What Do Front Line HIV Testers Think of Couples Testing and Counselling?
We spoke to three service providers to find their views on couples HIV testing and counselling:
- Holly MacLean, HIV/STI Testing Nurse, Nine Circles Community Health Centre, Winnipeg, Manitoba
- Ted Town, Counsellor, Options Clinic, London InterCommunity Health Centre, London, Ontario
- Geoffrey Ford, RN, Nurse Educator, STOP Outreach Team, Vancouver Coastal Health, Vancouver, British Columbia
What do you think the potential benefits are of couples testing and counselling? What are the potential drawbacks?
Most clinics and testing sites in Canada recognize that some visits can be more difficult than others, and are happy to accommodate for a partner or support person to be present during the visit. The idea of couples testing and counselling is interesting and would definitely be appealing to some clients who I see in a clinical setting for HIV/STI testing.
There are a number of benefits to couples testing and counselling. Many partners find strength in the support of one another. For many people, testing for HIV can be a difficult thing to do. The familiarity and support of a partner, and the act of offering support can help clients feel more engaged in the care they receive. Another reason people may like getting tested together is the opportunity for clear communication. They may find that testing together and having questions answered together helps with communication around sex and risk.
A third reason to consider couples testing and counselling may be that clients feel better about returning to a health provider or clinic if they were first introduced to it as partners. They may feel that the provider has a better understanding of their particular relationship or situation. Support and couples counselling is offered to people living with HIV and their partners at our clinic. Couples testing and counselling may be a natural way to transition some couples to this support if it is required.
One of the drawbacks of offering this type of testing and counselling is that it requires more skill from the provider in educating clients, especially about testing. Clients may be hesitant to ask questions, or may not be as forthcoming with information as they would be if they had a private visit.
I am concerned about people in abusive or controlling relationships who may come to the clinic with their partner for couples testing and counselling. There is the potential that a testing session may put one partner in greater danger of harm.
Do you think couples testing and counselling has a role to play in Canada? Who do you think would most benefit from this approach to testing? Tell us why.
I believe couples testing and counselling has value for some patients. When offered in a setting where individual follow-up is made possible, and clients feel supported as individuals and in their partnerships, couples testing and counselling may help to facilitate access to information and services.
Couples testing and counselling may be most beneficial for partners who have many questions and concerns. Partners who have very different knowledge/comfort levels around HIV may also benefit the most from this approach to testing. People in open relationships, polyamorous relationships, and fluid-bonded couples (couples that exchange bodily fluids) may appreciate the opportunity to have a discussion in the presence of a tester to discuss risks and concerns.
People for whom language presents a barrier to care may also appreciate the opportunity to test with their partner(s) for many of the reasons discussed above. Access to an interpreter would be important in these cases.
What steps need to be taken in Canada to make couples testing and counseling a reality in more testing sites?
I think it would be key to have a discussion about confidentiality of health information as a top priority in couples testing. Testing in Canada occurs in a variety of settings, by testers with different skill sets. There is the potential that information that a client wants to keep private is shared. That said, I definitely see a movement in health care toward holistic care of person and family. Recognizing that some clients live in partnership with others is an important part of providing holistic care.
Sites in Canada may want to carefully consider how they offer testing to clients. The skill and comfort level of a tester, and the appropriateness of the testing technologies used are important factors in planning how to offer the best service to clients. For instance, are there couples for whom rapid point-of-care testing may not be appropriate, due to window periods or the hesitation to test of one partner? Can a tester facilitate an effective visit if rapid point-of-care testing is used and one or both (or more) partners test positive? Does it make a difference if no rapid point-of-care testing is offered, or if rapid point-of-care testing is performed in front of clients versus in a separate room?
How clinicians document a session also needs to be considered. Where charting is done for client visits, each person in the counselling and testing session would need a separate chart, with care taken not to identify or share partners' health information. Programs may also need to look at how statistics for these visits are recorded: as one or as two patient interactions? If a doctor provides the care, how do they bill? Do provincial targets for number of patients seen change?
Finally, it may also be important (and I'd be interested to see) research on what clients have to say about the experience of testing with partners.
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