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What Counselors Tell Low-Risk Clients About HIV Test Performance

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In 1998, Gigerenzer et al. studied how heterosexual men with low-risk behavior were counseled about the accuracy of HIV test results. Most professional counselors conveyed the illusions that false positives do not occur and that a positive HIV test result means that the client is certainly infected. To help improve counseling quality, the authors provided feedback to all counseling centers in Germany. Sixteen years later we assessed whether HIV counseling in Germany has improved by replicating the original study with an expanded sample of 32 randomly selected counseling centers across the country. Since the original research, the positive predictive value (PPV) of HIV testing for a low-risk client has improved from about 50% to 96%. Hence, among every 26 low-risk clients who test positive, we can expect that one is actually not infected. Whereas test performance has improved over the last 16 years, counseling has not. About half of professional counselors communicated the illusion of certainty for sensitivity (15 of 30), specificity (16 of 30), and the PPV (18 of 30). Only one of the 30 counselors could correctly state the PPV. In what follows, we explain how to improve counselors' and clients' understanding of the PPV by representing the information in terms of natural frequencies rather than conditional probabilities. Doing so has been shown to improve the quality of counseling in different medical settings and may enhance future HIV counseling as well.
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Keywords: HIV counseling; HIV testing; HIV/AIDS; natural frequencies; numeracy; risk communication; risk literacy; transparent information

Document Type: Research Article

Publication date: September 1, 2015

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  • Current HIV Research aims to cover all the latest and outstanding developments of HIV research. We invite comprehensive review articles and novel, pioneering work in the basic and clinical fields on all areas of HIV research, including virus replication and gene expression, HIV assembly, virus-cell interaction, viral pathogenesis, epidemiology and transmission, anti-retroviral therapy and adherence, drug discovery, the latest developments in HIV/AIDS vaccines and animal models, mechanisms and interactions with AIDS related diseases, social and public health issues related to HIV disease, and prevention of viral infection. Each issue of the journal contains a series of timely in-depth reviews and original research written by leaders in the field covering a range of current topics on HIV research. Periodically, the journal will invite guest editors to devote an issue on a particular area of HIV research of great interest that increases our understanding of the virus and its complex interaction with the host.
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