Stigma, support, and messaging for people recently diagnosed with HIV: a qualitative study.

Background Despite advances in antiretroviral treatment and the message of undetectable equals untransmittable (U=U), there remain challenges related to stigma and quality of life for people living with HIV. This study aimed to understand the experiences of people recently diagnosed with HIV at a clinical service, to guide insights into how to improve care and support in the contemporary treatment era. Methods This qualitative study involved semi-structured interviews with individuals diagnosed with HIV between 2016 and 2021 at RPA Sexual Health service (a sexual health clinic in Sydney, Australia), or who were referred to the clinic directly after diagnosis. Participants were recruited through a short survey questionnaire between May 2022 and May 2023, and interviews were transcribed and analysed thematically. Results Fourteen participants were interviewed for the study, eight of whom were born outside of Australian or Aotearoa New Zealand. We found that diagnosis was still a shocking event requiring careful support; that there was ongoing stigma, shame, and reduced sexual confidence following diagnosis; and that beyond initial diagnosis, some people would benefit from ongoing support and education about key concepts regarding HIV treatment. Conclusion Our study suggests that HIV diagnosis remains disruptive, and sexual stigma is a key issue negatively impacting quality of life. Health providers can mitigate these issues by supporting the ongoing psychosocial needs of people with HIV in the early period of adjusting to HIV diagnosis, and referring to peer-based and other services. Initiating conversations about sex and dating and checking understandings of key health messages over time may promote improved care.

Providing HIV-negative results to low-risk clients by telephone.

BACKGROUND: In Australia, Health Department policies differ on the recommended method of providing HIV results. Traditionally, all results have been provided in person. Our aim was to trial provision of HIV-negative test results by telephone to low-risk clients attending sexual health services and to assess clients' preferences for delivery method. METHODS: During 4 months in 2009 at two sexual health services in Sydney, all clients assessed as low-risk for HIV infection were invited to receive their HIV result by telephone. Non-receipt of results was defined as failure to receive results within 30 days of the test being performed. RESULTS: Of 763 clients tested, 328 (43%) were excluded following risk assessment, 30 (4%) declined to participate and 405 (53%) were enrolled. Among enrolled clients, 86% received their HIV result by telephone within 30 days, 97% were satisfied with delivery of the result by telephone and 93% preferred telephone delivery for their next HIV result. Only one enrolled client returned a positive HIV result. Independent predictors of receiving results within the 30-day timeframe were clinic attendance for sexually transmissible infection screening (P=0.021), lack of anogenital symptoms (P=0.015) and not being a sex worker (P=0.001). CONCLUSIONS: In this study of telephone provision of HIV results to low HIV-risk clients, there were no adverse events and clients expressed satisfaction with the process plus a strong preference for telephone delivery of future results. There was a decreased rate of failure to receive HIV results compared with other Australian studies.

HIV results: practice at public sexual health clinics in New South Wales.

New South Wales (NSW) Health guidelines recommend all HIV results be given in person, however this practice fails to achieve high levels of result collection. Fourteen of all 38 NSW public sexual health clinics (37%) surveyed offer HIV results by telephone to low-risk patients, although all positive results are given in person. Efficiency of result-giving, accessibility to results, patient acceptability and awareness of more flexible national guidelines were cited as reasons for varying practice from state guidelines. NSW guidelines require revision to allow clinicians to determine the most effective and efficient mode of HIV result delivery to their patients.

HIV result giving. Is it time to change our thinking?

BACKGROUND: Ensuring patients receive post-test discussion when collecting HIV test results is an integral component of the HIV testing process. New South Wales Health Department (NSW Health) policy recommends that all patients be given their HIV results in person. We assessed the number of patients who returned for HIV test results to Royal Prince Alfred Sexual Health Clinic in Sydney, Australia, and predictors of return. METHODS: The files of 218 patients having consecutive HIV tests from the beginning of January to the end of April 2007 were manually reviewed. Non-consenting patients and those returning to the clinic for another reason were excluded. Multivariate logistic regression was used to determine factors associated with return for HIV results in person within 4 weeks of having the test. RESULTS: Seventy-two of 159 patients (45%) returned for their HIV result within 4 weeks of testing. Independent predictors of return were male gender (P = 0.041), attending the outreach men-only (v. base) clinic (P = 0.017), first HIV test at the clinic (P = 0.002) and sex overseas in the past year (P = 0.048). CONCLUSION: Over one-half of patients did not collect their HIV results in person and thus did not receive any post-test discussion. The strongest predictor of return for HIV test results was having a first HIV test at the clinic. Current NSW Health policy is failing to achieve high levels of HIV post-test discussion. For many patients, giving results by telephone may be a more appropriate strategy to ensure HIV post-test discussion.