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Some people react to a diagnosis of HIV infection with such despair that they deny the diagnosis and turn to drugs or alcohol to cope with it. Pretest and post-test counseling sessions are intended to reduce this risk. David G., 26 years old, is an example of someone who received neither pretest nor post-test counseling as part of his HIV antibody test—although by law both should have been provided. His reaction upon learning he was HIV positive illustrates why counseling is an important part of HIV testing.
In June 1992, David was driving home from a vacation when he developed nausea, diarrhea, and stomach pain. He attributed it to a recurring stomach problem. He lost weight and developed a fever that spiked at 104*F. His lover convinced him to be tested for HIV.
He went to a health-department clinic for an anonymous test. A staff member drew a blood sample; he returned two weeks later for the results. A woman asked him to follow her to a room. "We were standing in the hallway and as she opened the door, she said 'You're HIV positive.' I went into shock. She had just told me that my life had ended, and she said it while we were still standing in the hallway." If she had told him anything else, he didn't hear it.
David went home — and into denial. He began cleaning the house. "I tried to blow it off as if it weren't true." He worked extra hours as a home health worker. "I was saying: 'I'm healthy; I'm not sick. Watch me work.'" Marijuana and tranquilizers helped him relax. He didn't see a doctor.
"I wanted to escape from myself. I started drinking; I always kept a bottle handy. I took weekend trips to different towns, where I was a stranger, where I could pretend to be someone else, someone without HIV." He lost weight and grew weaker. One day he looked at himself in a mirror. He was jarred by the skeletal prominence of his collarbone, ribs, and hips. "Look what I've done to myself," he said aloud.
David sought good medical care, and with support from family and friends, he gained weight and began feeling better. He came to be at peace with his illness, though he'd lost his sight to cytomegalovirus infection. But in reflection, he said, "I'm sure my drinking, drug use, and denial robbed years from my life."
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