National Guidelines on Management of Sexual Violence in Kenya
National Guidelines on Management of Sexual Violence in Kenya
National Guidelines on Management of Sexual Violence in Kenya
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7.3 Counsel<strong>in</strong>g Related to Possible STIs Includ<strong>in</strong>g HIV<br />
Infecti<strong>on</strong><br />
HIV Pre- and Post-Test Counsel<strong>in</strong>g<br />
Counsel<strong>in</strong>g procedures should follow the established <str<strong>on</strong>g>Nati<strong>on</strong>al</str<strong>on</strong>g> HIV test<strong>in</strong>g <str<strong>on</strong>g>Guidel<strong>in</strong>es</str<strong>on</strong>g>.<br />
While the counselor may provide <strong>in</strong>formati<strong>on</strong> to the survivor, the survivor may not be<br />
<strong>in</strong> a positi<strong>on</strong> to pay careful attenti<strong>on</strong> to the <strong>in</strong>formati<strong>on</strong> given to her/him because s/he<br />
is highly traumatized. Therefore, it is essential for the counselor to clarify the survivor’s<br />
understand<strong>in</strong>g <strong>of</strong> the <strong>in</strong>formati<strong>on</strong> provided.<br />
Pre-Test Counsel<strong>in</strong>g<br />
The pre-test sessi<strong>on</strong> <strong>in</strong>troduces basic HIV-<strong>in</strong>formati<strong>on</strong>. The benefits <strong>of</strong> tak<strong>in</strong>g HIV-test<br />
should be expla<strong>in</strong>ed. The implicati<strong>on</strong>s <strong>of</strong> HIV test results if positive or if negative and<br />
the HIV test<strong>in</strong>g process should be expla<strong>in</strong>ed. Then the survivor should be <strong>of</strong>fered the<br />
test <strong>on</strong> site or taken to the appropriate site for test<strong>in</strong>g.<br />
The w<strong>in</strong>dow period between the time <strong>of</strong> exposure to HIV and test<strong>in</strong>g positive for HIV<br />
is approximately 6-weeks. It is possible that a pers<strong>on</strong> will show a HIV negative result<br />
when tested but can transmit the virus dur<strong>in</strong>g this period. It is therefore important to<br />
discuss previous risks and the possibilities <strong>of</strong> HIV <strong>in</strong>fecti<strong>on</strong> prior to the rape.<br />
Post-Test Counsel<strong>in</strong>g<br />
It should be remembered that PEP <strong>on</strong>ly reduces the risk <strong>of</strong> <strong>in</strong>fecti<strong>on</strong> and does not<br />
def<strong>in</strong>itively prevent HIV <strong>in</strong>fecti<strong>on</strong>. This needs to be communicated to the survivor<br />
at the beg<strong>in</strong>n<strong>in</strong>g <strong>of</strong> counsel<strong>in</strong>g. Many survivors cannot understand why if they are<br />
HIV negative they are given HIV drugs, whereas if the test is positive these drugs are<br />
stopped. Subsequent counsel<strong>in</strong>g sessi<strong>on</strong>s should be booked to co<strong>in</strong>cide with PEP<br />
cl<strong>in</strong>ical follow ups. Communicate and show the HIV test results to the survivor and<br />
expla<strong>in</strong> appropriate follow up steps. Counselor should be aware <strong>of</strong> the survivor’s<br />
reacti<strong>on</strong> and advise appropriately.<br />
• If positive: The counselor should refer the survivor to a facility where s/he can<br />
access the follow<strong>in</strong>g <strong>in</strong>formati<strong>on</strong> and services: HIV literacy and psychosocial<br />
support; Cl<strong>in</strong>ical assessment; <strong>Management</strong> <strong>of</strong> comm<strong>on</strong> opportunistic <strong>in</strong>fecti<strong>on</strong>s<br />
(OIs); Provisi<strong>on</strong> <strong>of</strong> cotrimoxazole prophylaxis; Antiretroviral treatment;<br />
Provisi<strong>on</strong> <strong>of</strong> c<strong>on</strong>doms; PMTCT <strong>in</strong>clud<strong>in</strong>g family plann<strong>in</strong>g and <strong>in</strong>fant feed<strong>in</strong>g;<br />
TB screen<strong>in</strong>g and referral; Malaria preventi<strong>on</strong> and treatment; STI management;<br />
Palliative care and symptom management; Safe dr<strong>in</strong>k<strong>in</strong>g water <strong>in</strong>terventi<strong>on</strong>s.<br />
• If negative: The counselor will ensure the follow<strong>in</strong>g take place: Preventi<strong>on</strong><br />
counsel<strong>in</strong>g; Partner test<strong>in</strong>g and disclosure; Emoti<strong>on</strong>al support; Referral to<br />
additi<strong>on</strong>al preventi<strong>on</strong> services as needed e.g. Male circumcisi<strong>on</strong>; Needle<br />
exchange for <strong>in</strong>ject<strong>in</strong>g drug users (IDUs); C<strong>on</strong>doms educati<strong>on</strong> and distributi<strong>on</strong>;<br />
Post-exposure prophylaxis (PEP). Safe sex <strong>in</strong>formati<strong>on</strong> and c<strong>on</strong>doms should<br />
also be provided appropriately.<br />
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