Hiv Risk Assessment

An HIV risk assessment should be undertaken on all patients who attend a sexual health clinic for a primary sexual health screen and at each subsequent visit. This assessment should still be undertaken even if the offer of an HIV test has been declined. Most clinics have an HIV pre-test discussion as part of the standard sexual history-taking proforma. However, there remains a need to be well-versed in the questions that are required and the information that should be given to the patient.

One of the aims of the pre-test discussion risk assessment is that the clinician should attempt to establish the likelihood of the patient testing HIVpositive. Some GUM clinics in the United Kingdom have protocols whereby all high-risk patients are referred straight to either Health Advisers or Clini cal Nurse Specialists to carry out the HIV pre-test discussion. Different criteria may apply regarding referrals to these professionals; these often depend on patients' risk behaviour and ethnicity. Patients who may be referred include men who have sex with men, intravenous drug users, and people from sub-Saharan Africa or the Caribbean, in addition to people who have sex with people from these groups. In some clinics the person taking the sexual history and assessing symptoms will do the pre-test counselling, and these people tend to be the Nurse Practitioners, Doctors, Health Practitioners or Health Advisers. All these groups should receive training and support about how to conduct appropriate pre- and post-test discussions.

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