Just because your client has been injecting in the past, or is currently injecting, it does not necessarily mean that they have been taking risks in relation to HIV. The first step is to very specifically evaluate risk behaviour with your client before coming to conclusions about drug–related or sexual risks.

It is important to reinforce strategies that the client is already using in relation to safer sex and safer drug use. It may be easier to build on existing strategies rather than to introduce completely new strategies.

Is your client too stoned or drunk to be able to take in the information? Would it be better to reschedule the counselling to another day?

Check carefully your client's reasons for testing. Are they testing because of outside pressures, or is it a free choice? Pressure may come from partners or family. It may be most acute in a prison or hospital setting.

Although it is important that drug users get the same information about employment, insurance, mortgages, international travel, it needs to be remembered that injecting drug use in itself may be an exclusion from many of these areas regardless of whether a test is undertaken. Further, a growing number of employers exclude drug users from employment whether they are injecting or not.

How stable is your client in their drug use? How may a positive result affect their drug use? Has your client recently started on a methadone programme or started to use in a more controlled way? In this case it may be best to allow your client time to settle into their new regime before testing.

Has your client recently entered a detoxification or rehabilitation programme? It may be best to allow your client to adjust to these changes before testing. Check the client's reasons for testing – is this encouraged by the rehabilitation centre? If so, why?

For many people the information given to them during a pre–test counselling situation may be complicated and confusing, compounded by nervousness and drug or alcohol related factors. It is often helpful to reinforce verbal information by writing or drawing key points, suggesting the client writes down key points, or through the use of a leaflet. The How To Enjoy … leaflet produced by the Healthy Options Team is a model of a leaflet which could be used for this process. See Recommended resources for further details of this leaflet.

Check with your client who they intend to confide in while they are waiting for the result. Many people disclose widely in expectation of a negative result. This may create real problems of confidentiality if the result is positive.

Many agencies are wary about encouraging people to test. Agencies working with drug users tend to take a more positive approach to testing. A positive result may give people access to housing, increased social security benefits and equipment which can strongly enhance their ability to live with HIV. Advisers also need to be able to assist HIV–negative drug users in gaining access to these material benefits, in order to reinforce the importance of safer behaviour.

Additionally, as has already been mentioned, injecting drug users are often excluded from life insurance, endowment mortgages etc, and these drawbacks of testing may be less pertinent. This does not make pre–test counselling a forgone conclusion and the client should always make an informed choice.