In settings where HIV testing is done and results are to be shared between the client and service provider, counselling before and after blood testing is mandatory. This means no individual/client should be tested for HIV without an informed consent under such circumstances. In case of minors or comatose patients, informed consent should be obtained from a guardian or close relative. Counselling is primarily directed at addressing the psychological and social needs of the client; however, an individual may choose to involve other people in the counselling process, such as family members, close friends, sexual partners and religious leaders. Type and intensity of counselling can be expected to change during the course of HIV infection as the individual's needs evolve.
The extent to which counselling can be provided will depend on the availability of staff and other people able and willing to engage in it. In principle, counselling can be done by a range of health professionals but other professionals and lay people can and should be encouraged to provide counselling services provided they have the required skills. However, counselling should be provided by trained counsellors and where there are no trained counsellors steps should be taken to set up training activities. It is important to note that effective counselling requires familiarity with and sensitivity to the social and cultural background of the client.
Counselling should be seen as a entry point for a life-long relationship between the client and the service provider where the two should interact in case of any eventualities. The client should be encouraged to see such engagement as strengthening the partinership. Counselling is not necessarily hospital or clinic based; domiciliary visits and provision of counselling through self-help groups, clubs or other settings should be encouraged.