Module 4: Risk Assessment Session
| Site: | UCSF Collaborative Learning Environment |
| Course: | Advanced Counselor Skills Pre-Training Course |
| Book: | Module 4: Risk Assessment Session |
| Printed by: | Guest user |
| Date: | Friday, July 17, 2026, 10:09 AM |
Description
Module 4: Risk Assessment Session
Module 4:
Risk Assessment Session
Module 4: Risk Assessment Session, Screen 2 of 10
Introduction
Now that you know the General Principles, let’s watch an actual session.
First, I’d like to introduce Paolo. Paolo is an HIV test counselor who works in a mobile test site, a van that parks outside gay bars, public cruising areas, and homeless encampments.
Paolo’s client is Greg. Paolo and Greg have already completed the Informed Consent section of the counseling session. Paolo also collected a finger stick blood sample from Greg and started the rapid test developing. Now the pair are back in the van’s counseling area with time to talk.
Introduction
Now that you know the General Principles, let’s watch an actual session.
First, I’d like to introduce Paolo. Paolo is an HIV test counselor who works in a mobile test site, a van that parks outside gay bars, public cruising areas, and homeless encampments.
Paolo’s client is Greg. Paolo and Greg have already completed the Informed Consent section of the counseling session. Paolo also collected a finger stick blood sample from Greg and started the rapid test developing. Now the pair are back in the van’s counseling area with time to talk. Module 4: Risk Assessment Session, Screen 3 of 10
Paolo Begins the Risk Assessment
Paolo: So, now we have about 20 minutes to talk while the test is developing. You mentioned when you first came in that you were worried. Tell me a little about that.
Greg: I know about HIV. I’ve tested a lot before. But I still don’t use a condom a lot of the time. It’s kind of stupid.
Paolo: Tell me what’s going on.
Greg: I just think to myself, “Why did I do that?”
Paolo: You’re not sure why this is happening.
Greg: Right. I know better—I want to use condoms, but I don’t—and that’s about it.
Paolo Begins the Risk Assessment
Paolo: So, now we have about 20 minutes to talk while the test is developing. You mentioned when you first came in that you were worried. Tell me a little about that.
Greg: I know about HIV. I’ve tested a lot before. But I still don’t use a condom a lot of the time. It’s kind of stupid.
Paolo: Tell me what’s going on.
Greg: I just think to myself, “Why did I do that?”
Paolo: You’re not sure why this is happening.
Greg: Right. I know better—I want to use condoms, but I don’t—and that’s about it.
Module 4: Risk Assessment Session, Screen 4 of 10
Everyone Knows Greg Is Gay
Paolo: That must be frustrating. I wonder if there’s a specific time when this happened recently.
Greg: A month ago. I met this guy at a party. It was sort of obvious that he wanted to go home with me.
Paolo: Uh huh.
Greg: I was flattered. But you know something? By the time we got to my place, I already knew I wasn’t gonna use a condom with him.
Paolo: You knew beforehand.
Greg: That’s right. I knew I wasn’t going to.
Paolo: How did you know that?
Greg: It’s embarrassing. I feel like people see me and assume things. When people meet me, they see this big queen. They instantly know I’m gay.
Paolo: And you don’t like that.
Everyone Knows Greg Is Gay
Paolo: That must be frustrating. I wonder if there’s a specific time when this happened recently. Greg: A month ago. I met this guy at a party. It was sort of obvious that he wanted to go home with me.Paolo: Uh huh.
Greg: I was flattered. But you know something? By the time we got to my place, I already knew I wasn’t gonna use a condom with him.
Paolo: You knew beforehand.
Greg: That’s right. I knew I wasn’t going to.
Paolo: How did you know that?
Greg: It’s embarrassing. I feel like people see me and assume things. When people meet me, they see this big queen. They instantly know I’m gay.
Paolo: And you don’t like that.
Module 4: Risk Assessment Session, Screen 5 of 10
Greg Starts to Explain
Greg: Well, I do and I don’t. It means I don’t have to come out to anyone, ever. It’s because I’m kind of effeminate. I mean, I’m fine with the way I am. I’ve done a lot of work to accept myself. But—
I don’t know.
[Paulo pauses before speaking.]
Paolo: I think you’re saying this has something to do with sex, too.
Greg: [Sighs] Yeah.
Paolo: And this guy from a month ago? You said you knew you weren’t going to use a condom with him.
Greg: I knew this guy would think that he was going to top me. Guys just look at me and think that.
Paolo: They assume that you’re only a bottom.
Greg Starts to Explain
Greg: Well, I do and I don’t. It means I don’t have to come out to anyone, ever. It’s because I’m kind of effeminate. I mean, I’m fine with the way I am. I’ve done a lot of work to accept myself. But—I don’t know.
[Paulo pauses before speaking.]
Paolo: I think you’re saying this has something to do with sex, too.
Greg: [Sighs] Yeah.
Paolo: And this guy from a month ago? You said you knew you weren’t going to use a condom with him.
Greg: I knew this guy would think that he was going to top me. Guys just look at me and think that.
Paolo: They assume that you’re only a bottom.
Module 4: Risk Assessment Session, Screen 6 of 10
Paolo Listens Carefully
Greg: Yeah. I knew this guy—Joe—was expecting that he’d top me. I know I’m not all that masculine. Guys take one look at me and think, “Oh, he’s a bottom.” Even my friends joke about it. But the truth is that I like both. I’m not just one thing.
Paolo: That must be frustrating.
Greg: I hate it. Then I feel like I have to prove a point. If a guy treats me that way, I have to switch things around and end up on top.
Paolo: Like you have something to prove.
Greg: Exactly. And then it’s harder to, uh, keep it up.
Paolo Listens Carefully
Greg: Yeah. I knew this guy—Joe—was expecting that he’d top me. I know I’m not all that masculine. Guys take one look at me and think, “Oh, he’s a bottom.” Even my friends joke about it. But the truth is that I like both. I’m not just one thing.
Paolo: That must be frustrating.Greg: I hate it. Then I feel like I have to prove a point. If a guy treats me that way, I have to switch things around and end up on top.
Paolo: Like you have something to prove.
Greg: Exactly. And then it’s harder to, uh, keep it up.
Module 4: Risk Assessment Session, Screen 7 of 10
Greg Feels Trapped
Paolo: I think I understand, but can you explain what you mean?
Greg: I can’t stay hard if I’m concentrating on proving something. I get nervous.
Paolo: I see now.
Greg: I get nervous and then I can’t stay hard. And I worry that a condom will make it worse, so I don’t use one.
Paolo: That’s why you didn’t use a condom with Joe.
Greg: Yeah.
Paolo: Earlier, you said you weren’t sure why there are times you don’t use condoms. Then you voiced a really compelling reason: You think guys see you as only a bottom. You don’t want to be labeled, so you end up topping without a condom to prove that you’re not just a bottom.
Greg: I hate that the most, feeling like I have to prove a point. It feels so stupid.
Paolo: This is really bothering you.
Greg Feels Trapped
Paolo: I think I understand, but can you explain what you mean?Greg: I can’t stay hard if I’m concentrating on proving something. I get nervous.
Paolo: I see now.
Greg: I get nervous and then I can’t stay hard. And I worry that a condom will make it worse, so I don’t use one.
Paolo: That’s why you didn’t use a condom with Joe.
Greg: Yeah.
Paolo: Earlier, you said you weren’t sure why there are times you don’t use condoms. Then you voiced a really compelling reason: You think guys see you as only a bottom. You don’t want to be labeled, so you end up topping without a condom to prove that you’re not just a bottom.
Greg: I hate that the most, feeling like I have to prove a point. It feels so stupid.
Paolo: This is really bothering you.
Module 4: Risk Assessment Session, Screen 8 of 10
Paolo Expresses Unconditional Positive Regard
Greg: Yeah, but you know, it’s not always that way. I almost always use a condom when I’m on the bottom or when it’s someone who knows me and knows what I like. It’s weird. I end up not using condoms with guys I don’t know that well, just to show them. And I don’t end up liking the sex that much.
Paolo: This is complicated. And you’re trying really hard to work it out. I wonder—
Maybe it’s upsetting because you wish there were another way to deal with this “prove a point” thing.
Greg: I do.
Paolo: This is important to you. What have you thought about doing, if anything?
Paolo Expresses Unconditional Positive Regard
Greg: Yeah, but you know, it’s not always that way. I almost always use a condom when I’m on the bottom or when it’s someone who knows me and knows what I like. It’s weird. I end up not using condoms with guys I don’t know that well, just to show them. And I don’t end up liking the sex that much.
Paolo: This is complicated. And you’re trying really hard to work it out. I wonder—Maybe it’s upsetting because you wish there were another way to deal with this “prove a point” thing.
Greg: I do.
Paolo: This is important to you. What have you thought about doing, if anything?
Module 4: Risk Assessment Session, Screen 9 of 10
The Session So Far
Paolo started the session by asking Greg about his immediate concerns. Then, using open-ended questions and a supportive, nonjudgmental manner, Paolo learned quite a bit about the context of Greg’s risk for HIV transmission.
Now Paolo needs to figure out how to guide the session forward from this point. If we could see his thoughts, they might look like this:
The Session So Far
Paolo started the session by asking Greg about his immediate concerns. Then, using open-ended questions and a supportive, nonjudgmental manner, Paolo learned quite a bit about the context of Greg’s risk for HIV transmission.
Now Paolo needs to figure out how to guide the session forward from this point. If we could see his thoughts, they might look like this:
Module 4: Risk Assessment Session, Screen 10 of 10
Conclusion
What do you think about Paolo’s approach to the rest of the session? Do you have additional questions or another idea about how to proceed?
There is more than one way to have an effective counseling session. The key is to stay rooted in the General Principles: client-centered counseling, context, individualized session, information alone does not change behavior, neutral stance, and limited role.
Although counselor approaches may vary, we all need a firm grounding in HIV transmission and prevention. We’ll cover this topic in the next module. Then we’ll rejoin Paolo and Greg’s session.
Conclusion
What do you think about Paolo’s approach to the rest of the session? Do you have additional questions or another idea about how to proceed?
There is more than one way to have an effective counseling session. The key is to stay rooted in the General Principles: client-centered counseling, context, individualized session, information alone does not change behavior, neutral stance, and limited role.
Although counselor approaches may vary, we all need a firm grounding in HIV transmission and prevention. We’ll cover this topic in the next module. Then we’ll rejoin Paolo and Greg’s session.