Lecture | Quiz | Learning Exercise | Answer Key

Developed by JHPIEGO’s Training in Reproductive Health Project with funding from USAID.

Lesson 2: Understanding Who is at Risk for HIV: Risk Assessment and Identification
Instructor: Jean Anderson

Answer Key

Quiz

1. Which of the following statements concerning HIV testing is true:
   1. Rapid tests are more specific than standard assays but are not very sensitive
   2. HIV tests may be falsely negative if testing is done within 8-12 weeks after infection has occurred.
   3. An indeterminate test usually indicates new or recent HIV infection
   4. Testing can be performed only on blood specimens
2. Risk assessment for HIV is useful in which of the following circumstances:
   1. HIV prevalence is low and resources for counseling and testing are few
   2. Deciding who should be offered testing in an STI clinic
   3. Deciding who should be offered testing in an antenatal care clinic
   4. Areas where HIV prevalence is high
3. A 26 year-old woman presents for her first antenatal care visit at 16 weeks gestation. She is offered HIV testing. Which of the following would be a benefit for her in learning her HIV status?
   1. She will know if her husband has been unfaithful to her
   2. If HIV-positive, she can be cured of HIV with antiretroviral drugs
   3. If HIV-positive, she can have access to interventions to reduce the risk of MTCT
   4. If HIV-negative, she will know that she is protected from HIV
4. A 31 year-old woman tests HIV-negative at her first antenatal care visit. Late in pregnancy she is retested because her husband has recently been diagnosed with HIV and the repeat test is positive. Which of the following is the most likely explanation for these different results?
   1. She was already infected at the time of the first test but was in the "window period" and had not yet developed detectable antibodies to HIV
   2. The second test is falsely positive
   3. There was an error in processing the first test
   4. Since the tests have conflicting results, no conclusions can be reached and she should be reassured that her risk is low

Learning Exercise

Case 1

Case 1 was a 35 year-old man with discharge from the penis, burning with urination, and recent weight loss. He is married and works as a truck driver. I would assess his risk for HIV as high. He has symptoms that might indicate an STI and is away from home a great deal, both of which increase the likelihood that he has engaged in high-risk sexual behavior. In addition he has lost a lot of weight in a short period of time. The advantages of him knowing his HIV status are several, even if he has no access to antiretroviral drugs. In most areas, even with limited resources, there are basic medications that can be used to treat symptoms related to HIV/AIDS or opportunistic infections (such as TB); knowing he is HIV+ may increase the likelihood that he will take measures to prevent transmission to sexual partners; he also can better plan for his future and that of his family. However, learning he is HIV-infected may be difficult to deal with because of stigma surrounding HIV and discrimination from others.

Case 2

In Case 2, we are dealing with a young married woman who is at 14 weeks of pregnancy and has two young children at home. She appears healthy and has no symptoms. She has no history of sexually transmitted infections, but her husband is also away from home a great deal. 

She is at risk for HIV, especially if she lives in an area with high HIV prevalence, because she is pregnant (and therefore has had unprotected sex) and because her husband is away from home often, which may increase the likelihood that he has other sexual partners. She should be offered HIV testing, because if she is HIV-infected, there are things that can be done to reduce her risk of mother-to-child transmission of HIV (stay tuned for upcoming lesson!). She is offered testing and refuses. This might happen for many reasons: she might not believe she is at risk or she might be afraid to know. In order to address this, it is important to talk more with her to discover her concerns.