BRIEF - SYNOPSIS OF THE HUMAN IMMUNODEFICIENCY VIRUS (HIV) SCREENING AND TESTING GUIDE

BACKGROUND The Public Health Agency of Canada (PHAC) estimates that, in 2011, 25% of people living with HIV in Canada were undiagnosed. Hesitation to seek testing may arise from fear, stigma and discrimination associated with the HIV diagnosis and related risk behaviours. This guide is designed to complement existing efforts to support care providers involved in HIV testing, in order to reduce the number of undiagnosed HIV infections in Canada. APPROACH PHAC commissioned a literature review and consulted with provinces and territories, and key stakeholders, including people living with HIV/AIDS, academics, nurses, physicians, professional associations, non-governmental organizations, policy-makers, community workers, and legal and ethical experts. As a result, the recommendations outlined in the guide are based on the most up-to-date evidence and expert opinion. SCREENING AND TESTING GUIDE The consideration and discussion of HIV testing should be made a component of routine periodic medical care. Offering HIV testing routinely can help normalize testing, and address the multiple barriers to reducing the number of undiagnosed cases in Canada. Begin with a brief explanation to the client on how HIV is transmitted: through unprotected sex, the sharing of drug-use equipment, and from a pregnant mother to her child. Clients can then consider their own situation and indicate whether they would like to have an HIV test. Upon request, a risk assessment may be conducted. As with other tests, testing is voluntary and verbal consent is sufficient. Negative test results provide an opportunity to remind clients of those practices that can help them maintain an HIV-negative status. There are a range of referrals and resources available to assist clients in reducing at-risk activities and maintaining a negative status. Those who are part of a couple should be encouraged to discuss HIV testing with their partners so they're not unknowingly involved in a serodiscordant relationship. Positive test results should always be provided in person and ideally by the initial care provider who has information resources and support referrals at the ready. An HIV positive diagnosis can be difficult news; it is important to take the time to discuss the results and answer any questions the client might have. Focus on positive messages by highlighting advances in HIV care, treatment and support. Note that HIV is now considered a chronic illness, and people living with HIV can live long, active and healthy lives. Advise the client about strategies for managing HIV and link them to care. Provide risk reduction information to prevent transmission Make the client aware that positive test results will be shared confidentially with the local public health department, which can assist in notifying previous and current partners of the need to be tested while protecting the client's anonymity and privacy. Strategies for informing past, current and future partners can be reviewed. If not already completed with the HIV test, clients should be tested for other STIs, hepatitis B and C, and tuberculosis.