Addressing HIV infection in office practice. Assessing risk, counseling, and testing

HIV risk assessment, counseling, and testing performed by primary care physicians can be valuable in the early identification of persons infected with HIV, can contribute to their appropriate medical treatment, and may help to prevent the further spread of the disease. HIV risk assessment comprises a detailed sexual and drug use history, awareness of the mechanisms of HIV transmission, and knowledge of which patients should be encouraged to undergo counseling and testing. During pretest counseling, the physician asks for informed consent for the HIV test, explains the meaning of positive and negative test results, reviews risk behaviors, and offers an appropriate prevention message. During posttest counseling, the physician informs the patient of the results, reviews the meaning of the test results, and reinforces the appropriate prevention messages. Follow-up care for seropositive patients should be arranged, including appropriate medical care, referral to social and support services, and, if indicated, mental health care.