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‘Normalising’ HIV testing – new guidance could make a big difference to testing and treatment

September 27th, 2008

Dr Petra

The latest edition of the British Medical Journal reports on the latest UK Guidelines for HIV Testing (September 2008). The guidance, from the Medical Foundation for AIDS and Sexual Health (MedFash) and the British Association for Sexual Health and HIV, recommends “all healthcare professionals should view HIV testing as a normal part of the diagnostic process and a duty of care”.

This ‘normalisation’ process suggests that where possible HIV testing should be routinely offered to appropriate clients. We currently have improved the speed of HIV testing, and treatment for those with HIV offers a good quality of life. However, HIV is still seen as an area which requires a specialist approach – which can waste time and resources – and delay diagnosis and treatment.

The new guidance suggests that testing could be shifted to wider settings (including community settings) and offered by a wider range of practitioners. The most radical suggestion within the recommendations won’t come as much of a surprise to those working in sexual health, which is that pre-test counselling may not always be necessary or appropriate.

Because HIV was seen so negatively in the past a lot of time, effort and specialist care was offered in ‘pre test counselling’ – where people suspected of being HIV positive (or who considered they may have HIV) were given intensive counselling to prepare them before their test, then were tested, waited for results, and often were offered counselling afterwards.

The new recommendations refer to the first stage of this process to move to a ‘pre test discussion’ – which does not have to happen with a specialist counsellor. A well supported and trained doctor, nurse or healthcare worker can offer basic information and resources to enable people to understand what the HIV test will involve and any implications arising from it.

This approach may well be controversial to some practitioners used to working in an area which has been specialist led. Activist groups appear to be welcoming the approach, and certainly this represents another positive move towards making sexual health services more easily accessible, patient centred and community based. Removing the pressure on front-end delivery of services can reduce patient bottle-necks where people are all waiting for testing, and having a shift from ‘counselling’ to ‘discussion’ also removes some of the percieved stigma associated with testing that can put some people off getting an HIV diagnosis.

Clearly not everyone will need an HIV test, and we need to be careful that the message of making HIV testing quicker and easier is not a replacement of using condoms, practising safer sex and managing your own sexual health. Hopefully making the process of HIV testing more accessible may also mean that practitioners working in different areas can join the dots in relation to infection. Meaning if a patient needs a test for Hep C or TB they will also be tested for HIV (something that’s not currently happening routinely).

I’d recommend anyone who is working either in the area of HIV, sexual health, reproductive health or communicable diseases checks out the new guidance which offer a welcome improvement to our sexual health services. If you are new to this area MedFash also have a great guide to HIV for non-specialists which helps explain more about HIV, testing and treatment.

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