Health Workers

Health care workers have an important role to play in preventing HIV, educating clients and community members about HIV, offering appropriate testing, and treating and caring for people living with HIV. As Aboriginal Health Practitioners this can be overwhelming at times. The following provides some useful information. 

Testing for HIV

Its important to offer HIV testing to the right client group at the right times.

HIV testing should be offered when:   

* There is a clinical suspicion of HIV or another STI or hepatitis B or C is diagnosed OR
* People disclose risk behaviours such as unprotected sex, reused injecting equipment or in the context of contact tracing

Who should be offered testing?

* Anyone who has had sex without a condom or when having sex a condom breaks
* Gay men and other men who have sex with other men and their partners
* Pregnant women and their partners
* People who have multiple sex partners should be offered HIV testing or anyone who has regular casual sex outside of an ongoing relationship
* People who inject drugs and their partners
* Partners of someone living with HIV

Normalising HIV testing:

* It is useful to normalise HIV testing as much as possible.
* When offering a HIV test it can be helpful to soften the suggestion by saying something like “let’s check you don’t have HIV”. Or we offer HIV to all clients on a regular basis.

HIV testing could also be offered

* During an Adult Health Check
* As part of a routine men’s or women’s health check.
* To both members of a couple in a new sexual relationship

Before testing seek informed consent:

Before testing: A full sexual, drug use and past medical history should be conducted to assist in determining whether an HIV test is indicated.

Informed consent is required from the person being tested for HIV prior to being tested. Informed consent means that the person being tested agrees to be tested on the basis that they:

* Understand the HIV testing process and the reasons why they are being offered a test and they are able to assess the outcomes if the test is negative or positive to HIV.
* For some people they may be used to providing informed consent but for many others with little understanding of HIV or their potential risk of exposure
* HIV testing may be new, frightening associated with shame stigma or judgement.

HIV testing

Most HIV testing in Australia occurs in Laboratories where HIV is detected in the sample of blood sent from the persons clinician.

* Test results are sent back to the person’s doctor, who will then inform the person of the result.
* There are two types of HIV analysis done in labs: antibody tests and antigen tests.
* The HIV antibody test indicates whether a person has come into contact with HIV.
* The antigen test detects HIV at an earlier stage than an HIV antibody test.
* In Australia, most labs use combined antibody-antigen tests.

Antibodies are usually produced between 2 and 8 weeks after infection with HIV. If the test is positive another test is done to confirm the result.

Rapid HIV Tests

In Australia rapid HIV testing or point of care testing is available.

* These tests are performed using disposable kits, which test either from a finger-prick sample of blood or saliva collected from around a person’s mouth.
* These test can show a result in approximately 10 to 20 minutes
* Rapid test results are not definitive. If a rapid test is reactive, a confirmatory laboratory test is needed, on a full blood sample.

Rapid testing is available at some sexual health services, NGOs like AIDS Councils and some hospitals and clinics and some people purchase rapid tests online, and test at home.

The ‘Window Period’

Health Care Workers should be mindful of reminding the person ordering a test for HIV of the window period. After someone has been exposed to HIV it can take up to three months for HIV to be detected in the persons blood. This means that to be fully sure that someone does not have HIV after an exposure to HIV they have to be tested after the window period.

HIV treatment advances

Medicine for HIV are known as HIV antiretroviral treatments or (ARTs).

ARTs are highly effective and can suppress the amount of virus in a person’s blood to an undetectable level which means a person cannot transmit the virus to someone else.

* Today ARTs have very few side effects.
* Commencing ARTs is recommended soon after diagnosis.
* The earlier the commencement of ARTs the better the persons overall health will be.
* However a person who has just been diagnosed with HIV may be upset and may not be ready to talk about treatment straight away so it is important to keep these people engaged in the treatment conversation.
Australian treatment guidelines now recommend that all people with HIV be encouraged to start treatment, regardless of their viral load or ‘CD4 count’.

HIV ARTs can only be prescribed by HIV specialist doctors who have undertaken special training, or by doctors who work as part of a specialised hospital unit. These doctors are sometimes referred to as ‘s100 prescribers’.

The HIV specialist will work out the best type of ARTs to take, taking into account the person’s age, sex and overall health. The specialist will then monitor how effective that combination is for their patient.

Diagnosis and starting treatment

Once a person has been diagnosed with HIV, their clinic or doctor will explain treatment options and refer them to an HIV specialist doctor or public hospital for HIV antiretroviral treatment to be prescribed.

* A person who has just been diagnosed with HIV will be upset and may not be ready to talk about treatment straight away.
* However recent evidence shows there are many benefits from commencing treatment as soon as possible after diagnosis.
* Australian treatment guidelines now recommend that all people with HIV be encouraged to start treatment, regardless of their viral load or ‘CD4 count’.

HIV antiretroviral treatment drugs (ART – short for AntiRetroviral Therapy) can only be prescribed by HIV specialist doctors who have undertaken special training, or by doctors who work as part of a specialised hospital unit. These doctors are sometimes referred to as ‘s100 prescribers’.

Providing support to people with HIV

Health workers’ role

Aboriginal health workers can have an important role in supporting people to deal with an HIV diagnosis, and referring people on to agencies that can provide professional counselling. Many people will have other health and social issues to deal with and an HIV diagnosis can seem like the last straw. Health workers can play a part in making sure that people understand that HIV is a serious but treatable medical condition, and dispel the myths about HIV that fuel stigma.

Family support

Family support can be great but most people in the community don’t know much about HIV. Many people think HIV has ‘gone away’, or that it only affects one group like gay men, or that it won’t get us, or that it’s still is a deadly disease, or that it can be spread by sneezing or sharing food. If people need support to tell their family they have HIV, it may be useful to guide them through some of the information on this website. Help them understand HIV, and the good news on modern treatment.

Think about talking to local clinic doctors and nurses about holding education sessions for non-medical staff on HIV and HIV treatment. These sessions can be great for learning the latest on HIV prevention and treatment, and for sharing ideas on how doctors, nurses and health workers can work together to provide care and support to people living with HIV and their families.

Letting partners know

Many people dread telling their partner they have HIV. It can be helpful for people to make an appointment to see their doctor or counsellor together.

Support services

There are services and specially trained people working at AIDS Councils and other organisations providing support for people with HIV. To locate services in your area, contact your local AIDS Council or organisation for people living with HIV.

HIV cure research

There is no cure for HIV. hivcure.com.au collates the latest news on HIV cure research. Developed by the National Association of People with HIV Australia in association with the Doherty Institute, the Alfred Hospital and the Kirby Institute, the website is part of a partnership between community organisations and scientists to ensure that people living with HIV in Australia can gain access information on progress toward a cure.

Preventing HIV – ‘combination prevention’

HIV prevention is no longer just about using condoms.

People now talk about ‘combination prevention’ as the new ‘prevention toolbox’. Combination prevention refers to the fact that there are now several ‘tools’ for preventing HIV that in combination may dramatically reduce infection rates.

Here are some of the new ‘tools’ – the terms and what they mean:

 PrEP

PrEP or pre-exposure prophylaxis is where someone who doesn’t have HIV takes HIV antiretroviral medication (Truvada or a generic form) to protect themselves from getting HIV.

* Some people take PrEP because they know their sexual partner has HIV and they want extra protection.
* Other people take PrEP because they want to enjoy sex without the worry of acquiring HIV.
* PrEP can be obtained from Doctors on a script and bought from chemists, pharmacies or online.

PrEP isn’t for everyone – for PrEP to work, the person must take their doctor’s advice about dosage. Also, PrEP only works to prevent HIV – not for other STIs. STIs are very common in our community so it’s important to continue to reinforce the message that safe sex is sex with a condom.

PEP

Post-exposure prophylaxis (PEP) is very different to PrEP.

* PEP is where a person who has been possibly exposed to HIV, for example due to condomless sex or sharing injecting equipment, is given a short course of HIV antiretrovirals to prevent HIV

PEP is usually prescribed by a doctor in high risk situations, for example where a person has had unsafe sex with a person with HIV and that person does not have an undetectable viral load or when blood s exchanged between injecting drug users where one is HIV positive and the other is negative.  However for PEP to be effective it has to be commenced within 72 hours or 3 days of the exposure, it can kill off any HIV on the system and prevent the person from getting HIV.

Treatment as prevention”

(TasP)’ refers to treatment as a prevention meaning HIV treatments are now considered a tool to prevent HIV.

* First HIV ARTs should be used for improving the health of the person living with HIV.
* People with HIV who are on ART can have so little HIV in their blood that it is undetectable in tests and called an ‘undetectable viral load’ (UVL).
* Research studies have shown people with an UVL cannot transmit HIV to others hence meaning treatment is now a prevention tool.

The effect of this is that if most people with HIV can access treatment and reach UVL, there will virtually no new transmissions or diagnosis.  The ideal is to get >90% of people living with HV on ART and of these >90% with an UVL.

Needle & syringe programs

NSPs are services that provide disposable syringes to injecting drug users. This actively discourages sharing of equipment and is referred to as a harm reduction policy. Introduction of NSPs in Australia is the main reason why rates of HIV among injecting drug users have remained low compared to other countries. Rates of HIV among Aboriginal and Torres Strait Islander people who inject drugs are higher than for non-Indigenous Australians, so it’s important to encourage people in our community to access NSPs and not be shamed – tell people that NSP staff will know they’re doing the right thing and won’t judge or lecture about using drugs.

Opioid substitution therapy

or OST is where people who have become dependent on an illicit drug are prescribed a substitute drug – this is called pharmacotherapy. In Australia the main pharmacotherapies used for people with opioid dependence are Methadone, Buprenorphine, and Naltrexone.

Detox and rehabilitation programs

can assist people to cease, reduce or stabilise their use of illicit drugs, prescription medications, or alcohol. Programs can involve counselling and group support, residential rehabilitation, detox as well as pharmacotherapies such as methadone, buprenorphine, or naltrexone.

Links to online resources

Online resources can be helpful too. These may not be accessible to many of the people you’re dealing with, but you may find them useful for working out how best to discuss HIV treatment and various aspects of living with HIV.