How to Tell Your Patient He Is HIV-Positive
Let’s face it—no one wants to have to tell a patient that he is HIV-positive. As hard as it can be to deliver an HIV diagnosis, it’s also an important opportunity to protect his health by getting him into treatment. You can make a difficult interaction easier by keeping that in mind.
It’s good to prepare him for a potential positive HIV test before you have to give the diagnosis. But given that most HIV tests now take 20 minutes or less, you don’t really have much time. So when you’re explaining how the test works and the possible outcomes, you should also be trying to gauge his ability to cope with an HIV diagnosis. Some good conversation starters include:
“What concerns or questions do you have about the test?”
“How would you feel if your test comes back positive?”
If he says he suspects the test will show he has HIV, try asking:
“What kind of support do you think you will need if the test shows you have HIV?”
If you do have HIV, will it be safe for you to tell your partner(s)?
“What have you heard about treatment for people living with HIV?”
When the results are positive, it’s best to be specific in the way you deliver the news: “The test confirms that you have HIV.”
After sharing the result, you need to gauge how well your patient has absorbed the news, whether he needs support, and whether he’s ready to continue the discussion about next steps.
Patients’ emotions are often layered and complex, so you can’t assume he will respond in a particular way, or that all patients will have the same needs. You can find out what he does need by asking: “What can I do for you right now?”
Although effective antiretroviral medications have been available for 20+ years, many people still think that HIV is always fatal. Be sure to stress that isn’t the case, and that he will have many effective treatment options.
Emphasize that regular medical care is essential to his well-being, and greatly improves the chances that he will live a long and healthy life. The sooner he starts treatment, the more likely he is to protect his health and reduce the risk he will pass HIV to his sexual and/or needle-sharing partner(s).
For many people, the first shock of the diagnosis is followed by the realization that their sexual and/or needle-sharing partner(s) need to be contacted. Explain that you’re required to notify the local health department when someone tests positive for HIV, and that department staff will contact him to talk about notifying his partners so they can also get an HIV test.
If your patient is concerned about confidentiality, explain that you or the health department can notify partners without naming him. If he expresses fear or anticipates abuse related to disclosing to a partner, it’s important to refer him to refer him to domestic violence services before moving ahead with partner notification.
For more on CDC’s Recommended Partner Services, visit here.
You can greatly increase the odds that your patient will get the follow-up care he needs by taking proactive steps to get him into treatment immediately. Ideally, this includes connecting him with a case manager who can help him make and keep medical appointments and get other services and supports that he will need to stay in care and achieve viral suppression.
If you don’t have a case manager in your office/clinic, be sure you keep an up-to-date list of local organizations that can help. Be a champion for him: make the connection yourself, and follow up with him and the organization to make sure he’s getting appropriate care and support.