Assessing the Center for Disease Control and Preventionʼs 1994 HIV Counseling, Testing, and Referral: Standards and Guidelines

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Abstract
Growing support for the focus of the 1994 HIV Counseling, Testing, and Referral Guidelines on early recognition of HIV infection and the findings of a multicenter, randomized controlled trial establishing the efficacy of the client-centered model of the Centers for Disease Control and Prevention have placed a new focus on the need for the effective delivery of HIV prevention counseling. The goal of this study was to compare published national guidelines on HIV counseling, testing, and referral with actual practice. The study employed a cross-sectional design and involved 51 interviews. Sixty-one percent of sites routinely completed personalized risk-reduction plans. Thirty-one percent of respondents indicated that HIV-positive clients spoke more than the counselor during posttest counseling, and 23% said the same for HIV-negative clients. Sixty-eight percent of respondents indicated that individual risks were discussed in the typical counseling session, whereas 30% reported discussing a combination of general information and individual risks. Most sites met referral standards (86%), found and notified HIV-positive clients who did not return for their test results (85%), and had at least one counselor observation per year (79%). Several measures indicated areas in which practice did not conform to guidelines, which may compromise the potential benefits of the HIV counseling, testing, and referral services.