Pre- and post-test conversations
Pre- and post-test conversations and information can provide support for individuals who are receiving HIV self-test kits, addressing stigma, providing accurate and accessible information and promoting linkage to care and support services. This may be done in person or through other means (e.g., pamphlets attached to the kit, online). These conversations can be an important part of normalizing HIV testing and should be approached with sensitivity, empathy and sex positivity, while recognizing an individual’s autonomy.
“Being willing to sit with and listen to folks, giving them time and space to feel their emotions” – Dialogue participant
“Always remember what your first test was like and what a positive result felt like” – Dialogue participant
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Below are some practice-based recommendations for you to consider when determining how to have pre- and post-test conversations with clients, as well as considerations around what to do when conversations may not be possible or desired by the individual taking the test.
Practice-based recommendations:
1. Recognize that some people may want to engage in detailed conversations about self-testing while others will want to simply take a self-test kit. Respect each person’s autonomy, tailor the information that you provide to their needs and preferences, and plan for other ways of sharing information if needed.
2. Recognize that not every situation is practical for detailed pre- and/or post-test conversations, and plan alternative methods for sharing information. Consider directing individuals to online resources or providing print materials like postcards, pamphlets or stickers when conversations are not possible or desired.
3. Consider including key messages and contact information for your organization with the self-test kits so people know who to follow up with if they have questions or concerns.
4. When feasible and desired, provide pre-test information covering educational topics relevant to the person and the situation (e.g., HIV basics, how to conduct a self-test and interpret the results).
5. When feasible and desired, provide post-test information covering educational topics relevant to the person and the situation (e.g., prevention of sexually transmitted infections, referral pathways for both HIV prevention and treatment services, the need for confirmatory testing, legal issues).
6. Inform individuals that support is available to them regardless of their test result and assure them that referrals to care and other services are available.
7. Create a safe and respectful environment to talk about sex and drug use and challenge HIV-related stigma and inaccurate information.
8. If you have expired self-test kits, consider using them to demonstrate how to use the test during your conversations. This can help to reduce anxiety about taking the test or confusion about how the test works.
9. Consider strategies to address individuals' concerns about receiving a positive result by helping them prepare for the possible outcomes and understand what the next steps might be.
10. If safety concerns are raised by an individual (e.g., if a person expresses concern that their partner might react negatively), provide support and appropriate referrals or alternative testing options.
11. Continuously assess and adapt conversations and information-sharing approaches on the basis of feedback from clients.
12. Consider providing staff with key messages or scripts to facilitate pre- and post-test conversations.
13. Provide a supportive environment for individuals with invalid results and be prepared to provide reassurance and guidance on repeat testing. Let individuals know that they can reach out to your organization if they have invalid results for more tests or support.
14. Provide a supportive environment for individuals with reactive results, allowing them time to process the information and express their feelings and concerns. Provide silence and time if needed. When the person is ready, discuss next steps including confirmatory testing and linkage to care.
15. Provide a supportive environment for individuals with a non-reactive result and allow them to ask questions and express feelings and concerns. Be prepared to provide referrals to prevention services or other needed support services.
16. Respect the lead of clients in determining the pace and depth of discussions, ensuring that they feel empowered and in control of their care decisions.
17. Ensure that all staff have access to support services to address emotionally difficult situations with clients, including referrals to services at other organizations when appropriate or desired.