Having an HIV test can be a pre–condition of having unprotected sex within a relationship. This sort of arrangement relies on the agreement that no unsafe sex will take place outside the relationship, and on an agreement between the partners of what constitutes acceptable sexual practice outside the relationship. For instance, one partner may have doubts about the safety of oral sex; the other may not.

This sort of disagreement could create profound anxiety and tension within the relationship, and helping both partners to address issues of this sort is an important part of post–test counselling too.

Counselling of couples may present problems for confidentiality in relation to HIV testing – for instance if one partner hasn't told the other partner about some aspects of his sexual history – but couples should be encouraged to seek counselling together after a negative or a positive result to ensure that they have a common understanding of the implications of the result for their relationship.

For some gay and bisexual men, particularly those at the beginning of their sexual careers, it may be helpful to emphasise that an HIV antibody test should not be considered a part of standard GU clinic monitoring in the same way that blood tests for syphilis and hepatitis B are routinely carried out. Establishing a pattern of routine HIV antibody testing may be psychologically damaging for some gay men; it may imply that seroconversion is an inevitability for gay men and may subconsciously encourage fatalism.

For other gay men, a pattern of repeat testing may emerge in which a man will receive a negative test result after unsafe sex, practice safer sex for a period and then have unsafe sex again. As they repeatedly test negative, they may attach less importance to safer sex practices and see themselves as either mysteriously immune to HIV infection, or else may begin to feel that it is only a matter of time until they do become infected given their difficulties in sustaining safer sexual practices.

In these situations testing may not provide a solution to the question of how they can protect themselves in the future. Some clinics now offer referral to specialised support groups or counselling for gay men who want to look at how they can make their sexual behaviour less risky in the future.

Many gay men will be very familiar with all the arguments for and against HIV testing and will be well informed about HIV infection, but may have held back from testing for a long time after making a decision that it wasn't necessary to know their antibody status.

For many however, the need to know may come to outweigh the need to remain ignorant of HIV status. This may be a consequence of involvement in a relationship with an HIV-positive or an HIV-negative person in which the desirability of unprotected sex is being discussed. It may also be a consequence of new information about treatment of asymptomatic HIV infection, or of anxieties about general health.

In all these circumstances, the counsellor will need to recognise that uncertainty may, paradoxically, have become a secure state, and that an apparently well–informed and together individual is likely to suffer just as great a shock if they receive a positive diagnosis as someone who receives a positive diagnosis out of the blue.