Who should be offered a HIV test?
You should consider offering a HIV test to any patient who is at risk. Risk factors include:
- unprotected sexual contact, particularly contact that took place in a country with a high prevalence of HIV, or with a person who has recently travelled to or migrated from a high prevalence country
- travel within a country with a high prevalence of HIV
- unprotected male to male sex
- presence of a sexually transmitted infection
- sharing injecting equipment or the use of unsterile tattooing or body piercing equipment
- exposure to unscreened blood or blood products through medical procedures
- anyone who is subjected to sexual assault.
Information for patients before the test
Talk to your patient about patient confidentiality and your legal responsibilities, such as the need to notify the Department of Health about any HIV diagnosis. Informed patient consent is always required. You should:
- discuss that HIV is a virus that is predominantly transmitted through blood-to-blood contact, or contact with sexual secretions
- discuss possible transmission routes of HIV, e.g. unprotected sex, sharing of injecting equipment
- explain what an antibody test is and what the test involves
- explain that there is a 3-month window period, and follow up testing may be needed depending on the patient's circumstances
- ensure your patient is aware of the possibility of a positive result
- explain that positive results are reported to the Department of Health
- explain that for positive results there is a requirement for contact tracing, and explain ways this can be done
- be aware of cultural understandings of sickness and wellbeing, and whether language is a barrier for understanding
- check that the patient knows they have to return to collect the test results in person and organise a follow-up appointment
- discuss that, in the event of a positive result, HIV can be treated with ongoing daily medication, and that although HIV is a chronic condition, people who live with HIV can expect to lead long healthy lives and enjoy healthy family life.
Conveying a HIV test result
The process of conveying a HIV test result to your patient, irrespective of the specific result, is affected by the type of test performed, the setting of the consultation and testing and the extent, if any, of additional testing required to confirm the patient’s HIV status.
The person who requests the test is responsible for ensuring that appropriate mechanisms are in place for delivering the test result.
The window period will be determined by the type of test used. More advanced HIV tests can detect infection sooner than others. It is important that a practitioner delivering a test result is aware of what test is being used and how soon after infection it can detect HIV.
A window period of 3 months should be used unless the practitioner delivering a test result is aware of the particular test that was used and its specific window period.
You should ensure the name, result, date of birth and postcode are correct before seeing your patient. Make sure you follow up patients if they don’t attend their appointment.
Conveying a negative result
The decision on how a negative HIV test result is provided – for example in person, by telephone - should be based on clinical judgement by the person responsible for conveying the test.
You should take into account your patient’s level of knowledge, psychological capacity to deal with the outcome of testing and understanding of the testing process, which should be assessed at the time of the sample collection.
When conveying a negative result, the discussion should include:
- checking that your patient understands how to minimise risk of acquiring HIV (for example safer sex, safer injecting practices)
- reviewing the window period and considering the need to retest.
Conveying a positive result
A positive result should always be provided in person except in extenuating circumstances. An example of when a result may need to be communicated by phone may arise if the patient does not return for the result, and/or may engage in risk behaviour based on the wrong assumption that they are HIV-negative.
When conveying a positive result, the discussion should include:
- giving the test result in person, and in a manner that is sensitive and appropriate to the patient’s gender, culture, behaviour, and language
- onwards referral to a HIV specialist, and answering questions about the referral process
- specialist assessment at either Royal Perth Hospital or Fiona Stanley Hopsital (see contact details below). Indicate in your referral that your patient has been recently diagnosed with HIV
- confirmation that HIV is a condition which can be treated, but not cured
- people living with HIV can live long and health lives when on treatment
- assessment of any immediate known support (family/friend/partner) who may provide any needed emotional support
- onwards referral to a support agency, to be accessed at the patient’s discretion
- contact tracing and partner notification
- transmission of HIV, and how onwards transmission may be prevented
- legal obligations and considerations, for example using condoms and practising safer sex.
Resources
Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM)
This organisation produces a range of information and resources to support the HIV, viral hepatitis and sexual health workforce, including Guide to Australian HIV Laws and Policies for Health Professionals (external site).
HIV/AIDS Legal Centre (HALC)
This NSW-based organisation produces resources on the law and HIV status, including the guide 'Disclosing your HIV Status in Western Australia'.
Multicultural HIV and Hepatitis Service (MHAHS)
The MHAHS (external site) provides consumer information on HIV and AIDS translated into 25 different languages, along with information for healthcare workers on how to work with people from culturally and linguistically diverse backgrounds.
Testing portal
The ASHM testing portal (external site) is for health professionals ordering, receiving and interpreting the results of HIV, Hepatitis C and Hepatitis B tests. It provides a framework to ensure quality testing is carried out.
WA AIDS Council (WAAC)
The WA AIDS Council provides information and training for health professionals on the different aspects of HIV/AIDS.
Consumer information
More information
- WA Health Sexual Health and Blood-borne Virus Program
Phone: 9222 2355
- Royal Perth Hospital Department of Clinical Immunology
Phone: 9224 2899
- Fiona Stanley Hospital Infection and Immunity Clinic
Phone: 6152 2222
Last reviewed: 26-10-2018
Produced by
Public Health