HIV Counselling
Author – Mohona Sengupta Editor – James Mackintosh
Last updated 20/05/23
Table of Contents
Introduction
Human Immunodeficiency Virus (HIV) is a virus that attacks the body’s immune system which makes it more vulnerable to infections and diseases which can be life threatening. HIV is primarily spread through sexual contact, sharing of needles and from mother to child during pregnancy, childbirth, or breastfeeding. Diagnosis can be from a simple blood test that screens for antibodies to the virus.
Setting up the consultation
Telling a patient they have been diagnosed with HIV can be devastating and can cause a range of emotions. It is important for healthcare professionals to approach the situation with empathy and sensitivity to ensure the patient receives the support they need during this difficult time.
The first step in telling a patient they have been diagnosed with HIV is to prepare for the conversation. This may involve reviewing the patient’s medical history, planning what you want to say and having support services readily available for the patient. This can be a complex and emotional topic so keep sufficient time for the conversation.
Explaining the diagnosis
When explaining the diagnosis, explain what HIV is and how it is transmitted. It may also be helpful to provide information about the stages of HIV and what this means for the patient’s health. Following this, the patient will need to be told the treatment options.
Patients with a new diagnosis, who are well otherwise, will need to be seen by a specialist HIV team preferably within 48 hours of testing positive. Whilst it is important to reiterate that there is currently no cure for HIV, antiretroviral therapy (ART) can effectively manage the virus and slow the progression of the disease, irrespective of their CD4 count. ART involved taking a combination of antiviral drugs that work to reduce the amount of virus in the body, prevent the virus from replications and strengthen the immune system.
With early diagnosis and treatment, people with HIV can live long and healthy lives. Monitoring of HIV infection is carried out in specialist clinics using the CD4 count and viral load. This is crucial to ensure that effectiveness of treatment and any side effects are monitored continually.
Side effects of ART:
As with any treatment, ART can cause side effects which range from mild to more severe. These include appetite loss, lipodystrophy, diarrhoea, mood changes and trouble sleeping. More severe but rarer side effects include diabetes, lactic acidosis, kidney damage or numbness in hands or feet. However, the patient must be told that they should NOT suddenly discontinue or adjust the dose of ART without specialist advice as this can cause treatment resistance.
Support and Prevention
People living with HIV should take steps to prevent the transmission of the virus to others. This may include using condoms during sexual activity, avoiding sharing needles and other injecting equipment.
A large part of the initial consultation will involve discussing the support and resources available to the patient. This may include support groups, counselling services and further advice. Ensure the patient understands that they are not alone and there are many people and organisations that can help them through this difficult time.
Conclusion
Finally, it is important to end the conversation by reiterating your support for the patient. Let them know that you are available to answer any questions that they may have in the future, and you will continue to be there for them as they navigate this difficult time.
HIV Counselling Checklist
- Preparation: choose a private setting for the consultation and ensure you have all information to hand before approaching the patient.
- Introduction: explain the purpose of the appointment and that you have received the results of their HIV test.
- Delivery of the diagnoses: clearly and accurately inform the patient of their HIV diagnosis.
- Explanation of the virus: provide a brief explanation of what HIV is and how it affects the body.
- Discussion of treatment options: explain the standard treatment for HIV, which is antiretroviral therapy, and how it works to manage the virus.
- Discussion of potential side effects: this is important so the patient is fully informed, including problems with discontinuing treatment.
- Prevention of transmission: discuss the steps the patient can take to prevent the transmission of HIV to others, such as using condoms and avoiding sharing needles.
- Availability of support: discuss the range of support services available to the patient, including counselling, support groups and financial assistance programs.
- Follow-up appointment: schedule a follow-up appointment to monitor the patient’s progress and ensure that their treatment is working effectively.
- Offer of support: remind the patient you are there for them and will continue with providing long term support.