. Author manuscript; available in PMC: 2014 Oct 2.

Published in final edited form as: AIDS Behav. 2014 Sep;18(9):1785–1800. doi: 10.1007/s10461-014-0707-1

Table 2.

Overview of Uphungu Wanga counseling sessions.

Day of Diagnosis
- Introduce session, build rapport and explore emotional status post-AHI diagnosis, assess coping, describe future sessions, normalize discussion, ask permission to proceed.
- Assess current sexual behaviors (types of sexual behaviors, number of partners, condom use)
- Use the elicit-provide-elicit technique to address reduction risk of transmission during AHI:
  - ▪
    Elicit client’s perception of risk and sexual relationships.
  - ▪
    Educate about HIV and AHI; reference AHI messages (Table 1).
  - ▪
    Elicit and explore realistic risk reduction strategies.
- Explore: 1) motivation to reduce risky behaviors and 2) confidence to try chosen risk reduction strategies, for each possible partner; explore relevant barriers, facilitators, skills.
- Finalize risk-reduction plan and identify at least one goal for next three days.
Day 3
- Introduce session, assess coping with AHI diagnosis, ask permission to proceed.
- Review goal(s); explore successes and challenges in trying goal(s); assess sexual risk behaviors since last session.
- Use the elicit-provide-elicit technique to address:
  - ▪
    Triggers
  - ▪
    AHI messages
- Offer risk-reduction options using the menu of options (i.e., abstinence, avoidance, non-penetrative sex acts, using a condom, partner reduction).
- Explore: 1) motivation to reduce risky behaviors and 2) confidence in trying chosen risk reduction strategy(ies), for each possible partner, soliciting ideas from client on how to maintain low-risk behaviors; explore relevant barriers, facilitators, and skills.
- Revise current risk-reduction plan, as needed, and identify at least one goal for the next four days.
Week 1
- Introduce session, assess coping, review AHI messages, ask permission to proceed.
- Review goal(s); explore successes and challenges in trying goal(s); assess sexual risk behaviors since last session.
- Assess disclosure of HIV diagnosis and introduce disclosure as another risk-reduction strategy:
  - ▪
    Using the elicit-provide-elicit technique, discuss the benefits of and concerns with disclosure.
  - ▪
    Introduce options for disclosing (i.e., patient notification, provider notification, couples counseling).
  - ▪
    Explore: 1) motivation to disclose and 2) confidence in disclosing to a sexual partner; explore relevant barriers, facilitators, and skills.
  - ▪
    Among willing clients, make a plan for disclosure (e.g., deciding who needs to know; anticipating partner reactions; deciding what information to share and where and when to disclose) and practice communication skills.
- Revise current risk-reduction plan as needed, and identify at least one goal for the next week; identify disclosure goal among willing clients.
Week 2
- Introduce session, assess coping, review AHI messages, ask permission to proceed.
- Review goal(s); explore successes and challenges in trying goal(s); assess sexual risk behaviors since last session.
- Ask client to choose discussion topic (options: having children when HIV-positive, including PMTCT; how to be intimate when HIV-positive; avoiding fear of one’s partner; maintaining abstinence; using condoms and how to be safer during sex; having sex with someone who is HIV positive; telling others, including one’s children, “I am positive”; and finding social support and social networks).
- Explore 1) motivation and 2) confidence in behavior discussed in topic choice; explore relevant barriers, facilitators, and skills.
- Revise risk-reduction plan for longer time frame and identify longer-term goals.
Week 8: Booster
- Introduce session, assess coping, ask permission to proceed.
- Review goal(s); explore successes and challenges in trying goal(s); assess sexual risk behaviors since last session.
- Revisit disclosure.
- Using the elicit-provide-elicit technique, explore understanding of the transition from AHI to established infection.
- Provide information about maintaining long-term health (e.g., engaging in the health care system, monitoring CD4, developing support systems, local resources).
- Discuss long-term risk reduction goals, explore 1) motivation and 2) confidence in long-term risk reduction, and develop long-term plan; explore relevant barriers, facilitators, and skills.