HIV Testing for Low-Risk Clients

HIV Testing Reviewed, From the Max Planck Institute, 1998.

If everybody tests “reactive” (positive) on an “HIV test”, then whose tests are to be considered accurate? Not heterosexual German men, goes the answer:

Abstract. This study addresses the counselling of heterosexual men with low-risk behaviour who, voluntarily or involuntarily, take a HIV test. If such a man tests positive, the chance that he is infected can be as low as 50%. We study what information counsellors communicate to clients concerning the meaning of a positive test and whether they communicate this information in a way the client can understand.

A positive test is not positive? Only some of the time, they say. When? Who knows – when they show sufficient “risk behaviors” to have their non-specific test be “interpreted” as “specific.” Until then, it’s “very important,” they say, to warn people against believing their “Hiv test” results.

To get realistic data, one of us visited as a client 20 public health centres in Germany to take 20 counselling sessions and HIV tests. A majority of the counsellors explained that false positives do not occur, and half of the counsellors told the client that if he tests positive, it is 100% certain that he is infected with the virus. Counsellors communicated numerical information in terms of probabilities rather than absolute frequencies, became confused, and were inconsistent.

HIV Test” counselors telling untruths? Peddling false information?

Recall that under the currently available estimates, only some 50% of heterosexual German men with low-risk behaviour actually have HIV if they test positive. The information provided by the counsellors was quite different. Half of the counsellors (ten of 18; two repeatedly ignored this question) told the client that if he tested positive it was absolutely certain (100%) that he has HIV (Table 1 and Session 1). Five told him that the probability is 99.9% or higher (e.g., Session 3). Th us, if the client had tested positive and trusted the information provided by these 15 counsellors, he might indeed have contemplated suicide, as many have before (Stine, 1996).

And we don’t want people to kill themselves, based on faulty test results.

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