Impact of Counseling in Voluntary Counseling and Testing Programs for Persons at Risk for or Living with HIV Infection, David Holtgrave & Jean McGuire, 45 Clinical Infectious Diseases S240 (2007)

In light of the 2006 CDC guidelines that encourage less counseling before and after HIV testing, this article's authors reviewed the evidence regarding voluntary counseling and testing (VCT) to determine the value of pre-and post-test HIV counseling for individuals who test positive as well as for those who test negative for HIV. The authors examined several studies on the impact of VCT on persons who have tested positive for HIV and found that counseling and testing services can reduce the rates of high-risk sexual behavior and the incidence of sexual transmission of HIV. However, because of the focus on counseling and testing as a "bundle," no studies had focused on the incremental effect of counseling alone on people who test positive for HIV. More significantly, the authors found that among people who test negative for HIV, counseling before and after the test clearly has a beneficial effect on risk behaviors and STD incidences in real world settings. According to the authors, although the focus has primarily been on counseling services for people who test positive for HIV, brief counseling services for those who test negative have real public health value, are feasible in clinical settings, and cost very little to implement. The CDC has expressed concern that the quality of counseling in some HIV testing situations may be low quality and thus of little or no value. This study suggests that rather than abandon counseling, its quality should be raised to the standard of client-centered counseling. The study's authors suggest that it may be necessary to explore who in the healthcare system can help meet client-centered counseling standards if clinicians do not have the time, including, for example, non-clinicians in the healthcare system or community-based organizations.