Skip to Content
 
 
 
Find:
Advanced Search

Dale Tadlock Resources

Articles, Blogs, and News

Adolescent HIV Counseling & Testing

Rosenfeld, S. (1990, December). Recommended Guidelines—Adolescent HIV Counseling & Testing. Massachusetts Department of Public Health.

Jim walks into his youth worker’s office to talk. After some idle chatting, he shares with Ed, the youth worker, that he feels that there is reason to believe he could have been exposed to the HIV virus and wants to be tested. What does Ed say? How should Ed advise Jim about where and how to get tested? As HIV spreads among the teenage population, more and more youth workers will be faced with this situation. When it happens, it is important that the youth worker respond in a developmentally and culturally appropriate way that helps the teen deal with the psychological, legal, and economic risks of being tested.

Testing teens presents several special issues and considerations. Adolescents should have the same rights as adults to confidentiality of HIV-related medical information. A young person who should be or has been tested must be able to trust a youth worker to maintain confidentiality. Consent is also an important consideration. Consent laws may vary by state. In Massachusetts, the state for which this protocol is written, teens are legally able to give their own written, informed consent to be tested, as required by law for testing. As with anyone, a parent or adult should be available to provide support if the adolescent tests positive. This designated support role must be a person with whom the teen feels safe, not just someone the teen can "talk to."

There are benefits and risks in testing adolescents for HIV. Among the benefits are the following:

  • To help adolescents know their antibody status so that they understand their risk of developing AIDS or transmitting the virus.
  • To motivate behavior change or risk-reduction in adolescents who continue to practice high-risk behaviors and who feel that a positive test result may help them reduce these behaviors, or reduce their chances for disease progression.
  • To reduce anxiety in adolescents who are at low risk for HIV infection, yet who are anxious about it.
  • To reduce anxiety in adolescents who are at high risk, as knowledge of antibody status can be a powerful positive motivator.

There are also risks to HIV testing among adolescents:

  • A false sense of security and denial if the test proves negative.
  • Severe psychological reactions.
  • Adverse social consequences.
  • Isolation and alienation.

The article also notes some particular risks involved with testing minority youth:

"Seropositive status can have a special set of ramifications for youth of color. People of color and ethnic minorities get much of their support from each other. Therefore, the risks of rejection, ostracization, increased homophobia, and stigmatization can be extremely dire for youth of color. Additionally, alienation and isolation from the majoirty culture may restrict access to health and social services." (p. 6)

When determining whether to be tested, a youth worker should seek six objectives:

  • To determine one’s motivation for the test.
  • To assess whether the youth is emotionally stable enough to handle a possible positive test outcome and even the testing process itself.
  • To verify and assess the strength of the social and family support system available to the adolescent.
  • To assure that three test conditions could be met if the youth decided to test: voluntary, informed, and confidential.
  • To support immediate risk reduction.
  • To facilitate a clear decision by the youth.

It is important that no adolescent be tested without at least two pre-test counseling sessions. (Four are recommended.) According to the article, "While this means that some high-risk youth may delay testing, the urgency of testing asymptomatic adolescents is less important than adequate preparation." (p. 11) Following the test, three post-test sessions are recommended, including the session in which the results are given. The pre-and post-test sessions should address the primary concerns of the adolescent as well as educate the teen being tested. These sessions should be conducted at the testing location and should be done by the appropriate professional. These sessions are detailed for the professional in this protocol.

 

QUESTIONS FOR REFLECTION AND DISCUSSION

  1. If your youth organization has no policy on HIV referrals, what would you consider to be the appropriate procedure?
  2. Are you familiar with the laws of your home state or country governing HIV testing for teens? If not, how can you obtain that information and share it with your fellow youth workers? If you are familiar, how has that information been incorporated into your organization’s policies?
  3. What are the laws in your state or country regarding confidentiality for teens being tested for HIV? How would you balance a parent’s right to know with a teen’s right for confidentiality (if it is mandated by your government)?
  4. In addition to providing the correct legal and emotional support for teens being tested, how could one counsel a teen spiritually before and/or after the test? What kind of support or services is your youth organization equipped to offer?

 

IMPLICATIONS

  1. As the HIV epidemic spreads among teens, it is inevitable that more youth workers will be faced with the testing scenario. This presents a great challenge to the youth leader as he or she is called on to provide support that is both gentle, forgiving, and legally sound. A youth worker needs to know one’s governement regulations and prepare for possible future referrals.
  2. HIV among teens forces youth workers to think and meditate on the balance between compassion and grace with the consequences of sin (both personal and/or corporate). More than ever, a youth leader today needs to seriously reflect on this issue.
  3. Protocols of this type are useful in addressing this issue. (The counseling protocols in this document are excellent for both the para-professional and the professional.) Still, ensure that all the information is most current. In this particular guideline, some of the testing information is now out-of-date. This simply reinforces the need for youth workers to stay well-read on the information concerning HIV and AIDS.
Dale Tadlock cCYS


Testing a Teen for HIV

Testing a teen for HIV.

 

PURPOSE OF INTERVENTION

The youth worker can provide information about HIV and HIV testing and assist the teen in deciding whether HIV testing is something that should be pursued. Actual pre-test counseling should be done by a professional at a testing site. Any detailed pre-test counseling, outside of helping a teen decide to seek pre-test counseling and testing, should be done only by professionals as it is considered outside of the responsibility and capability of most youth workers.

EXACT NATURE OF INTERVENTION

Intervention of this type should be carried out only when the teenager has expressed a desire to be tested. Also appropriate for intervention would be situations that arise from discussion of testing based on an HIV risk assessment. A teen should never be pressured to be tested for HIV.

PRINCIPLES OF INTERVENTION

There are vast differences in the ways that adolescents understand, process, and react to information. For this reason, HIV testing should occur based only on the expected benefit to the adolescent.

If a youth has had a reasonable possibility of infection, knowing his or her status could be very beneficial. Not only will the test result help them evalutate their potential for infecting others, but it can greatly reduce stress and anxiety in adolescents who are at high risk. (Often the stress and anxiety lead a teen to more risky behavior.) In adolescents who are at low risk for HIV infection, testing can relieve stress and anxiety as well.

While the benefits to testing should be acknowledged, there are severe risks that must also be considered. The most obvious risk is that of adverse social consequences such as anxiety, nightmares, sleep disturbance, depression, and suicidal behavior in reaction to a positive test result. Another serious risk is a false sense of security and denial if the test is negative. Some adolescents, already feeling invincible, feel "immune" from HIV after a negative result, and they continue or increase risky behaviors. These risks must be considered and evaluated for each teen.

When facilitating a teenager in deciding on HIV testing, there are five objectives the youth worker should consider:

  • Determine the motivation for the test.
  • Assess the teen’s emotional stability in handling a possible outcome.
  • Verify and assess the strength of the social and family support structure available to the adolescent.
  • Support the teen in immediately reducing the HIV risk.
  • Facilitate a clear decision by the youth.

To assess an adolescent in regard to the above objectives, three questions should be explored:

  • "Why do you want to be tested?"
  • "Who are you going to tell?"
  • "What are you going to do when you get the results?"

[Rosenfield, S. (1990, December). Recommended guidelines—adolescent HIV counseling and testing. Massachusetts Department of Public Health.)]

Exploring these three questions with the previous five objectives in mind, one should get a solid grasp on whether the teen should be considered for a referral to a test center. At the test center, pre-test counseling should be administered with the adolescent. A professional counselor will evaluate the adolescent in question before allowing the teen to be tested. (These assessments usually take 2-4 sessions.) For this reason, the youth worker should not heap undo pressure upon him- or herself. The general rule should be: if in doubt refer the young person to a counselor at a testing site.

PRECAUTIONS

Counseling teenagers seeking or needing HIV testing can be very trying and complex. There are two issues that must be researched and considered by the youth worker before doing HIV test counseling and referrals. The first consideration is that of the local and state laws in the state in which the youth worker resides and/or works. The Centers for Disease Control list nine states that currently do not allow anonymous testing. (Anonymous testing sites do not require any disclosure of identity.) Those states (as of December 1996) are Alabama, Idaho, Mississippi, Nevada, North Dakota, South Carolina, South Dakota, Tennessee, and Wyoming. The requirements for confidential testing vary from state to state and change often. (Proper identity is required for insurance purposes or other such inquiries.) Those making referrals to a confidential testing site should research the requirements and the legal ramifications of making a teen referral to such a testing site. A local AIDS hotline should be able to provide advice and counsel on this issue.

Secondly, the issue of confidentiality is critical. It is important not only at the testing site, but in the youth worker’s "office" as well. One should check local and state laws regarding disclosure. Generally speaking, most states allow teens to sign their own consent for testing. Legally, as a result, parents do not have to be consulted. This raises many issues for the youth worker doing a referral for testing. Each church should explore this issue and prepare a written policy on disclosure that is responsible, legally sound, and sensitive to the need for the teenager’s confidentiality.

FURTHER SUGGESTIONS

Before referring to a testing site, the following should be considered:

  • It is recommended that adolescents be tested in a facility in which mental and medical care is readily available, in case of a positive result. A familiar and trustworthy environment is much more constructive to the teen seeking proper help over a period of time.
  • The testing site should provide a consistent counselor/client relationship. If the teen continually sees different counselors, trust will not properly develop; this could lead to inconsistent care in the case of a positive result.
  • Adolescent test sites (whether anonymous or confidential) must ensure privacy for the adolescent.
  • Although confidential testing best promotes ongoing care and introduces fewer ethical issues for the youth worker, anonymous testing should not be ignored if available. For adolescents who are homeless or have no financial resources, anonymous testing may be the only option. (Often anonymous test sites are free.)
Dale Tadlock cCYS


Testing a Teen for HIV

Testing a teen for HIV.

 

PURPOSE OF INTERVENTION

The youth worker can provide information about HIV and HIV testing and assist the teen in deciding whether HIV testing is something that should be pursued. Actual pre-test counseling should be done by a professional at a testing site. Any detailed pre-test counseling, outside of helping a teen decide to seek pre-test counseling and testing, should be done only by professionals as it is considered outside of the responsibility and capability of most youth workers.

EXACT NATURE OF INTERVENTION

Intervention of this type should be carried out only when the teenager has expressed a desire to be tested. Also appropriate for intervention would be situations that arise from discussion of testing based on an HIV risk assessment. A teen should never be pressured to be tested for HIV.

PRINCIPLES OF INTERVENTION

There are vast differences in the ways that adolescents understand, process, and react to information. For this reason, HIV testing should occur based only on the expected benefit to the adolescent.

If a youth has had a reasonable possibility of infection, knowing his or her status could be very beneficial. Not only will the test result help them evalutate their potential for infecting others, but it can greatly reduce stress and anxiety in adolescents who are at high risk. (Often the stress and anxiety lead a teen to more risky behavior.) In adolescents who are at low risk for HIV infection, testing can relieve stress and anxiety as well.

While the benefits to testing should be acknowledged, there are severe risks that must also be considered. The most obvious risk is that of adverse social consequences such as anxiety, nightmares, sleep disturbance, depression, and suicidal behavior in reaction to a positive test result. Another serious risk is a false sense of security and denial if the test is negative. Some adolescents, already feeling invincible, feel "immune" from HIV after a negative result, and they continue or increase risky behaviors. These risks must be considered and evaluated for each teen.

When facilitating a teenager in deciding on HIV testing, there are five objectives the youth worker should consider:

  • Determine the motivation for the test.
  • Assess the teen’s emotional stability in handling a possible outcome.
  • Verify and assess the strength of the social and family support structure available to the adolescent.
  • Support the teen in immediately reducing the HIV risk.
  • Facilitate a clear decision by the youth.

To assess an adolescent in regard to the above objectives, three questions should be explored:

  • "Why do you want to be tested?"
  • "Who are you going to tell?"
  • "What are you going to do when you get the results?"

[Rosenfield, S. (1990, December). Recommended guidelines—adolescent HIV counseling and testing. Massachusetts Department of Public Health.)]

Exploring these three questions with the previous five objectives in mind, one should get a solid grasp on whether the teen should be considered for a referral to a test center. At the test center, pre-test counseling should be administered with the adolescent. A professional counselor will evaluate the adolescent in question before allowing the teen to be tested. (These assessments usually take 2-4 sessions.) For this reason, the youth worker should not heap undo pressure upon him- or herself. The general rule should be: if in doubt refer the young person to a counselor at a testing site.

PRECAUTIONS

Counseling teenagers seeking or needing HIV testing can be very trying and complex. There are two issues that must be researched and considered by the youth worker before doing HIV test counseling and referrals. The first consideration is that of the local and state laws in the state in which the youth worker resides and/or works. The Centers for Disease Control list nine states that currently do not allow anonymous testing. (Anonymous testing sites do not require any disclosure of identity.) Those states (as of December 1996) are Alabama, Idaho, Mississippi, Nevada, North Dakota, South Carolina, South Dakota, Tennessee, and Wyoming. The requirements for confidential testing vary from state to state and change often. (Proper identity is required for insurance purposes or other such inquiries.) Those making referrals to a confidential testing site should research the requirements and the legal ramifications of making a teen referral to such a testing site. A local AIDS hotline should be able to provide advice and counsel on this issue.

Secondly, the issue of confidentiality is critical. It is important not only at the testing site, but in the youth worker’s "office" as well. One should check local and state laws regarding disclosure. Generally speaking, most states allow teens to sign their own consent for testing. Legally, as a result, parents do not have to be consulted. This raises many issues for the youth worker doing a referral for testing. Each church should explore this issue and prepare a written policy on disclosure that is responsible, legally sound, and sensitive to the need for the teenager’s confidentiality.

FURTHER SUGGESTIONS

Before referring to a testing site, the following should be considered:

  • It is recommended that adolescents be tested in a facility in which mental and medical care is readily available, in case of a positive result. A familiar and trustworthy environment is much more constructive to the teen seeking proper help over a period of time.
  • The testing site should provide a consistent counselor/client relationship. If the teen continually sees different counselors, trust will not properly develop; this could lead to inconsistent care in the case of a positive result.
  • Adolescent test sites (whether anonymous or confidential) must ensure privacy for the adolescent.
  • Although confidential testing best promotes ongoing care and introduces fewer ethical issues for the youth worker, anonymous testing should not be ignored if available. For adolescents who are homeless or have no financial resources, anonymous testing may be the only option. (Often anonymous test sites are free.)
Dale Tadlock cCYS


Adolescent HIV Counseling & Testing

Rosenfeld, S. (1990, December). Recommended Guidelines—Adolescent HIV Counseling & Testing. Massachusetts Department of Public Health.

Jim walks into his youth worker’s office to talk. After some idle chatting, he shares with Ed, the youth worker, that he feels that there is reason to believe he could have been exposed to the HIV virus and wants to be tested. What does Ed say? How should Ed advise Jim about where and how to get tested? As HIV spreads among the teenage population, more and more youth workers will be faced with this situation. When it happens, it is important that the youth worker respond in a developmentally and culturally appropriate way that helps the teen deal with the psychological, legal, and economic risks of being tested.

Testing teens presents several special issues and considerations. Adolescents should have the same rights as adults to confidentiality of HIV-related medical information. A young person who should be or has been tested must be able to trust a youth worker to maintain confidentiality. Consent is also an important consideration. Consent laws may vary by state. In Massachusetts, the state for which this protocol is written, teens are legally able to give their own written, informed consent to be tested, as required by law for testing. As with anyone, a parent or adult should be available to provide support if the adolescent tests positive. This designated support role must be a person with whom the teen feels safe, not just someone the teen can "talk to."

There are benefits and risks in testing adolescents for HIV. Among the benefits are the following:

  • To help adolescents know their antibody status so that they understand their risk of developing AIDS or transmitting the virus.
  • To motivate behavior change or risk-reduction in adolescents who continue to practice high-risk behaviors and who feel that a positive test result may help them reduce these behaviors, or reduce their chances for disease progression.
  • To reduce anxiety in adolescents who are at low risk for HIV infection, yet who are anxious about it.
  • To reduce anxiety in adolescents who are at high risk, as knowledge of antibody status can be a powerful positive motivator.

There are also risks to HIV testing among adolescents:

  • A false sense of security and denial if the test proves negative.
  • Severe psychological reactions.
  • Adverse social consequences.
  • Isolation and alienation.

The article also notes some particular risks involved with testing minority youth:

"Seropositive status can have a special set of ramifications for youth of color. People of color and ethnic minorities get much of their support from each other. Therefore, the risks of rejection, ostracization, increased homophobia, and stigmatization can be extremely dire for youth of color. Additionally, alienation and isolation from the majoirty culture may restrict access to health and social services." (p. 6)

When determining whether to be tested, a youth worker should seek six objectives:

  • To determine one’s motivation for the test.
  • To assess whether the youth is emotionally stable enough to handle a possible positive test outcome and even the testing process itself.
  • To verify and assess the strength of the social and family support system available to the adolescent.
  • To assure that three test conditions could be met if the youth decided to test: voluntary, informed, and confidential.
  • To support immediate risk reduction.
  • To facilitate a clear decision by the youth.

It is important that no adolescent be tested without at least two pre-test counseling sessions. (Four are recommended.) According to the article, "While this means that some high-risk youth may delay testing, the urgency of testing asymptomatic adolescents is less important than adequate preparation." (p. 11) Following the test, three post-test sessions are recommended, including the session in which the results are given. The pre-and post-test sessions should address the primary concerns of the adolescent as well as educate the teen being tested. These sessions should be conducted at the testing location and should be done by the appropriate professional. These sessions are detailed for the professional in this protocol.

 

QUESTIONS FOR REFLECTION AND DISCUSSION

  1. If your youth organization has no policy on HIV referrals, what would you consider to be the appropriate procedure?
  2. Are you familiar with the laws of your home state or country governing HIV testing for teens? If not, how can you obtain that information and share it with your fellow youth workers? If you are familiar, how has that information been incorporated into your organization’s policies?
  3. What are the laws in your state or country regarding confidentiality for teens being tested for HIV? How would you balance a parent’s right to know with a teen’s right for confidentiality (if it is mandated by your government)?
  4. In addition to providing the correct legal and emotional support for teens being tested, how could one counsel a teen spiritually before and/or after the test? What kind of support or services is your youth organization equipped to offer?

 

IMPLICATIONS

  1. As the HIV epidemic spreads among teens, it is inevitable that more youth workers will be faced with the testing scenario. This presents a great challenge to the youth leader as he or she is called on to provide support that is both gentle, forgiving, and legally sound. A youth worker needs to know one’s governement regulations and prepare for possible future referrals.
  2. HIV among teens forces youth workers to think and meditate on the balance between compassion and grace with the consequences of sin (both personal and/or corporate). More than ever, a youth leader today needs to seriously reflect on this issue.
  3. Protocols of this type are useful in addressing this issue. (The counseling protocols in this document are excellent for both the para-professional and the professional.) Still, ensure that all the information is most current. In this particular guideline, some of the testing information is now out-of-date. This simply reinforces the need for youth workers to stay well-read on the information concerning HIV and AIDS.
Dale Tadlock cCYS


TechMission Corps City Vision College ChristianVolunteering.org