The History Of Hiv Pre And Posttest Discussions In The Uk

Since the advent of the first serum antibody HIV test in 1985, there has been a need to engage in an appropriate dialogue with patients who undertake HIV testing. The reasons for this are varied, but historically, before the advent of

Advanced Clinical Skills for GU Nurses. Edited by Matthew Grundy-Bowers and Jonathan Davies © 2007 John Wiley & Sons Ltd antiretroviral therapy, a diagnosis of HIV was potentially life-threatening, and there was a significant social stigma associated with being HIV-positive. Some may say that this attitude still exists, but in comparison with the 1980s, when HIV-positive children were banned from schools and adults with HIV lost jobs because of their status, much influential work has been done in the UK to change public opinion.

Obtaining verbal or written consent from the patient before taking the test has always been considered best practice. Historically, there have been various methods of obtaining this, but the central importance of having valid consent has always been paramount.

Many groups and individuals have added, adapted and made their own recommendations about the content of pre- and post-test dialogue. Variations have occurred in what is considered good practice in pre- and post-test discussions.

The conversation with the patient regarding HIV testing has over the years been given names such as 'counselling' and 'discussion'. More recently a culture shift has happened within Genito-Urinary Clinics whereby many more individuals are offered HIV testing. This increased emphasis has occurred for a variety of reasons, predominantly related to the increasing rates of HIV infection and the escalating numbers of people in the community who remain undiagnosed. The 2004 figures released from the Health Protection Agency now estimate that there are 53,000 people living in the UK with HIV, and approximately one-third of these are still undiagnosed. In addition, there are increasing numbers of people in the UK who were traditionally seen as having a low prevalence of HIV (such as heterosexuals) who now constitute a significant proportion of the people in this undetected group. As a consequence, one of the main recommendations from the Department of Health publication The National Strategy for Sexual Health and HIV is that all patients attending a GUM clinic are offered an HIV test regardless of risk factors, ethnicity or lifestyle.

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