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Materials in this module will help you: 

  • Tell clients their HIV test is reactive (or positive)
  • Offer emotional and practical support to clients who have received this news; support them to begin the next steps in their care
  • Talk to clients who have positive/reactive tests about notifying  their partners
  • Deliver news of a non-reactive test; reinforce prevention messages and share information about other services (PrEP, harm reduction, mental health) as needed

Delivering Results

Be direct: for example, “It’s not the news we hoped for. Your test is reactive.”

  • Provide immediate comfort and support. Expect a range of emotional responses: disbelief, shock, anger (at you or a former partner), guilt, shame, fear, or anxiety; people may also express relief at having symptoms explained, or no emotional response
  • Encourage them to express their emotions, and allow them time and space to do so, even if there is lengthy silence
  • Remind them that there are now many treatments for HIV that allow people to live long, healthy lives. You will help them find a doctor and other supports they need.
  • Double back to talk about the people in their life that can support them (discussed in the pre-test counselling); will they be able to see this person today?
  • Start the discussion about next steps

Follow-Up to Reactive Result

  • Talk about where clients can go for HIV treatment, and if possible, make an appointment for them (optimally within 72 hours); encourage them to consider prompt treatment to maximize the health benefits and reduce the risk of further transmissions
  • Recommend standard laboratory-based testing to confirm the diagnosis; obtain consent and draw blood.
  • Schedule an appointment (in about a week) for them to return for their test results and to follow up on today’s conversations – even if they decline standard testing
  • Explain that the result of the standard testing will be automatically reported to Public Health (either anonymously or nominally depending how the testing was done) by the Public Health Ontario Laboratory; advise clients who have tested nominally about legislated Public Health follow-up, including counselling, treatment and care support, and discussions of contact notification
  • Talk about practices that can reduce possible transmission of HIV to current and future partners; the legal requirements around disclosure (see the discussion of legal issues around disclosure on the next page) and what they want to tell family and others

Public Health Process

When a client tests nominally (using their real name and OHIP number), the Public Health Unit where they live is automatically notified about their positive test by the Public Health Ontario Laboratory. In accordance with Ontario’s Infectious Disease Protocol, and the current best practice recommendations for Public Health STI case management, Public Health will contact the client as soon as possible after being notified of a positive test. Public health staff will work with the client to:

  • Actively engage them in entering and continuing HIV care and to start antiretroviral therapy
  • Refer clients to treatment, including community and mental health services as needed, and follow- up with them periodically
  • Help manage other health challenges
  • Ensure individuals engaging in high-risk practices have the support needed to reduce the risk of transmitting HIV (U=U, condoms) practices
  • Ensure partner notification is completed by either the client or the PHU
  • Develop an approach to care for each client

If a client tests anonymously, the local Public Health Unit is notified about their test, but not their identity. However, as a HIV test counsellor, you can contact Public Health about your client’s sexual contacts and have them do follow-up contact tracing without revealing your client’s identity.

Disclosure (Legal)

Disclosure means telling people you have HIV. Except when there is a “realistic possibility of transmission” to a sexual partner, this is not something a person living with HIV is required to do. Advise clients who are not virally suppressed, or who have an unknown HIV viral load (ex: newly diagnosed individuals):

  • To tell a future sexual partner before any penetrative sexual act. Although condoms will reduce the risk of HIV transmission, until HIV treatment can lower their viral load,* it is still possible for them to face criminal charges if they don’t disclose their status.
  • Beyond this obligation, be selective who they tell at this early stage. They only need to tell people that will be supportive and helpful

* Once a person has two HIV viral load tests, both under 200 copies, and at least 6 months apart, they will not be charged if they do not tell a sexual partner, as long as they take their medications regularly and remain undetectable.

Resources about disclosure including legal requirements to notify a sexual partner

  • HIV Disclosure–CATIE has compiled resources including how to disclose to romantic or sexual partners, health care providers and legal implications.

At: https://www.catie.ca/treatment-care-hiv-treatment-care-and-support/disclosure

  • HIV disclosure: How Do I Tell My Kids – Created by Teresa Group in 2018, this guide was created, primarily for women, considering disclosure conversations with their children and family.

At: https://teresagroup.ca/index.php/resources/

  • The HIV/AIDS Legal Clinic of Ontario (HALCO) provide free legal services and advice on a range of legal issues related to HIV including the legal requirement to notify sexual partners, and the legal consequences of not doing so. See https://www.halco.org/areas-of-law/hiv-criminal-law for regular updates. Clients can be referred to HALCO for an intake.
Text Box: Resources for Newly Diagnosed Clients It’s all still possible: Starting points for living well with HIV– This resource, produced by CATIE offers basic information on HIV, treatment, how to stay healthy and avoid passing HIV to others, disclosure and next steps. At: https://www.catie.ca/en/practical-guides/starting-point Managing your Health: A guide for people living with HIV – Is a useful resource produced by CATIE for newly diagnosed clients, and will also link your client to CATIE, for more, when they are ready. At: https://www.catie.ca/myh

Caring for Yourself

It can be stressful to tell someone that they have HIV..

  • Take the time you need after a stressful appointment.
  • Identify colleagues or others in your workplace who might provide support.
  • Learn about the internal processes for self-care at your site

Here are some resources that may be helpful. Although none of them were specifically created for HIV test counsellors, they may give you some ideas about how to manage the challenges you encounter in your work life, and the stress that comes with these challenges.

  • Self-care for AIDS Service Organization Workers – The AIDS Bereavement and Resiliency Program of Ontario works with organizations to build capacity, provide support, and share tools & resources that foster resiliency in the face of multiple loss grief. At: https://abrpo.org/resources/
  • Reach Out: Self care for professionals – This Australian resource for mental health counsellors offers a number of useful tools to assess your own well-being and create a self-care plan.

At: https://schools.au.reachout.com/articles/self-care-for-professionals

  • Self-Care Starter Kit – This basic guide from Homewood Health (a Canadian provider of mental health and addictions care) is a simple tool to begin considering this issue.

At: https://www.ualberta.ca/human-resources-health-safety-environment/media-library/health-and-wellbeing/mental-health/other/self-care-starter-kit—homewood.pdf