Case study 2: Screening pre and post-test counselling

You are a counsellor working at a mental health service. Tony a 35 year old man presents to you as a client. He has a history of mental health problems and has just received a letter in the mail from a Blood Donation service claiming that he may have been exposed to hepatitis C over 15 years ago from a blood transfusion. He is clinically depressed and claims he will commit suicide if his young children (5 and 7 years old) are positive. He says he would rather die than tell his wife or be tested. What do you do?

Issues for discussion

  1. Tony may have cleared the virus, approximately up to ~25% of people clear the virus following exposure, but still carry antibodies.
  2. Even if he is positive, hepatitis C is not classified as a Sexually Transmitted Infection (only transmitted blood to blood) therefore it is highly unlikely that he has transmitted hepatitis C either sexually or in a household setting to his partner or children.
  3. A father cannot transmit hep C to his unborn child while in the womb.
  4. The mother would have to be hep C positive for the children to have acquired hepatitis C, even then there is a low likelihood (2-5%) chance of transmission when detectable levels of HCV is in the mothers blood (when the mother is HCV PCR+).

Client issues

  1. The priority issue is to provide Tony with support
  2. How does Tony’s mental health status affect the decision to test for hepatitis C?
  3. Discuss whether testing may or may not be the most effective strategy to begin with; waiting until Tony has stabilised and been given more information may be a better time to organise testing.
  4. Tony’s anxiety may be lessened by some factual information (above) and emotional support.
  5. Encouraging support from his family rather than feeling he has to hide his possible illness may help with his isolation.
  6. Supply resource information and family referral support
  7. Take care with the messages conveyed about hepatitis C; experiences surrounding diagnosis often impact a person’s sense of empowerment or powerlessness
  8. Supply information on local support group and Hepatitis C Council.
  9. It is also important to offer Tony referral to a relevant General Practitioner or a counselling service.

Organisational issues