Nursing in Practice March/April 2019 (issue 107) - Page 38

38 CLINICAL How to approach an HIV consultation Shaun Watson gives advice on handling HIV consultations in primary care T he landscape of HIV is changing from an initial life-limiting acute infection to a long-term condition with a normal lifespan. 1-3 Over recent years there has been a fall in annual HIV rates, thought to be due to the use of medications to prevent HIV (pre-exposure prophylaxis), the use of antiretrovirals to suppress the amount of virus in people with HIV (undetectable = untransmittable) and the immediate use of antiretrovirals. 4,5 However, people are still acquiring HIV and late diagnosis (when the CD4 count is less than 200 cells/mm at the start of antiretroviral therapy) is still an issue. The later someone is diagnosed, the poorer the immune response and prognosis. 6,7 Late diagnosis is more frequent in older people. In the UK in 2016, 31% of 15- to 24-year-olds were diagnosed late, rising to 63% of over-65s, although the greatest absolute number of late diagnoses occurred in 35- to 49-year-olds, in whom the percentage was 45%. 4,6 Testing for HIV in people who may be at risk therefore remains important. Over the decades, HIV testing has become easier to carry out, not only in sexual health clinics but also via home-testing kits and in GP practices, A&E, and community venues such as drop-in centres and churches. There are many HIV testing kits on the market – some are via blood spot (finger-prick or dry blood testing) and others via oral swabs. Most HIV point-of-care test kits will give a result in five to 20 minutes. The type of test available will be dependent on where you work and local policy. Who should you test? The answer is everyone who is sexually active, but unfortunately stereotypes may kick in, so an HIV test may be readily offered to a gay man in a monogamous relationship but not to the married 80-year-old man or the recently divorced 63-year-old woman, where discussing sexual health and sexual risk may be too embarrassing or not high on the list of concerns. Therefore, skilled communication is key in situations where you may be talking about sex as well as potential risk. An environment where the person feels safe In the UK in 2016, to be open and honest about their risk is important so that the recently divorced woman who is dating but not 31% of 15- to 24-year-olds were diagnosed late, rising to 63% of over-65s March/April 2019