Discussing HIV testing

STEM:
You are attached to a genital-urinary clinic. Jim is 23 and has asked for an ‘AIDS
test’; the task of discussing this with him has been delegated to you. Please discuss the
test with him before the blood taken.

Discussing HIV testing

STEM:
You are attached to a genital-urinary clinic. Jim is 23 and has asked for an ‘AIDS
test’; the task of discussing this with him has been delegated to you. Please discuss the
test with him before the blood taken.
Examiner notes:
This is an example of HIV testing for the ‘worried well’. The test must not be
performed unless the issues have been carefully discussed, the grounds for doing it
have been established and the patients informed (verbal) consent obtained.

Observe for:
Communication skills with an anxious patient on a sensitive topic
Awareness of the ethical issues surrounding HIV testing
Knowledge of HIV and AIDS
Skill as an educator

Core skills: Discussion in preparation for an HIV test

1. Introductions and guarantee of confidentiality
2. Assessment of risk
3. Discussion of HIV/AIDS
4. Discussion of the test
5. Discussion of legal, financial and social implications of the test
6. Discussion of the consequences of positive and negative test
7. Request for consent
8. Advice about behaviour pending test result.

 see marking sheet

 Marking sheet
TASK REQUIREMENTS MARK (max)
Introduction & Student introduces himself, including role. Establishes patient’s identity, uses 2
communication introduction to build rapport. Student uses open questions, uses listening skills
Guarantee Tells the patient that the discussion you are about to have and the result of the test, if 1
Confidentiality done, will be handled with complete confidentiality
Assess Risk ∙ Current state of health, including any pointers to HIV/AIDS 5
∙ Sexual Orientation
∙ Sexual behaviour, including numbers of partners, type of intercourse (vaginal,
anal-penetrative, receptive), use of condoms ½ mark for
∙ Partners: promiscuity and sexual orientation each dot point
∙ History of sexually transmitted disease
∙ Country of origin, travel and sexual behaviour overseas
∙ History of drug abuse 1 mark for
∙ History of blood or blood product transfusion, or organ donation getting risk
 at this stage, student gives patient rough estimate of risk (low, med, high) right - MED
Discuss Checks patients knowledge of the disease and give them some basic information 3
HIV/AIDS about:
∙ The fact that you can test for HIV infection, not for AIDS (AIDS test is misnomer) 1 mark for
∙ The window period between infection and seroconversion (normally no more than each dot point
3 months) during which a false negative result may be obtained if described
∙ Transmission, primary HIV infection, seroconversion, the asymptomatic period properly, ½ if
when lymphocyte counts decline, then AIDS insufficient
 if the patient is seeking the test because of very recent unprotected intercourse
and is likely to be in the window period, they may opt to defer the test. They must be
encouraged to practice safe sex in the meantime
Discuss the test ∙ Check that the patient now understands that the test is for HIV antibodies 3 marks
∙ It involves taking a small amount of venous blood
∙ Tell the patient when the result will be available
∙ Tell the patient that the result will be given verbally, ideally by the student (since
he/she is the one who has reached the agreement with them to do the test)
Discuss the ∙ When applying for a mortgage, insurance etc. the patient may be asked whether 3 marks
legal, financial they have had an HIV test (other than a mandatory insurance test) and may be refuse
and social insurance if they admit to it.
implications of ∙ If the test is positive, the patient will be strongly encouraged to give consent for his
the test GP and dentist to be notified and the result will then be permanently in his GP
records.
∙ The patient may be asked about his HIV status at employment medicals, although
they are not legally obliged to divulge the information
∙ If positive, the patient’s partner(s) should be informed
Consequences Student should assess the patients ability to cope with the implications of a positive 5 marks
test, and prepare them for it. You are assessing their personal readiness, and support
mechanisms. Some implications of a positive test are:
∙ It would need to be repeated to confirm its positivity
∙ It would give the patient greater certainty, albeit of an unpleasant nature
∙ The patient would be offered continuing medical support and follow-up
∙ It would allow early treatment, including anti-retroviral treatment and prophylaxis
against opportunistic infections Student has to
∙ It would allow the patient to alert others (partners, health professionals) of the risk discuss the
of transmission possibility of
It would motivate the patient to practise safe sex, safe drug use etc. both a positive
If negative and negative
∙ The possibility of a false negative has to be considered test result and
∙ It would give the patient reassurance its impacts
∙ The patient should still behave responsibly to minimise their risk of HIV infection
Obtain consent Having already estimated and discussed the risk, the patient should now be 1 mark
encouraged to weight up the pros and cons of having the test done and asked for
their decision
Advice about The student tells the patient that he/she should be particularly careful to practice safe 1 mark
behaviour sex, safe drug use etc. until the result is known
pending the test
result

TOTAL: / 24
Patient information and instructions

You name is Jim, formerly Yousef Akbar, a 23 year old Melbourne man. You
emigrated from Pakistan with your family when you were 12. You grew up in
Melbourne and attended high school. After high school you went to university to
study finance and accounting during weekends you work at a local bookstore.

You have come in because 2 months ago you had an ‘one night stand’ with a girl you
met at a university bar. It was unprotected vaginal and anal sex. At the time you were
unaware of her STD status but she looked clean and was around 30.

Recently she called you about because she discovered that one of her prior boyfriends
had been diagnosed with HIV and urged you and your sexual contacts to get tested.

Currently you are seeing a girl and have started kissing but have not had sexual
intercourse yet (but you want to). You hope that this news won’t jeopardise your
chances with her. You’ve had no sexual partners since the girl in the one-night-stand.

You health has been otherwise well. You are ill, no flu-like symptoms, rash (etc. of
seroconversion). Your sexual orientation has always been hetero, you’ve had 4 other
sexual partners in the past, and have used protection most of the time if they weren’t
on the pill. You believe all previous partners have had no history of STDs. You have
no previous history of STDs. After coming to Australia you have not gone overseas.
You have never used illicit drugs, or had blood transfusions.

Other health issues: none, alcohol: some, smoking a few ciggies (1 pack a week) try
and do this as quick as possible.

Previous HIV knowledge: AIDS is caused by a virus, you can get it from sexual
contact of sharing needles. If you get it you get sick and die, there are medications but
no cure. Don’t know much else.

Attitude to test: ask about the test, what is it, how fast can I get results. Only be
interested in confidentiality issues if student brings it up. After student’s explanation
say you want the test.

You main focus is to know if you are HIV (+) or not, don’t ask about legal, financial
or social implications of the test. If student discusses these say “I understand” after
each point they bring up. However, do not discourage them from these questions!
(worth a lot of marks). If they bring up issues of confidentiality ask who gets to know
the results and how they will be given.

Attitude to current partner: refrain from having sexual intercourse, feel happy that
non-sexual contact like kissing and petting is still ok and there is practically no risk of
transmission to her. However you are not intending on telling her just yet that you
could be HIV positive until test results are back.

Do not ask about what behaviour is appropriate pending test results.