From the Guidelines
The most appropriate approach to disclose a positive Human Immunodeficiency Virus (HIV) screen result to a patient is to deliver the news in a private setting, with adequate time for discussion, and using clear, direct language, as recommended by the American College of Physicians and HIV Medicine Association 1. When disclosing the result, it is essential to begin by explaining that the HIV screening test came back positive, emphasizing that this is a preliminary result requiring confirmation through additional testing.
- Provide immediate emotional support and reassurance that HIV is now a manageable chronic condition with effective treatments.
- Discuss the next steps, including confirmatory testing (typically Western blot or immunofluorescence assay), CD4 count, and viral load measurements to determine disease status.
- Explain that modern antiretroviral therapy (ART) can suppress the virus to undetectable levels, allowing for a normal lifespan and preventing transmission to others.
- Address immediate concerns about confidentiality, partner notification, and connect the patient with appropriate resources, including HIV specialists, counselors, and support groups. This approach balances honesty with compassion, providing critical information while acknowledging the significant emotional impact of an HIV diagnosis and establishing a foundation for ongoing care and support, as emphasized in the revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings 1.
From the Research
Disclosure of HIV Diagnosis
The disclosure of a positive Human Immunodeficiency Virus (HIV) screen result to a patient requires a sensitive and supportive approach.
- A study on assertive disclosure communication found that assertive compared to non-assertive communication led to intimate partner responses with lower negative affect, warmer feelings toward the character, and greater intentions to provide support and to continue a sexual relationship 2.
- However, the provided studies do not directly address the approach to disclose a positive HIV screen result to a patient in a clinical setting.
Clinical Considerations
When disclosing a positive HIV diagnosis, healthcare providers should consider the patient's emotional and psychological well-being.
- A case study reported a patient whose Western blot was negative for over two years after antiretroviral therapy, highlighting the importance of interpreting negative serological tests carefully in patients with HIV infection 3.
- Guidelines for antiretroviral therapy recommend treatment for all adults with HIV infection, regardless of CD4 cell count, and emphasize the importance of monitoring and supporting patients throughout their treatment 4, 5.
Patient Support and Education
Healthcare providers should prioritize patient support and education when disclosing a positive HIV diagnosis.
- A study on HIV screening found that patients may decline testing due to a lack of understanding about the purpose and benefits of HIV screening 6.
- Healthcare providers should address these concerns and provide patients with accurate and comprehensive information about their diagnosis, treatment options, and ongoing care.