Talking to Clients about Their Sexual Histories and HIV Testing

Talking to Clients about Their Sexual Histories and HIV Testing

By David Martin, PhD, ABPP (Senior Director, APA Office on AIDS)

Talking to Clients about Their Sexual Histories and HIV Testing

It is important to talk with your clients about their sexual histories and about the importance of HIV testing. (Source: The Stigma Project on Flickr. Some rights reserved.)

June 27 is National HIV Testing Day.  Of the estimated 1.2 million people living with HIV in the United States, approximately 20% don’t even know they have HIV. The U.S. Preventive Services Task Force (USPSTF) recommends that everyone ages 15-65 be tested for HIV at least once as part of routine medical care.

Who else should get tested?

  • People who have vaginal or anal sex without using a condom or taking Truvada® (a medication that can prevent HIV infection if taken as prescribed) every day.
  • People who inject drugs and who share injection drug equipment.
  • Even people taking precautions while engaging in these behaviors should be tested periodically.

Aside from considering getting tested yourself, if you are a clinical, counseling, or school psychology student, you should seek ways of integrating information about HIV testing while assessing your clients.

Here’s why:

  • Many psychology practicum and internship sites are located in health facilities where the clients are poor and underserved.
  • Among people diagnosed with HIV, incidence is highest in regions where unemployment and poverty are most prevalent and educational levels are lowest.
  • Lack of socioeconomic resources and unstable housing are linked to riskier health behaviors (e.g., earlier initiation of sexual activity, less frequent condom use), which can lead to contracting HIV.
  • Ethnic minorities, notably African Americans and Latinos, are at disproportionate risk for HIV.

Here are 5 things you can do to address HIV testing with your clients:

1. Talk to your clients about HIV/AIDS.

When seeing a patient for the first time, or during initial assessment, a portion of the evaluation should always entail a health screening anyway. Integration of HIV-risk questions is not hard:  “Do you have a regular doctor? … Have you ever been tested to see if you have diabetes? … high blood pressure?  … problems with your thyroid?  … problems with your liver?  … been tested for HIV?  Treating HIV as just another health issue to which the client should attend should help reduce any feelings of HIV-related stigma.  There are a number of medical history outlines available; here’s one (PDF).

2. Ask about their sexual history. 

I learned to take sexual histories on all my patients when I was in training.  Asking about different specific sexual activities (anal, oral, vaginal sex, insertive or receptive) as a routine part of the interview is critical in assessing risk for HIV and other sexually-transmitted diseases. You probably don’t want to start with these questions. The CDC’s Taking Routine Histories of Sexual Health:  A System-Wide Approach for Health Centers (PDF) outlines how to lead up to questions this specific. If you’re uncomfortable (and most people are at first), practice with fellow students or friends—and learn to use language that is familiar to and comfortable for your clients. This would not be the time to stutter in the interview—it would signal your discomfort to your client and make him/her more anxious.

3. Don’t leave out substance use.

It’s important to assess your client’s history of substance use because injection drug use is linked directly to HIV transmission and because alcohol and drug use are associated with increased sexual risk.  Use non-judgmental approaches when asking questions about drug/alcohol use.  One of my former patients admitted to injecting heroin after six months of being clean.  Instead of lecturing him on the dangers of injecting drugs (which he already understood) I put on my empathy hat and asked what had happened.  It was a great opening to talk about the various stressors in his life (which were numerous and profound)—we treated his heroin relapse like difficulty quitting smoking.  The Substance Abuse and Mental Health Services Administration (SAMHSA) provides a useful list of substance-abuse screening instruments.

4. Talk to your supervisor.

Different supervisors may have different approaches to discussing these issues.  Psychodynamically-oriented supervisors may want to emphasize feelings about being tested, whereas supervisors from CBT backgrounds may focus on skills and specific behaviors leading to testing.  Both approaches are important, and in approaching this topic with clients, the therapeutic relationship is always crucial.

5. Use the tools you have available.

There are several resources to help your clients determine their risk for HIV, including:

If your client tests positive, there are resources available, including informational websites and magazines specifically for people with HIV/AIDS like HIV Plus, Positively Aware, and POZ.

If you would like to know more about HIV and how APA is responding, I invite you to visit our webpage.