For people who have a positive test result

Published: 30 June 2012

The following guidance is reproduced from the European testing guidelines of the International Union against Sexually Transmitted Infections and the World Health Organization.1

The HIV-positive result should be given in a confidential environment and in a clear and direct manner. Patients are often very distressed when first informed about a positive HIV test result. They are faced with major adaptive challenges, such as accepting the possibility of a shortened lifespan, coping with other people’s reactions to a stigmatising illness, and with developing and adopting strategies for maintaining physical and emotional health. Appropriate support should be available on-site or through referral to address the behavioural, psychosocial and medical implications of HIV infection.

The following issues should be covered:

  • Inform the patient straightforwardly that the HIV test was positive.
  • Obtain a second blood sample and arrange for a repeat test to confirm the result.
  • Make sure that the patient has understood the implications of a positive test.
  • Address the question of whom the patient wants to inform, now and later, e.g. partner(s), friends, family. Discuss what will happen next and clarify whether the client wants to talk further at this stage or not.
  • Schedule a new consultation in the near future, e.g. next day.
  • Screening tests for gonorrhoea, chlamydia and syphilis should be offered.

Experience has shown that even when the patient expected a positive result, there is still a powerful emotional reaction. Hence, it may be wise to postpone some of the information giving to subsequent consultations:

  • Inform the patient about the HIV result from second sample and confirm that the HIV diagnosis is definite.
  • Inform them about current treatment options. Discuss antiretroviral drugs and emphasise their ability to control HIV disease effectively. Inform them that mortality rates for HIV-infected persons have become much closer to general mortality rates since the introduction of HAART.
  • Assess the need for psychological support or contact with other services, e.g. drug dependency, and refer as necessary.
  • Address how to avoid transmitting HIV and other STI (if applicable) to others.
  • Discuss safe sex, use of condoms, not sharing needles, etc.
  • Discuss the need for partner notification.

For women, there are some particular issues which should be included in the counselling at an early stage:

  • Discuss the implications for possible future pregnancy.
  • If already pregnant, discuss the implications.

To return to the BHIVA guidelines, it is envisaged that if testing was not carried out in a sexual health or HIV setting, that much of the detailed post-test discussion will be carried out at the HIV clinic. An appointment with an HIV professional (doctor, specialist nurse, sexual health adviser, voluntary sector counsellor) should be given within 48 hours.

Moreover, regardless of where the test was conducted, all patients should be assessed by a doctor who provides HIV care within two weeks of a positive HIV test result, unless the patient chooses to defer this.2 3

Further reading

Further advice on the post-test discussion is given by the Society of Sexual Health Advisers.4

References

  1. IUSTI and WHO 2008 European guideline on HIV testing. http://www.iusti.org/regions/europe/HIV%20Testing%20Guideline%2011.11.08.pdf, 2008
  2. British HIV Association, British Association for Sexual Health and HIV, Children’s HIV Association. Don’t forget the children: Guidance for the HIV testing of children with HIV-positive parents. Available at http://www.chiva.org.uk/health/conferences/previous/dontforget (accessed 29 April 2010), 2009
  3. BHIVA Standards for HIV clinical care. BHIVA, 2007
  4. Jarrett S et al. HIV testing and management. In The Manual for Sexual Health Advisers, www.ssha.info, 2004
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.