| I. ASSESS AND INQUIRE |
| Create a Confidential Atmosphere |
| Assure youth that visit is confidential, that testing is their choice, and that they are free to consent to or decline testing per local laws |
| Acknowledge that it can be embarrassing to discuss sexual behaviors |
| Help youth to identify a supportive adult who is aware that he/she is being tested |
| HIV/AIDS Knowledge |
| Allow adolescent to verbalize understanding of HIV. Clarify misconceptions and fill in knowledge gaps |
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| Assess youth's feelings about testing and previous HIV testing experiences |
| Inquire if youth knows anyone with HIV/AIDS (e.g., sexual partner, family member) |
| Sexual Risk Assessment |
| Assess sexual behaviors without making assumptions about sexual orientation |
| Assess number of partners, age differential, and their known risks |
| Assess frequency of substance use in the context of sexual behavior |
| Assess consistency of condom use and obstacles to use (e.g., unassertiveness, desire to become pregnant, fear of violence, or religious beliefs) |
| Assess for history of sexual abuse or rape |
| Substance Use and Other Risk Assessment |
| Assess level of drug and alcohol use and contexts in which use occurs |
| Review risk of impaired judgment that may result in unsafe sex |
| Assess potential need and motivation for drug treatment |
| Assess violence and substance use in home and community |
| II. DISCUSS AND EDUCATE |
| Discuss postponing sex for youth who are not sexually active |
| Demonstrate proper male condom, female condom, and dental dam use on anatomical model, and provide opportunity for practice |
| Discuss sexual activities that do not involve exchange of body fluids (outercourse) |
| Rehearse effective ways to communicate risk reduction with sexual partner(s) |
| Discuss harm reduction strategies for youth using drugs |
| Develop a personalized risk-reduction plan |
| III. READINESS FOR HIV TESTING AND REFERRAL |
| Inform adolescent about both anonymous and confidential testing |
| Provide education about partner notification programs and other options for disclosure to partners |
| Assess youth's understanding of the meanings of positive and negative test results |
| Assess youth's understanding of benefits of early intervention |
| Determine with youth if testing should occur at this time and, if so, obtain informed consent |
| Discuss strategies for coping (how to relieve stress and anxiety during the testing process) |
| Arrange follow-up appointment and means of contacting youth confidentially, if needed |
| Determine referral needs (e.g., medical, psychosocial, school /vocational, substance abuse, reproductive health, legal, housing, psychiatric) |
