Explain your professional role (avoiding titles such as DIS).
Explain confidentiality.
Explain the purpose of the session:
to provide information about the disease to which exposed and the reason for treatment
to provide information to help prevent future exposures
to help the patient know what to do if reexposed
Patient Assessment
The interviewer maintains active, two-way client-centered communications
throughout the interview by:
communicating at the patient's level of understanding;
using open-ended questions;
using appropriate nonverbal communication;
using positive reinforcement;
soliciting feedback;
listening effectively; and
using plain paper to record interview notes (never take standard
forms into the interview).
Patient Concerns
Identify and resolve any of the patient's concerns (why given
treatment with a negative test; why talk with DIS if test is negative; confidentiality;
time; clinic experience; etc.).
Determine the content and emphasis of disease intervention
behaviors based on the patient's attitudes and needs.
Socio-sexual Information
Describe the importance of having accurate personal and medical
information in resolving the patient's disease problems.
Question the patient conversationally about where he or she
lives; telephone number; alternative locating information; living with whom:
employment; travel; recreation; and social groups. Explain reasons for questions
if patient shows signs of concern.
Medical History and Disease Comprehension
Determine what the patient knows about the disease.
Reinforce what the patient knows about the disease, and correct
any misconceptions that arise.
Present an individualized discussion, not a medical lecture.
Discuss incubation and the natural course of the disease, mode
of transmission, symptoms, possible sites of exposure, risk of re-infection,
risk reduction, and patient's STD history.
Pursue A-1's based on the responsiveness of the patient.
Disease Intervention Behaviors
Assuring Examination of Partners and Associates
Review confidentiality and the professional role of the DIS.
Briefly review the patient's comprehension of the disease and
the modes of transmission.
Define the significance of immediate partner referral, emphasizing
that one or more may have an STD which would re-expose the patient.
Establish that the referral will be done immediately and will
be for everyone's benefit.
Assess the patient's response to the session thus far and determine
the patient's concerns regarding partners.
Determine the patient's capability to participate in partner
referral (if that option exists).
Evaluate problems and select appropriate solutions. Some specific
motivational approaches to problem solving are:
prevention of reexposure to disease
potential of having asymptomatic partners
risk of being asymptomatic if infected
risk of complications if infected
inconvenience
concern about partners or social group
rapid examination reduces potential for spread
reduce the chance of complications by helping now.
Gather the following information about each partner:
Name (including nicknames), address (including apartment number), telephone number, living arrangements, work address and telephone number, age/race/sex/marital status, physical description, and other
locating information
Exposure information
Pursue A-2's and A-3's (A-2's will include the original patient's partners).
Risk-Reduction Plan
(This section shifts attention to the patient's behaviors that
put him or her at risk for all sexually transmitted disease, and includes an
HIV counseling session. These messages should be individualized and tailored
to each patient.)
Point out that the patient can expose themselves to HIV or
other STDs in exactly the same manner as this exposure occurred.
Determine what the patient knows about HIV and other STDs,
and correct any misconceptions.
Review the patient's sexual and drug-related behaviors and
STD history from earlier in the interview, and engage the patient in a discussion
regarding the patient's perceived risks for HIV and STDs.
Reinforce and support patient's knowledge, actions, intentions,
and communications about current or future safer sex and other risk-reduction
behavior changes.
Negotiate a realistic and incremental plan for reducing risks.
Help the patient identify possible barriers to behavior change,
particularly condom use.
Document what the patient feels is a reasonable, attainable
risk-reduction plan, and offer the patient a copy.
Offer the patient the opportunity to test for HIV. If the patient
refuses the test, offer the facility's HIV services in the future.
Document the date and time for return appointments for STD
and HIV test results.
If tested, discuss the patient's plan to cope while waiting
for the test results. If the patient appears not to have a support system,
offer your office phone number and a hotline number as part of support available
during the waiting period.
Conclusion
Evaluate remaining patient needs or potential compliance problems.
Reinforce any commitments made by the patient.
Redefine respective roles and referral procedures.
Program Operations Guidelines for STD Prevention
