The ideal time for diagnosing HIV is before our patient progresses to symptoms - the chances for early diagnosis are higher and so the potential health benefits greater.
To support this we need to offer HIV tests to people who do not have any symptoms of HIV but who might be at risk. How, realistically, can this be done in a practice?
There are two strategies.
HIV screening is one approach that is appropriate for high prevalence areas for HIV. Examples of screening include offering a test to all newly registered patients or all women seeking contraception or an abortion. For more information on this see the fourth, and final, section of Update yourself.
Opportunistic testing for HIV of those at risk is the strategy we explore in this section. It depends on sexual history-taking. Clinicians should be aware of the benefits of diagnosing HIV early, and should be able to:
- introduce the topic of HIV with patients in a way that makes no assumptions
- take a sexual history and ask other relevant questions to assess risk
Knowledge of risk groups and of risk behaviours helps us to offer HIV tests to those at higher risk.
Afua, 39 - a patient's view
I remember well when I first met my new GP after I moved to the area - it must have been nearly 10 years ago now. I was asking for more of my contraceptive pill. I remember that after she had asked me a few things about my work and so on, she asked where I came from – she must have spotted my accent. When I told her I was from Ghana she surprised me. She said something about how there were quite a few infections that were commoner in other countries than here in the UK, and so they were offering hepatitis and HIV tests as a matter of routine – had I ever had tests for those conditions? Had I ever wondered if I might be at risk?
I must have looked a bit doubtful because she went on to explain the benefits of knowing about these infections if you had them. I declined at the time but thought about it quite a bit – I had had a couple of boyfriends in Ghana before I came to the UK. Then later I asked her for the tests and we agreed to test for HIV and hepatitis. As I hadn’t had any kids at that point she suggested it would be worth checking my rubella immunity and check for sickle too.
I was of course shocked to find I had HIV, but I adjusted and my health has stayed excellent even though I am now on medication. A new partner and two children later – things are good! My GP is just retiring – I will miss her, we agree we have a special bond.