), in a sample of twenty adults who stutter and compared with twenty control group matched to age and gender. Results reveal that mean scores of the personality dimension of Conscientiousness were significantly higher in adults who stutter compared to the control group. Furthermore, male who stutter characterized by significantly higher Neuroticism, than male control group. Following the present results, clinicians might include data on Conscientiousness and Neuroticism to follow an individualized counseling procedure.

Who chooses vasectomy in Rwanda? Survey data from couples who chose vasectomy, 2010-2012

BackgroundVasectomy is safe and highly effective; however, it remains an underused method of family planning (FP) in Africa. In view of this, three Rwandan physicians were trained in no-scalpel vasectomy with thermal cautery and fascial interposition on the prostatic end as vasectomy trainers in 2010, and this initiative has resulted in over 2900 vasectomy clients from February 2010 to December 2012. Study designThis cross-sectional descriptive study describes vasectomy clients (n=316) and their wives (n=300) from 15 randomly selected hospitals in Rwanda. ResultsThe vasectomy clients were mainly over age 40, had young children (age <3) and were married and cohabiting. Limited financial resources, satisfaction with existing family size and avoiding side effects from hormonal methods (wives′) were key motivators for vasectomy uptake. High rates of previous FP use and high degree of interspousal communication are known correlates of higher FP use. ConclusionsFuture and current Rwandan FP programs and other interested parties will benefit from understanding which couples elect vasectomy, their motivations for doing so and their service utilization experiences. Better integration of vasectomy counseling and postvasectomy procedures will benefit the program. ImplicationsUntil this project, vasectomy projects in sub-Saharan Africa were viewed as unrealistic. This study confirms factors influencing vasectomy uptake identified in earlier research, but does so within a robust sample of vasectomy users and their wives and provides a strong understanding of who likely vasectomy users are in this context. Promotion of vasectomy services should be considered as an essential element of a healthy contraceptive method mix.

Reflections on informed choice in resource-poor settings: The case of infant feeding counselling in PMTCT programmes in Tanzania

A growing emphasis on patient involvement in health care has brought ‘informed choice’ to the core of the debate on provider–patient interaction in global health-care programmes. How the principles of patient involvement and informed choice are implemented and experienced in diverging health systems and cultural contexts are issues of increasing interest. Infant feeding and infant feeding counselling of HIV-positive women have posed particular challenges related to choice. Based on ethnographic research conducted from 5 November 2008 to 5 August 2009 within prevention of mother-to-child transmission of HIV (PMTCT) programmes in two hospitals in rural and semi-urban Tanzania, this study explores nurse counsellors' and HIV-positive women's experiences of infant feeding counselling and patient choice. One of the hospitals (hospital A) promoted exclusive breastfeeding as the only infant feeding option, while the other hospital (hospital B) aimed to follow the Tanzanian PMTCT infant feeding guidelines of 2007 promoting patient choice in infant feeding methods. Women in hospital A expressed trust in the advice given and confidence in their own ability to practice exclusive breastfeeding, while women in hospital B expressed great uncertainty and confusion about how best to feed their infants. This paper reflects on the feasibility of a counselling procedure that promotes choice of infant feeding methods in PMTCT programmes in severely resource-poor settings where HIV-positive women have limited access to resources and to up-to-date knowledge on HIV and infant feeding outside the counselling room. We suggest that a universalistic procedure presenting the same unambiguous message on infant feeding to all women enrolled in the PMTCT programme in this and similar settings is likely to produce more confidence, less confusion and, hence, better results in terms of HIV-free survival of the baby.

The role of Sudanese community pharmacists in patients’ self-care

To describe the current and potential roles of Sudanese community pharmacists in responding to symptoms (RTS) and chronic diseases management (CDM) and identify perceived barriers. Community pharmacies in Khartoum State. A structured, self-administered, piloted questionnaire was conducted of pharmacists in charge of 274, randomly selected, community pharmacies. Close ended questions and a 5-point Likert-type scale were used to measure responses. Respondents' demographics, their current activities, attitude and involvement in RTS and CDM and potential barriers. Response rate was 67 %. The majority of respondents (>90 %) reported that they are involved in RTS activities but have negative views regarding practice standards. They lack specific lists of minor conditions and their treatment (87.4 %), recorded counseling procedure (84.7 %), and referral forms (85.8 %). Almost all community pharmacists see an important role for them in CDM (4.54 ± 0.74, 95.3 %) and accept team work with other health care providers (4.46 ± 0.74, 87.5 %). Lack of proper knowledge and training, time, space, patients' acceptance and official recognition of pharmacists' new role, were some of the identified barriers. Sudanese community pharmacists provide RTS and CDM services; however, clinical knowledge and training and well defined national practice standards needs were identified. The current product-focused activities need to be refined to include more patient-focused services. For Improved patients' self-care services, a number of obstacles identified by surveyed pharmacists need to resolved. This requires collaboration of different parties including academics, governmental bodies and professional organizations.

FIT HARRT Plus: A Study of Participant Informed Text Messages to Promote Physical Activity in Adolescent and Young Adult African American Women

project began in June 2012. The intervention involved screening each adolescent woman on initial entry to the juvenile detention center for the date of her last sexual encounter using a new emergency contraception screening form approved by medical administrators. Physician notification took place if the last reported sexual encounter occurred within five days prior to arrival. All eligible patients presented to the medical clinic for counseling the same day of admission or the following day for overnight admissions. When feasible, physicians offered and prescribed emergency contraception immediately. Medical staff and physicians documented screening, counseling, offering of EC and acceptance or refusal of EC in the patient’s medical record. We calculated a sample size of 42 in the pre and post-intervention groups to achieve 90% power, alpha 0.05. We performed statistical analysis using 2 x 2 contingency tables and Fisher’s exact test. Results: The population consisted of young women aged 11 e 17 years seen in the medical department at the juvenile detention center from November 2010 to July 2013. The pre-intervention group included charts reviewed prior to June 2012 (n1⁄4 49) and the post-intervention group included charts reviewed from June 2012 to July 2013 (n 1⁄4 104). Of those encounters, 14 and 27 adolescents, in the pre and post intervention groups respectively, were eligible to receive emergency contraception by reporting sexual activity within the five days prior to admission. With the addition of the emergency contraception screening form, the number of youth screened for EC eligibility increased significantly from 55% preintervention to 80% post-intervention (p < .05). The number of eligible young women offered EC also increased from 21% preintervention to 96% post-intervention (p < .05). While not statistically significant, the number of eligible young women taking EC likewise increased from 14% pre-intervention to 41% postintervention. The majority of post-intervention eligible patients declined EC for the following reasons: desired pregnancy, “If I am pregnant, then I am,” and “I don’t want to take it.” Conclusions: Applying a universal and standardized screening and counseling procedure results in increased EC awareness and utilization among detained young women. Timely access to EC may result in decreased unintended pregnancies among these especially high risk teens. Preventing teen pregnancies reduces abortions, miscarriages, teen parenting and its consequences. Sources of Support: None.

“Notify Your Partners—It’s the Law”

HIV care providers in the United States must counsel clients about disclosure to sexual partners and report anyone who is suspected of noncompliance. This study compared provider attitudes and practices in relation to counseling clients about mandatory disclosure in North Carolina and Alabama, the 2 states with similar HIV epidemiology but different laws for HIV control. Personal interviews were conducted with 20 providers in each state (n = 40). The results were analyzed in a qualitative, cross-comparison method to identify patterns of convergence or difference. Providers in both states believed that clients often failed to notify sexual partners and were secretive if questioned about disclosure. Differences in counseling styles and procedures for each state were noteworthy. Compared to Alabama, North Carolina had harsher penalties for nondisclosure, stricter and more standardized procedures for counseling, and providers expressed greater support for HIV criminalization. Although most North Carolina providers viewed the stricter standards as beneficial for HIV care and control, Alabama providers were likely to view such standards as a barrier to patient care. These results indicated a direct relation between state HIV law, provider attitudes, and counseling procedures for mandatory disclosure.