The proposed study addresses a major gap in our understanding of the process of HTV counseling and testing for men who have sex with men (MSM). Rapid HIV testing is currently being implemented in counseling and testing (C&T) programs nationwide as part of an initiative to increase testing among high-risk populations outside of clinical settings. Given that the majority of high-risk men also frequent bathhouses, these are ideal venues in which to provide C&T. Rapid testing represents a revolution in the practice of C&T because it compresses the pre- and post-test session separated by a week into one session. While rapid testing will ensure that clients receive their results, it will increase the level of tension in the session because neither the counselor nor the client will have time to prepare for the result. Experience from post-test counseling suggests that the anxious period before receiving life-altering diagnostic news is not the best time to engage clients in a discussion of their risk behavior, yet this is what rapid testing will entail. The challenges of implementing rapid testing provide an opportunity to examine what actually transpires in C&T sessions. Although C&T has been widely promoted as a risk-reduction intervention in the U.S., outcome studies have found that MSM testing three or more times not only continue to report high-risk behavior but actually seroconvert at higher rates than previously untested clients. Previous C&T process analysis has examined either the counseling interaction, the client's or the counselor's experience independently. This is the first study to examine C&T process from all three perspectives. 70 test sessions will be digitally audio-recorded to describe patterns and variations in counselors' strategies for providing risk reduction counseling in both rapid and standard C&T. Follow-up interviews with the same clients and counselors will elicit narratives about the test experience. Interviews with 30 men who have not tested in the last 2 years will examine reasons for not testing. By developing new measures for evaluating the process of C&T, the proposed study will make a major methodological contribution to the evaluation of HIV prevention interventions and provide tools for counselor training and supervision based on empirical observation of real-world practice.
| Sheon, Nicolas; Lee, Seung-Hee; Facente, Shelley (2010) From questionnaire to conversation: a structural intervention to improve HIV test counseling. Patient Educ Couns 81:468-75 |
| Sheon, Nicolas; Lee, Seung-Hee (2009) Sero-skeptics: discussions between test counselors and their clients about sexual partner HIV status disclosure. AIDS Care 21:133-9 |
| Lee, Seung-Hee; Sheon, Nicolas (2008) Responsibility and risk: accounts of reasons for seeking an HIV test. Sociol Health Illn 30:167-81 |
