Transtheoretical Model Transtheoretical Model (Stages of (Stages of Change)Change)

Stage of ChangeStage of Change CharacteristicsCharacteristics InterventionsInterventions

PrecontemplativePrecontemplative Doesn’t see it. No!UnawareDefensivenessResistance

Help them think about itEngagementTrust buildingGet a reaction, eithercognitive or emotional

ContemplativeContemplative Maybe, but . . .Ambivalence, unsureProblem awarenessOpenness to information

Explore pros and consHelp explore ambivalenceExplore barriersPass information

Ready for ActionReady for Action

(Preparation)(Preparation)

Decided, Yes!Ready to doExperimentationCoaching; teach skills

Solve it!Encourage, empower, supportEmphasize optionsFocus on developing a step

Stages of ChangeStages of ChangeStage of ChangeStage of Change CharacteristicsCharacteristics InterventionsInterventions

ActionAction Doing it!Practice new behaviorsAvoiding old behaviors

Help them do it!Support, praise, recognitionFocus on rewardsFollow-up, reach outProblem-solving

MaintenanceMaintenance Living it!Sustaining behavior

Live it!ReinforcementSupport, praise, recognitionFind other supportsBecome a role model toothers

Principles of ChangePrinciples of Change

► Based on a variety of psychological theories Based on a variety of psychological theories of changeof change

► A person’s relationship to changing a A person’s relationship to changing a behavior is dynamicbehavior is dynamic

► The stages of change are NOT linearThe stages of change are NOT linear► Relapse/recyclingRelapse/recycling► People are in different stages for different People are in different stages for different

behaviorsbehaviors► Steps in behavior change are incrementalSteps in behavior change are incremental

Your Role in ChangeYour Role in Change

Clients are competent to make choices and changes in their lives.

Change cannot be imposed. Reward and encouragement are

more effective than punishment and judgment.

Change depends on the pros of change outweighing the cons.

Counseling and TestingCounseling and Testing

►HIV TestHIV Test►Counseling in Behavior ChangeCounseling in Behavior Change►Health EducationHealth Education►Client-centered disclosure counselingClient-centered disclosure counseling►ReferralsReferrals

TestsTests

►Conventional HIV Testing (2 visits)Conventional HIV Testing (2 visits) Informed ConsentInformed Consent Client receives counseling and gives Client receives counseling and gives

samplesample ELISA or EIA testELISA or EIA test If positive 2x at lab, confirmed w/Western If positive 2x at lab, confirmed w/Western

BlotBlot 1-2 wks later, given result1-2 wks later, given result

Standardized Test ResultsStandardized Test Results

►HIV-positiveHIV-positive►HIV-negativeHIV-negative► InconclusiveInconclusive

TestsTests

►Rapid Testing (1 visit)Rapid Testing (1 visit) Informed ConsentInformed Consent Oral or blood sampleOral or blood sample OraQuick ADVAJNCE rapid HIV-1/HIV-2 OraQuick ADVAJNCE rapid HIV-1/HIV-2

antibody testantibody test Health Education or HIV counselingHealth Education or HIV counseling 20-40 minutes20-40 minutes

Results Rapid TestResults Rapid Test

►Preliminary positivePreliminary positive►Confirmed positiveConfirmed positive►NegativeNegative► InvalidInvalid

Notes on TestingNotes on Testing

►Does not determine whether or not Does not determine whether or not someone has AIDSsomeone has AIDS

►Further testing required to understand Further testing required to understand state of immune systemstate of immune system

►Accuracy of testsAccuracy of tests Considered one of the most accurate Considered one of the most accurate

medical screening testsmedical screening tests Positive results tested 2x, negative tested Positive results tested 2x, negative tested

1x1x

Further Notes on TestingFurther Notes on Testing

►98% of HIV antibody tests given are 98% of HIV antibody tests given are negativenegative

►2/3rds of clients receiving positive result 2/3rds of clients receiving positive result have previously received at least 4 have previously received at least 4 negativenegative

►HIV-positive persons offered variety of HIV-positive persons offered variety of referralsreferrals

►Always make individual assessments Always make individual assessments and referralsand referrals

Informed ConsentInformed Consent

►Anonymous TestingAnonymous Testing►Confidential TestingConfidential Testing

Differences:Differences:►Consent formsConsent forms►Written resultsWritten results►IdentifiersIdentifiers►HIV reporting by nameHIV reporting by name

Window PeriodWindow Period►Difference between exposure and Difference between exposure and

infectioninfection►Window Period►Incubation Period

Window PeriodWindow Period

PracticePractice

►Section 2: HIV and the Immune System

►1. What is an antibody?►2. Why do you test for an antibody

instead of the virus itself?

PracticePractice

► Section 8: Rapid and Conventional HIV Testing

► 3. Why do I have to wait seven to 14 days for a conventional test or confirmatory

► positive test result?► 4. Can you tell me if I have AIDS?► 5. What’s the difference between conventional

testing and rapid testing?► 6. What does a positive test result mean?► 7. What does a negative test result mean?► 8. What does an inconclusive test result mean? Is

an invalid test result the same thing?► 9. What does a preliminary positive mean?

PracticePractice

►Section 9: The Window Period►10. If I test negative, then I don’t have

anything to worry about, right?►11. What is the window period?►12. How often should I come back for testing?►Section 11: Informed Consent►13. What is the difference between

anonymous and confidential testing?►14. How sure can I be that the system you

have in place is completely confidential?

Safer SexSafer Sex

DemonstrationDemonstration

Male CondomMale Condom

Female CondomFemale Condom

THRIVETHRIVE

http://thrive.preventioninstitute.org/thrivhttp://thrive.preventioninstitute.org/thrive/index.phpe/index.php

Community MappingCommunity Mapping

►http://breeze.cce.cornell.edu/http://breeze.cce.cornell.edu/communityresources/communityresources/