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Failure of clients to return for post-test counseling for human immunodeficiency virus (HIV) has been noted consistently as a problem with HIV counseling and testing in sexually transmitted diseases clinics.To assess trends in the rates of HIV post-test counseling in an urban sexually transmitted diseases clinic. To determine the usefulness of providing post-test counseling by telephone to clients at low risk for HIV as a means of increasing post-test counseling rates and efficiency of clinic operations.Human immunodeficiency virus post-test counseling rates were evaluated among clients of a sexually transmitted diseases clinic from January 1990 through May 1994. Low-risk clients (n= 1,304) from July 1994 through September 1994 were given the option of obtaining negative HIV test results by telephone. Rates of post-test counseling within 45 days were compared with historical controls from March 1994 through May 1994, during which time a return visit was required.The rate of post-test counseling increased significantly from 1990 to 1992 but remained stable thereafter. After the introduction of post-test counseling by telephone, 704 of 1,304 low-risk clients (54.0%) obtained post-test counseling compared with 476 of 1,187 (40.1%) clients during the control period (odds ratio = 1.75; 95% confidence interval = 1.50–2.06). Post-test counseling rates increased especially among clients younger than 20 years of age (30.6% versus 52.7%) and among those with multiple new sex partners in the last month (31.6% versus 56.1%).Telephone post-test counseling is an effective method of increasing access for low-risk clients attending sexually transmitted diseases clinics and may be especially useful for those who are otherwise unlikely to obtain post-test counseling.