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• Conveying Openness
• Components of an Integrated Risk Assessment
• Example of a Risk Assessment

HCET Home > On-line Training > HIV Risk Assessment in Women > 5. Assessing HIV Risk

Assessing risk is not a new concept for family planning providers. It is an integral part of each client visit and is used to identify behaviors that may put the client at risk for pregnancy, STIs or other sexual health related problems. Most clinics have standard risk assessment forms that will capture risk for HIV infection. The key is providing counseling for identified risks and developing strategies for addressing any risk not identified by the “standard” form.

HIV risk assessment is an important, but imperfect way to assess risk for HIV infection. Patients may conceal high-risk behaviors, and others (especially women in high-risk areas) may be unknowingly at risk from an infected sex partner. In high prevalence family planning clinics, testing women who reported drug use or an IDU partner detected only 41-57% of all cases. Offering testing routinely to all women resulted in greater acceptance (up to 96%), and detected 87% of all HIV infections. (25)

    Risk assessments may be completed by a client questionnaire or verbally.

• Some clients will be more comfortable writing down personal information and others give more information when asked about risk.

• If using a client questionnaire, the clinician should discuss each identified risk.

HIV risk assessment is also a process whereby the health care provider can assist the client to assess and take ownership of her personal risk behaviors. The client must accept that she is engaging in risky behaviors before she and her health care provider can move into the next step of planning for risk reduction.

For more information, go to:

• CDC's Revised Guidelines for HIV Counseling, Testing, and Referral and Revised Recommendations for HIV Screening of Pregnant Women

Conveying Openness

How we ask questions and our own attitudes can influence how comfortable our clients feel discussing private information. Two important aspects of discussing and obtaining risk information are developing trust and providing a safe environment where clients can discuss their risk for infection without fear of judgment.

Using open-ended questions will allow you to gain more information regarding risk and personal circumstances and allow the client the opportunity to acknowledge risk. This technique also requires more input from the client than "yes" or "no," which allows the client to become more involved in the visit and shows that you care about her  feelings and concerns.

Maintaining a non-judgmental attitude is one of the hardest and most valuable tools a clinician can use when discussing personal issues.

• How questions are asked, non-verbal clues and tone of voice can reveal the clinician's acceptance or disapproval of a behavior.

• Becoming familiar with one's own personal attitudes, values and beliefs relating to HIV risk is the first step to becoming less judgmental. The second is learning more about and becoming more comfortable with behaviors that fall outside the clinician's own beliefs.

Activity: Below are two examples of client interaction to gather risk! Try and identify ways in which utilizing these techniques can produce more accurate information related to a risk your client may be taking.

Client's Story: Rebecca is a new client in the family planning clinic. She has come in for a STI exam and requests condoms. She is an attractive 20-year-old college student. She had sexual contact 5 days ago and now has a discharge. She is nervous about coming to the clinic because she has many sex partners and thinks that she will be judged. She decides that she will see how she feels about sharing that information when she gets to the clinic:

Components of an Integrated Risk Assessment

Most of the components of an HIV risk assessment are included in the medical, social or sexual intake/assessment forms most family planning providers already use. Questions may be asked directly by the health care provider or information gathered by using a self-assessment form that is reviewed with the client after completion.

Below are some topics that should be covered and sample questions.

• Previous testing for HIV - when and results of test
  • Tell me about the last time you got tested for HIV.

• History of consensual/non-consensual sexual activity
  • When was the first time you had sex?
  • Do you ever feel like you “have” to have sex?
  • Tell me about any times that you were coerced or forced to have sex.

• Injection drug use/needle-sharing or sexual partner history of injection drug use
  • Have you ever experimented with injecting drugs?
  • Have you ever discussed injection drug use with a sex partner?
  • Do you know if anyone you have had sex with, has injected drugs?

• History of sharing tattoo or body piercing equipment
  • If you have tattoos or body piercing, how did you make sure the needles were clean?
  • Can you recall a time that you shared a needle with anyone for any reason?

• Effect of alcohol or other drug use on sexual behavior
  • How many times have you used alcohol or drugs before having sex?
  • What kind of role do you think alcohol or other drugs play in your sex life?
  • Have you ever had “too much” and don’t remember what happened to you?

• History of sexually transmitted infections and testing
  • Which STIs have you been tested for in the past?
  • What STIs have you had?
  • Has a doctor or nurse ever told you that you had a sexual infection?

• Number of sex partners (male and female) in the your life and in the past 6 months
  • Tell me about your sex partner or partners.
  • In your whole life, how many people have you had sex with?
  • Tell me about the people you have had sex with in the last 6 months.
  • Having sex with both men and women seems to be more common these days. Have you ever tried sex with a male/female?

• Types of sexual activity (oral, anal, vaginal)
  • I need to ask some pretty personal questions about your sex life so that I can provide you with proper care. Is that okay? Have you ever tried oral or anal sex?
  • Tell me about some of the things you do sexually with your partner(s).
  • Some people don’t believe oral sex is actually sex, how do you feel about it?
  • Have you ever substituted oral sex for vaginal sex? What about anal sex instead of vaginal sex?

• History of exchanging sex for money, drugs or shelter
  • Have there ever been times that you had sex with someone to get food, shelter or money?
  • Have you ever had sex with someone to get drugs?

• Use of condoms - for what types of sexual activities; if not used, what are the barriers?
  • If you use condoms, do you use them for oral, anal and vaginal sex?
  • Tell me about the times you used a condom. How did you feel about yourself after using a condom? What would make it easier to use a condom more often?
  • Tell me about the times you didn’t use a condom. What were some of the reasons you chose not to? Did you worry during or afterwards about the risk?
  • How often do you use condoms?

• History of HIV prevention already attempted
  • What kind of things have you been doing to protect yourself from infections?
  • How do you make sure you don't get any infections?

• Plans to become pregnant or currently pregnant
  • Are you pregnant or trying to get pregnant?
  • Do you want to have a baby soon?

• History of a blood transfusion between 1977 and 1985
  • Before 1985, did you ever get sick or hurt and the doctors had to give you blood?

• Partners’ sexual history
  • How many people has your current partner had sex with?
  • Of the people you have had sex with in the last year, how many sex partners did they have?
  • Have you ever asked a sex partner about their previous partners?
  • Have you ever asked a sex partner if he/she ever had sex with someone of the same sex?
  • Has you partner ever had an STI?
  • How many children does your partner have?

• Concerns that a sex partner put the client at risk for HIV
  • Is there any chance one of your sex partners could have HIV?
  • If you did have HIV, who gave it to you?
  • Are you concerned that any of your sex partners could have HIV?
  • Have you ever discussed HIV concerns with a sex partner?
  • Who do you think put you at risk?

• History of being in jail or having partners who are or have ever been in jail/prison
  • Have you or any of your sex partners ever spent any time in jail?

Example of a Risk Assessment for Women
     Adapted from A Guide to the Clinical Care of Women with HIV, 2001 edition

Risk Assessment for STD/HIV for Women
Number of sex partners in the previous year_____, and lifetime_____.
Sex with: Men  Women  Both
History of sexually transmitted infection: Yes  No
History of using: intravenous drugs  sharing needles  crystal meth crack cocaine
History of a sex partner who was incarcerated: Yes  No
History of alcohol abuse: Yes  No
History of feeling that the sex partner puts the patient at risk: Yes  No
How does the woman protect herself from AIDS?
How does the woman protect herself from unplanned pregnancy?
Is there anything else that she feels should mention to ensure good medical care?

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URL: http://65.163.14.21/training/hiv/5assess.htm
 Last update: 03/05/08