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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