- With the advent of effective therapy HIV has become a much more manageable disease and is now usually considered a life-long chronic disease.
- Having a HIV test should not lead to any adverse consequences: knowing one’s status is extremely important and beneficial if one is HIV positive and a negative test should not have any negative consequences.
- Earlier detection of HIV leads to better outcomes for the individual and less likelihood of transmission in the population.
- There is no longer a requirement for written consent for a HIV test. Verbal consent should still be obtained and documented in the chart (“informed consent obtained verbally for HIV test” would suffice). You cannot do a HIV test without verbal consent.
The following points should be explained to the person:
- It is important to know one’s HIV status. There is no benefit to having HIV and not being aware of the result. Also, an earlier diagnosis of HIV is associated with a better outcome when compared to later diagnoses.
- HIV test results are confidential; the result will go into the medical chart.
- In the unlikely event of a positive result there are options for therapy and the expectation is that patients will do well, with minimal change to quality of life or life goals. In many cases life expectancy may not be significantly reduced if the patient tolerates the medications and takes them appropriately.
- If the result is negative there still may be a “window-period” to take into account. This is a 3-month period of time after an exposure to HIV where the test may remain negative despite new HIV infection. A HIV test that is negative 3 months since the last risk exposure can be usually considered as a true negative test. If there are ongoing risks the patient will need at least annual testing.
- A positive test would require a second confirmatory test (the Western Blot) before it would be considered a true positive result.
- Main routes of transmission of HIV. Methods aimed at reducing the risk of acquisition/transmission should be discussed.
Who should get a HIV test?
Patients with identifiable risk factors for HIV acquisition, including (but not limited to):
- Intravenous drug users and their sexual partners.
- Patients with a history of high risk sexual encounters.
- Patients from a country with high HIV prevalence with any risk factors.
- Patients who have shared equipment for piercing the skin/tattooing.
- Patients who have received blood product(s) or blood transfusion(s) in times or settings with suboptimal HIV screening procedures.
- All patients in whom HIV infection is considered in the differential diagnosis, including (but not limited to):
- Patients with unexplained fever, weight loss, colitis, adenopathy, cytopaenias.
- Patients with unexplained diseases associated with immunosuppression, including tuberculosis