Sexual Health, HIV/AIDS and Hepatitis C

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HIV Pre-Test Discussion

Whilst pre- and post- test discussion is generally associated with testing for HIV, components of pre- and post- test discussion apply to testing for many sexually transmissible and blood-borne infections.

• Ensure client is aware of the confidentiality surrounding the test

Assess risk factors such as types of sexual behaviour, number of partners:

• Potential for exposure to HIV, Hepatitis B, Hepatitis C, Syphilis and other STIs such as Chlamydia
• Determine when exposure to risk occurred

Previous testing

• when, where
• is result available?
• what was tested?

Explain the test:

• Why the test is done (treatment, improve outcomes, reduce risk of transmission)
• How the test is done
• What the test tells and does not tell (ie discuss exactly what you are testing for)
• For infections with window periods, discuss implications, advise if and when repeat testing will be necessary

Confidentiality issues:

• In order to ensure confidentiality and to standardise notification, medical practitioners are requested to use the National Centre Code when requesting HIV testing and, if the the test is positive, when notifying the AIDS Medical Unit. The code consists of four letters - the first two letters of the surname followed by the  first two letters on the first name, all printed in block capitals, followed by the date of birth. For example:
    - John Smith born on 23.09.64 becomes SMJO 23.09.64
    - John McSmith born the same day becomes  MCJO 23.09.64
• Discuss ways the patient should protect their own confidentiality (eg carefully consider who they will tell)
• Inform the patient of legal requirements for and mechanisms of notification in the case of a positive test for a notifiable infection
• Inform the patient of the procedures relating to contact tracing in the case of a positive test

Discuss how and when to obtain results:

• It is strongly recommended all HIV (and probably Hep B and Hep C) results are given in person by medical practitioners or experienced sexual health nurses. It is important to stress to the patient prior to the test that test results will not be given over the phone to ensure the patient does not assume the worst when asked to come into the surgery to get the results. Consider making an appointment to give back the results at the time the test is taken

Discuss implications of a negative result:

• Discuss prevention - don't let people go away with the idea a negative test somehow confers immunity on them for future risk taking behaviour.
• Reinforce the positive aspects of safe sex practises. Opportunity for further education
• May require repeat test if exposure still within 12 week window period

Discuss implications of a positive result:

• What a positive result would mean
• Discuss the options for medical treatment and follow-up
• Consider the availability of family or friends who may be available to talk with if the result is positive (support systems)
• Does the patient have any holidays available if needed to be able to come to terms with the result   
• Discuss contact tracing and what this means
• Evaluate patient's coping skills

Risk reduction:

• Stress importance of ongoing risk reduction strategies
• Specifically address any risks identified in history
• Offer follow-up support.

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