♯ChangeTheFaceofHIV
HIV TESTING IN PRIMARY CARE
Q&A TO SUPPORT HANDLING POSSIBLE PATIENT REACTIONS
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What if a patient insists they are not at risk / cannot see
the benefit of testing?
HIV is a condition that can affect anyone. Although men who
have sex with men (MSM) and black minority ethnic (BME)
populations are most at risk of HIV, late diagnosis
predominantly
affects
heterosexual
people
in
the
UK.
Therefore, it is important to test, even if the patient’s
risk, or perceived risk, is low.
First acknowledge that the patient does not consider
themselves to be at risk, and respond by reinforcing that HIV
testing is part of everyday medical practice. As part of the
discussion, make sure the patient is aware that HIV is now a
treatable long-term condition and that with early diagnosis
and prompt treatment, people living with HIV can lead normal
lives.1 It is hugely beneficial for patients to know their HIV
status, even if the likelihood of them having HIV is small.
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How can I handle a
upset) to the offer
You should respond
concern, and try to
patient who reacts badly (e.g. is angry or
of a test?
with an acknowledgement of the patient’s
normalise the test using phrases such as:
‘You are very unlikely to have HIV but as your doctor I
need to consider all the possibilities and it’s good to rule
out conditions like HIV.’
It is also important to position HIV testing as part of
everyday medical practice and to communicate that HIV is now a
treatable long-term condition. With early diagnosis and prompt
treatment, people living with HIV can lead normal lives.1
UK/HIV/0019/16, August 2016
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If I offer a patient an HIV test, will they think I am judging
them and their lifestyle?
By helping your patient understand that testing for HIV is
part of everyday medical practice, you will reassure them that
you aren’t making any assumptions or judgements about their
health or lifestyle. It’s also important to reassure patients
of the benefits of HIV testing and of knowing their HIV
status. Remember that with early diagnosis and prompt
treatment, people living with HIV can lead normal lives.1
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What if a patient is worried about confidentiality of the test
and the result?
If a patient raises any confidentiality concerns, remember to
reassure them that the test and the result will be kept
confidential. As with any other medical condition, HIV is
covered by the practice confidentiality policy.2
If you have any concerns, your local sexual heath or HIV
clinic or the National AIDS Trust (NAT) should be able to
provide further support.
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What if a patient is happy for you, as their GP, to know but
is concerned about who else in the practice will have access
to their medical records?
You should explain that all administrative staff receive
training on confidentiality and the same strict expectations
of confidentiality apply to them as they do to all healthcare
professionals. Depending on what their role is, they may well
be considered part of the direct care team and so will also be
able to see patient records.2
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Aren’t there important cultural sensitivities around offering
HIV testing?
Yes, there can be cultural sensitivities around HIV, however,
HIV testing should be approached the same way for all patients
based on the presenting symptoms as part of a differential
diagnosis. By normalising HIV testing in a primary care
setting, we have a better chance of reducing undiagnosed HIV
UK/HIV/0019/16, August 2016
and therefore onward transmission. HIV
standard practice in other medical
testing, in particular, has proved to be
how HIV testing can become normalised
outside of sexual health.
testing is part of
settings: Antenatal
a success story for
in medical settings
HIV testing in primary care is hugely beneficial as the
earlier the diagnosis, the better the outcomes for both the
patient and public health. With early diagnosis and prompt
treatment, people living with HIV can lead normal lives.1
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What if a patient is worried that being tested or diagnosed
will affect their ability to get or keep life insurance?
The updated ‘HIV and Life Insurance’ guide from the
Association of British Insurers (July 2016) states that ‘HIV
is treated by insurers like any other medical condition.’3
The vast majority of life insurance contracts in the UK do not
have exclusions for any medical conditions, including HIV,
which are diagnosed after the life insurance cover has
started. This means if a life insurance policy is already in
place, then the company does not need to be informed of a
diagnosis.3
As with other medical conditions, patients with HIV should
disclose their HIV status when applying for insurance, as if
this information is not included on an application form, the
policy will likely be deemed invalid and the company may not
pay out.3
Having a positive HIV diagnosis doesn’t affect the ability to
purchase life insurance. There are a number of products
offered by insurers that cover pre-existing medical conditions
and, like other insurance products, the policy and price
differs between insurers.3
Even if the patient is concerned about their insurance, it’s
important to communicate the benefit of HIV testing and being
aware of their HIV status. When diagnosed and treated early,
people living with HIV can lead normal lives and onward
transmission is reduced.
UK/HIV/0019/16, August 2016
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Should I use my professional judgement about which patients to
offer the test to, i.e. which would be most receptive / open
to the offer?
You should offer an HIV test to any patient who presents with
signs and symptoms of HIV infection, such as weight loss of
unknown cause, oral thrush, shingles, glandular fever like
symptoms, persistent diarrhoea. Although this isn’t an
exhaustive list of signs and symptoms of HIV, these are ones
which are likely to present to primary care. Look out for
conditions that are unusually severe, or that are difficult to
treat / keep re-occurring. If you don’t know the cause for the
patient’s symptoms then include an HIV test, along with other
routine diagnostic tests.
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What information and further support can I offer to patients?
What websites / organisations can I recommend to them?
National Aids Trust, Terrence Higgins Trust and NHS Choices
are three very useful websites that contain comprehensive and
patient-friendly information about HIV testing.
http://www.nat.org.uk/HIV-in-the-UK/KeyIssues/HIV_Testing.aspx
http://www.tht.org.uk/sexual-health/About-HIV/Testing-for-HIV
http://www.nhs.uk/conditions/HIV/Pages/Diagnosispg.aspx
References
1. May M, Gompels M, Delpech V, et al. (2014). Impact on life expectancy of
HIV-1 positive individuals of CD4+ cell count and viral load response to
antiretroviral therapy. AIDS. 28(8):1193-1202.
2. National AIDs Trust. (2014). HIV Patient Information and NHS
Confidentiality in England. Available at:
http://www.nat.org.uk/media/Files/Publications/Jan-2014-HIV-PatientConfidentiality-NHS.pdf. [Accessed: July 2016].
3. Association of British Insurers. (2016). HIV and Life Insurance.
Available at:
https://www.abi.org.uk/~/media/Files/Documents/Publications/Public/2016/
HIV%20and%20Insurance/HIV%20and%20Insurance%20Guide.pdf. [Accessed: July
2016].
UK/HIV/0019/16, August 2016