Testing for HIV

'It should be within the competence of any doctor, midwife, nurse or trained health care worker to obtain consent for and conduct an HIV test.' — UK National Guidelines for HIV Testing 2008.

'An experienced practice nurse with good communication skills who is given the right training can confidently do the test. A lot of the HIV tests we offer are done by nurses or assistant practitioners.' — Jason Warriner, Clinical Director of the Terrence Higgins Trust.

Testing is one of the key steps in the prevention and management of HIV. Staff on the frontline of health care, especially registered nurses, assistant practitioners and health care assistants, are in an ideal position to talk to their patients or clients about being tested. We know the benefits – better prognosis for those who are diagnosed and the reduction in onward transmission – so it is in the best interests of your patients and clients that more nurses, assistant practitioners, and health care assistants take up the baton and perform HIV tests.

Testing for HIV

Performing an HIV test is easy and straightforward; there is nothing particularly special or difficult about it. If you do not have any experience with HIV tests or have some concerns, training can help. Talk to your line manager about the training opportunities available where you work. The earlier HIV is diagnosed, the better the prognosis so why don’t more people get tested? Take a moment to think about the questions and concerns someone might have about taking an HIV test, then explore the animation below.

Deciding to have an HIV test can be worrying. As the animation above shows, there are many reasons people decline testing or put it off. One way you can help allay fears and encourage clients and patients to have a test is to remind them of the benefits an HIV test will bring. These include:

• It allows people to take steps to protect their health, for example, by starting drug therapy.
• It allows people who receive a positive diagnosis to receive the information, care, and support they need.
• It allows those who test negative to put their mind at rest and may motivate them to take steps to remain negative.
• It encourages partner disclosure and testing.
• It allows people to take steps to ensure they don’t pass on HIV to others.
• Not knowing brings its own worries – having the answer lets people take control.

Your role in pre-test discussions is to ensure the patient or client has the information they need to make an informed decision. They should:

• Understand the implications of the test  - what a positive and negative result mean.
• Be aware of their individual risk and why they should be tested
• Have enough information to make a decision for or against testing.
• Be educated on ways to minimise the risks of HIV transmission and,
• Understand the benefits testing and an early diagnosis can bring.

The testing process

Testing for HIV is a quick and simple process. Your patients or clients may mistakenly refer to it as an ‘AIDS test’ but it is actually a test for antibodies to HIV. Blood is taken from an arm or finger pin-prick and then tested for antibodies to HIV. A negative test result means that no antibodies to the virus were found. A positive result means that HIV antibodies are present and the person is then said to be HIV-positive.  It does not, however, mean that the person has or will develop AIDS.

HIV antibodies cannot be detected immediately after infection. The time between becoming infected and showing signs of infection is called the ‘window period’. The window period is currently 12 weeks - tests taken during this time may not detect the antibodies to HIV, and as a result, be inaccurate. Anyone tested during the window period should repeat the test at the end of the 12 weeks just to be sure. Tests that can diagnose HIV earlier are in constant development. Periodically check with your employer or the HIV testing centres in your community to learn what is available.

Traditional tests involve venepuncture, with the blood sample being sent to a laboratory for testing. The results are available in about two weeks. Rapid tests involve a finger prick blood or a saliva sample which is then applied to a test device, with the results being available in about 20 minutes. Watch the slideshow below to see each step in the process of how a rapid HIV blood test is performed.

Giving the results

If you refer someone for an HIV test, be certain you know what type of test is available – it may be that a rapid test is important where people are unable or unwilling to wait for their results or where you are concerned that they may not return to receive those results. HIV tests are confidential and free of charge. They are available at GP surgeries, genitor-urinary medicine (GUM) and sexual health clinics, antenatal clinics, and private health clinics. Tests performed at GP surgeries will go on the patient’s medical record; those performed at GUM clinics or private health clinics will not, so it is important that you discuss this with your patient or client. Also, private health clinics will charge for the test. HIV charities such as those listed in the ‘Useful Resources’ section provide information on testing centres as well as confidential telephone lines and other services to help those who have questions about the test or their results.

For anyone, waiting for the results of an HIV test is an anxious time. There are certain steps you can take to help minimise the stress. Work through the activity below to identify the 'eight essentials' when giving people their HIV test results, regardless of whether the result is positive or negative. 

If the result is negative, you will first need to consider the need for a second test if the patient is within the window period. Many people who learn that they are HIV negative are motivated to remain this way, so this is an ideal time to discuss safe sexual and drug use practices. Some people who have practiced unsafe activities but test negative may mistakenly believe that this validates their activities. Remind patients or clients that testing negative now doesn’t guarantee that they will remain this way if they engage in risky behaviours.

A person’s response to a positive result will vary depending on a variety of factors including whether they are prepared for the result and the support they have from family, friends, and their community. Testing positive can be an emotional and confusing time. Clients or patients who learn they have HIV infection should be referred to a specialist HIV clinic where they can receive the information and specialised care they need. Depending on your patient and his or her response, it may be that discussions about treatment options are too much to take in at this time. If you feel confident that he or she will return, or seek information elsewhere, leave the ‘next steps’ for a later time. If you are uncertain whether the person will come back, give them information they can take away with them. Explore the activity below for seven top tips when telling someone of a positive HIV diagnosis.