HIV Counseling, Testing and Referral Program
The Wisconsin Counseling, Testing, and Referral (CTR) Program has been an important part of
the overall strategy to fight HIV and AIDS in Wisconsin. The program has been instrumental
in assisting individuals with HIV in accessing medical treatment, social support, and
partner counseling and referral services (formerly known as partner notification). It has
also been an important HIV prevention strategy. Every client who is tested is also
counseled to reduce their risk of acquiring or transmitting the disease.
CTR Program activities are directed at providing the following services:
- readily accessible counseling, testing and referral services for individuals at risk for
- testing at low or no cost to individuals who would not otherwise be able to afford
- anonymous testing for persons with confidentiality concerns that might prevent them from
- client-centered counseling designed to reduce client risk of acquiring or transmitting
- appropriate referrals for medical or psychological evaluation and social support;
- referral for or assistance with the notification of sexual and needle sharing partners.
inception, the CTR Program has performed over 175,000 HIV antibody tests of which 2,000
tests were HIV positive. The Program currently consists of 33 agencies providing
counseling and testing services in 49 locations throughout the state. All designated AIDS
Services Organizations (ASOs) provide counseling and testing services onsite through
outreach to individuals at highest risk for infection.
Program was reorganized in 1999 to redirect services to those at higher risk for HIV
infection. This was particularly important due to dramatic improvements in HIV drug
therapy. People who are infected must be diagnosed and placed on treatment early to
receive the greatest benefit from drug therapy.
The process of counseling and testing
Clients either make appointments or access CTR services at
agencies that provide walk-in services. Upon arrival, most clients complete a
questionnaire on demographic and risk information. The questionnaire has a unique
identifier (not the clients name) that eventually links information with the
clients test result. Demographic and risk information is used by the Wisconsin
AIDS/HIV Program to analyze program utilization and to evaluate services.
Clients discuss their concerns and risk for HIV infection with a
counselor who works with the client to develop a realistic plan to reduce risk for HIV
infection. The counselor also discusses HIV antibody testing and answers client questions
regarding testing. Testing is voluntary and clients provide written informed consent
before being tested. A serum or oral fluid specimen is collected and a return appointment
is made for two weeks from the initial visit for the client to obtain their test results.
Clients are required to return to receive their test results. For
clients who test HIV positive, counselors provide emotional support and link the client to
needed medical and social support services. Clients are also offered partner counseling
and referrals services at this time. For clients who test negative, counselors discuss the
clients risk reduction plan and issues that may have surfaced during the two-week
Most sites offer both serum and oral fluid HIV antibody testing. Serum
testing requires a phlebotomist to draw blood from the client, whereas oral fluid testing
utilizes a device placed in the mouth to absorb a fluid known as "oral mucosal
transudate". Both types of specimens are tested on a enzyme immunoassay (EIA) which
is a screening test for the HIV antibody. If initially positive on the EIA, the specimens
are re-evaluated by repeating the EIA in duplicate. If repeatedly reactive, the Western
blot confirmatory test is performed. Specimens are considered positive if the EIA tests
are repeatedly reactive and the Western blot assay is reactive.
All sites provide both anonymous testing and confidential HIV testing.
Confidential testing requires that the client provide their name to be tested, as with any
other medical procedure. Anonymous testing enables the client to be tested without
providing their name. Studies indicate that some individuals at high risk for HIV choose
not to be tested when anonymous testing is not available.
The majority of counseling and testing services have been established
at local health department (LHD) clinics and community health clinics. Current sites
include LHD sexually transmitted disease (STD) clinics, other non-STD local health
department clinics, gay-affiliated STD clinics, family planning clinics, community health
centers, and community-based organizations.
The Division of Public Health AIDS/HIV Program trains new CTR staff on
client-centered HIV prevention counseling that promote behavior change rather than
providing solely prevention information.
The AIDS/HIV Program covers the cost of centralized laboratory testing
at the State Laboratory of Hygiene and the City of Milwaukee Health Department. The State
Laboratory of Hygiene conducts the majority of testing for the program while the Milwaukee
Health Department provides laboratory testing only for the Milwaukee Central Health
Clinic, a high volume sexually-transmitted disease clinic.
In addition to the CTR Program, HIV antibody testing is also offered in
the Wisconsin AIDS/HIV Partner Counseling and Referral Services (PCRS) Program to sexual
or needle-sharing partners of individuals with HIV infection. For additional information
on the Wisconsin HIV CTR Program, contact Jim Stodola at 608-261-9429.
Listing of Publicly
Funded HIV Counseling, Testing & Referral Agencies (PDF,
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August 06, 2013