Terry's case: A Youth at Risk

References

*1. Tobin M, Chow F, Bowmer I et al (eds): A Comprehensive Guide for the Care of Persons with HIV Disease. Module 2: Infants, Children, Youth. College of Family Physicians of Canada, Mississauga, Ont., 1995

*2. Tobin M, Chow F, Bowmer I et al (eds): A Comprehensive Guide for the care of Persons with HIV Disease. Module 1: Adults - Men, Women, Adolescents. College of Family Physicians of Canada, Mississauga, Ont., 1993

*3. Steben M, Mensah MN, Bally GA et al (eds): Practice Guidelines for the Obstetrical and Gynaecological Care of Women Living with HIV. Society of Obstetricians and Gynaecologists of Canada, Ottawa, 1994

4. Safer Sex Guidelines, Healthy Sexuality and HIV -- A Resource Guide for Educators and Counsellors. Canadian AIDS Society, Ottawa, 1994

5. Health and Welfare Canada, Working Group on HIV Infection in Organ and Tissue Transplantation: Guideline for the prevention of HIV infection in organ and tissue transplantation. Can Dis Wkly Rep 1989; 15 (suppl 4): 1-17

6. HIV infection in the workplace: a CMA policy summary. Can Med Assoc J 1993; 148: 1800A-1800H

7. Recommendations of the US Public Health Task Force on the use of zidovudine to reduce perinatal transmission of human immunodeficiency virus. MMWR 1994; 43 (RR-11): 1-20

8. Comité provincial des maladies infectieuses en service de garde : Avis de santé publique sur le contrôle des maladies transmissibles par le sang, dans le contexte d'un service de garde à l'enfance. Ministère de la Santé et des Services Sociaux, Québec, 1994

*Copies of these reports are available free of charge from:

National AIDS Clearinghouse
Canadian Public Health Association
1565 Carling Ave., suite 400
Ottawa ON K1Z 8R1
Tel: (613) 725-3769, Fax: (613) 725-9826

Safer Sex Guidelines (reference 4) is available at a nominal charge from the Canadian AIDS Society, 100 Sparks St., Ottawa ON K1P 5B7. Tel: (613) 230-3580, Fax: (613) 563- 4998.

Resources

National Therapy Hotline (Community AIDS Treatment Information Exchange): 1 800 263-1638

Provincial/territorial AIDS coordinators:

Alberta (403) 427-0836
Nova Scotia (902) 424-8698
British Columbia (604) 660-6170
Ontario 800 268-6066
Manitoba (204) 945-6839
Quebec (514) 873-9890
New Brunswick (506) 453-3092
Prince Edward Island (902) 368-4978
Newfoundland (709) 729-3430
Saskatchewan (306) 787-8316
Northwest Territories (403) 920-8946
Yukon Territory (403) 668-9444

Know your local resources

Compile a list of telephone numbers, addresses and contact people for the following:

HIV-experienced colleagues
Sexual health or STD clinic
Anonymous HIV test site
Social services
Drug-use treatment centre
Needle-exchange site
Legal services
Public health officer/medical health officer
Support group for people living with HIV
Ethnic/aboriginal resource group
AIDS hotline

Pretest counselling

A person's request for HIV testing should be honoured.

• Explore risk history and discuss reasons for the test.
• Assess the person's risk of having been exposed to or of being infected with HIV.
• Provide information about HIV infection and testing, including the meaning of positive, negative and indeterminate test results, and the impact of the window period.
• Discuss risk reduction and explore specific ways in which the person can avoid or reduce risk-producing behaviour.
• Identify testing options available in the region, specifically nominal, non-nominal and anonymous testing.
• Discuss the potential benefits and harms of being tested and of being found HIV-positive.
• Discuss the confidentiality of test results in relation to office or clinical procedures, communicating results to other health care officials, provincial reporting requirements and partner notification.
• Discuss the stress related to waiting for test results and possible reactions to learning the results.
• Assess the window period by identifying the most recent risk event and plan an appropriate time for testing.
• Obtain and record informed consent, whether provided in writing or verbally, before testing is conducted.
• Arrange a return appointment after a predetermined interval for a face-to-face visit to inform the patient of his or her test results.

A person has the right to decline testing.

Post-test counselling

HIV test results are given only in person.

• Assess the patient's understanding of the test result.
  
• Encourage the patient to express feelings and reactions.

Negative and indeterminate result

• Discuss any need for repeat testing.
  
• Review the ways in which HIV is transmitted.
  
• Review risk-producing behaviour and assess the patient's commitment to risk-reducing strategies.

Positive result

• Assess the psychological response to being HIV positive.
  
• Plan how the patient can overcome adverse psychological reactions to being found HIV positive.
  
• Arrange additional psychological and social support services as needed.
  
• Povide reassurance about the person's immediate safety.
  
• Arrange for medical follow-up.
  
• If possible, review transmission modes and risk-reduction strategies.
  
• Arrange for partner notification, if necessary.

Other important issues (emphasize early if poor follow-up is likely)

• Discuss health, reproductive and treatment issues.
• Review importance of partner testing and notification and offer assistance if the person needs it.
• Reiterate the patient's right to privacy and confidentiality with respect to medical information.