Assessing the Center for Disease Control and Prevention's 1994 HIV Counseling, Testing, and Referral: Standards and Guidelines: How Closely Does Practice Conform to Existing Recommendations?

Background: 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 clientcentered 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. Goal: The goal of this study was to compare published national guidelines on HIV counseling, testing, and referral with actual practice. Study Design: The study employed a cross-sectional design and involved 51 interviews. Results: 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%). Conclusions: 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.