Health Workers

Testing for HIV

Laboratory testing

After receiving blood samples from clinics full HIV testing is performed by pathologists in laboratories. 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 the person had come into contact with HIV. 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.
  • The antigen test detects HIV at an earlier stage than an HIV antibody test.
  • In Australia, most labs use combined antibody-antigen tests.

Rapid HIV tests

There are also rapid tests for HIV. These are performed using disposable kits, which test either blood from a finger-prick sample of blood or saliva collected from around a person’s mouth. Rapid testing is available at some sexual health services, NGOs like AIDS Councils and some hospitals and clinics. Some people purchase rapid tests online, and test at home.

Most kits used in Australian clinics test blood from a finger-prick sample, with indicators on the kit showing a result in 10 to 20 minutes. The person waits at the clinic for the result. Rapid test results are not definitive. A reactive result just indicates that the person may have HIV. If a rapid test is reactive, a confirmatory laboratory test is needed, on a full blood sample.

The ‘Window Period’

HIV tests cannot detect HIV in the blood of a person immediately after a person is infected. This delay is called the ‘window period’. Each type of test has a different window period, but can be up to 3 months.

The window period means that people testing negative for HIV who have had an exposure risk should re-test three months later – after the window period has ended.

Who should get tested?

People should test for HIV if there is a risk they have been exposed to HIV. For the Aboriginal community, risk is associated with:

  • condomless anal or vaginal sex, or condom breakage
  • sharing injecting drug equipment.

Anyone testing positive for another STI should be offered an HIV test within 30 days.

How often should people be tested?

People can find it confronting to be advised they should test for HIV. They may feel judged after explaining an exposure risk such as condomless sex or injecting drug use. It can be helpful to soften the suggestion by saying something like “let’s check you don’t have HIV”. This is much less alarming than saying “you may have contracted HIV – you better have a test”.

Adult Health Checks are an ideal opportunity to offer sexual health checks, including HIV and viral hepatitis tests. HIV and STI testing needs to be normalised. Making sexual health checks part of routine men’s and women’s health checks will help overcome the stigma and shame that can be associated with STI’s and BBV’s.

Both members of a couple in a new sexual relationship should be advised to test for STI’s, including HIV. Anyone who has regular casual sex outside of an ongoing relationship should get tested at least every six months – or ideally three months.

Gay men and other men who have sex with men should test after engaging in condomless anal sex, and have a full HIV/STI sexual health check at least every 12 months – even if a condom is generally used.

Diagnosis and starting treatment

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’.

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.

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’.

HIV treatment advances

Modern HIV antiretroviral treatments are highly effective, with far fewer side-effects than treatments available up to the mid-1990s. There are now five types or classes of HIV antiretroviral drugs, each of which works in a different way against HIV. These drugs are usually prescribed in combination – called ‘combination therapy’. Some antiretroviral ‘combinations’ can now be taken as a single daily pill.

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

Undetectable viral load- what does this mean?

Many people on antiretroviral treatment reach the point where the HIV viral load is undetectable. This means that the level of the virus in their blood is so low they are unlikely to transmit HIV. It is predicted that as more people with HIV go on treatment and reach an undetectable viral load, rates of new HIV infections will go down. This is often referred to as ‘treatment as prevention’.

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.

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’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.

The Positive Aboriginal and Torres Strait Islander Network, or PATSIN, is made up entirely of Aboriginal and Torres Strait Islander people living with HIV. PATSIN provides culturally appropriate support to people with HIV in our community. PATSIN is hosted by the National Association of People with HIV Australia (NAPWHA), and meets face-to-face and by teleconference throughout the year. The network provides the opportunity for HIV-positive Aboriginal and Torres Strait Islander people to advocate for policy change at a national level. PATSIN members network in their communities – talking about ways to promote safe sex, safe needle use, HIV testing and early treatment. PATSIN can be contacted by email: patsin@napwha.org.au or by phoning NAPWHA on 1800 259 666.

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.

‘Better to Know’

‘Better to Know’ is a website for young Aboriginal and Torres Strait Islander men and women. It provides detailed information on STIs, HIV, testing and treatment – in two sections, Men’s Business and Women’s Business. Site users can receive SMS or email reminders to have a sexual health check. The site is also a practical tool for health workers and counsellors in Aboriginal health services, sexual health centres and general practice to assist patients in partner notification. Users can use the site to notify recent sexual partners that they may have been at risk of having an STI and encourage them to have a sexual health check. The notification can be made anonymously.

‘Us Mob and HIV’

Us Mob and HIV is a booklet designed to increase Aboriginal and Torres Strait Islander people’s understanding of HIV. The booklet provides introductory information about HIV, transmission and prevention, HIV testing, HIV treatments, health monitoring and care and support needs, as well as contact details for services. Download the booklet or contact your local AIDS Council for hard copies of the booklet.

ANTHYM – Aboriginal Nations Torres Strait Islander HIV Youth Mob

ANTHYM seeks to empower Aboriginal and Torres Strait Islander young people to reduce HIV and sexually transmitted infections within our communities through the promotion of safe sex and safe injecting practices. Visit the ANTHYM Facebook page at http://www.anthym.org/

2 Spirits

The 2 Spirits program was established in 1996 as the Queensland Aboriginal and Torres Strait Islander HIV/AIDS Project. The project was renamed 2 Spirits in 2009 – ‘2 Spirits’ referring to a person possessing both masculine and feminine spirits. The 2 Spirits logo above was developed by artist Arone Meeks. It features male and female images, along with the symbol of infinity and the colours of the Aboriginal and Torres Strait Islander flags.

Covering the entire state of Queensland, the program promotes the health of Aboriginal and Torres Strait Islander gay men and sistergirl communities through sexual health promotion, campaigns, community outreach, education workshops, support and referrals. Visit the 2 Spirits Facebook page for information about its activities.

Condoman

The Condoman campaign was developed in the late eighties in recognition of the fact that the Grim Reaper HIV awareness campaign was doing nothing to promote sexual health among Aboriginal and Torres Strait Islander people. In 1987, Aunty Gracelyn Smallwood and other Aboriginal Sexual Health Workers in Townsville developed the Condoman campaign – sexual health resource which was culturally-based. Condoman is now an iconic figure and his message “Don’t Be Shame Be Game” has reached generations of Aboriginal and Torres Strait Islander people. Condoman was relaunched in 2009 by the QuAC / 2 Spirits Project, with the support of Queensland Health and the Queensland Aboriginal and Islander Health Council (QAIHC). The image of Condoman was rebranded and updated and he is now works with his sidekick Lubelicious.
See http://www.condoman.com.au.

Aboriginal Community Controlled Health Services
Aboriginal Community Controlled Health Services (ACCHS) deliver education and health promotion campaigns as part of their preventative health programs, including on STI, HIV and hepatitis prevention.

For information about health promotion programs and resources produced by Aboriginal controlled health services, contact your state/territory Aboriginal health service peak:

South Australia: AHCSA (Aboriginal Health Council of South Australia).

See AHCSA’s handbook on STIs and bloodborne viruses, ‘RESPECT’ – OUR MOB

Tasmania: Tasmanian Aboriginal Health Service (TAHS)

Victoria: VACCHO (Victorian Aboriginal Community Controlled Health Organisation)

Read more about VACCHO’s sexual health resources.

NSW: Aboriginal Health and Medical Research Council of NSW (AH&MRC).

AH&MRC has produced a sexual and reproductive health kit, DOIN ‘IT’ RIGHT!

Queensland: QAIHC (Queensland Aboriginal and Islander Health Council)

QAIHC and the Queensland AIDS Council host Condoman

NT: AMSANT (Aboriginal Medical Services Alliance of the Northern Territory

WA: AHCWA (Aboriginal Health Council of WA)

NACCHO

NACCHO (the National Aboriginal Community Controlled Health Organisation), is the national peak for the more than 150 Aboriginal Community Controlled Organisations across Australia. Read more about NACCHO’s role and work.

Privacy and confidentiality

Letting sexual partners know they need to test

If a person is diagnosed with HIV, their doctor will talk to them about letting their sexual partners know they should get tested. This is called “contact tracing”.

It’s important to explain to people who have been diagnosed with HIV that contact tracing is not about blame or keeping track of people with HIV. Contact tracing is just to make sure that as many people as possible who may have HIV get tested, and start treatment. As a health worker you can support people to understand contact tracing. Explain it’s completely confidential – the doctor or clinic will just let the person’s recent sexual partners know that it’s time to have a test, without mentioning the name of the person who’s been diagnosed.

‘Better to Know’ provides guidance on contact tracing – including on how to do this anonymously.

Who else needs to know?

  • Centrelink: People can tell Centrelink they have HIV if they want to – but they don’t have to. They may want to tell Centrelink if having HIV is affecting job seeking.
  • Employers: There is generally no need to advise employers of an HIV diagnosis. There are very few jobs that people with HIV can’t do. For jobs that may involve a risk of HIV or other infectious conditions being transmitted, it’s up to the employer to ask employees to complete a health questionnaire.
  • Health care providers: Clinics and doctors may be aware a patient has HIV because this information is in a referral letter, or recorded on an e-health system.  It is illegal for health services to discriminate against a person because they have HIV.

Community empowerment through education

Education on health issues is the key to improving the overall health of our community and this goes for HIV too. The key to reducing HIV and STI rates among our people is to improve understanding of sexual health and STI risks, especially among young people. We also need to encourage more open discussion of HIV – how it’s transmitted and how it can be prevented.

There have been significant scientific advances in recent years but HIV rates are rising in our community. We need to make sure our community is empowered to get these rates down – this means getting educated on new prevention tools.

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. Things have moved so fast in the past few years, it can be confusing. Here are some of the new ‘tools’ – the terms and what they mean:

  • PrEP or pre-exposure prophylaxis PrEP is where someone who doesn’t have HIV (they’re HIV-negative) takes HIV antiretroviral medication (Truvada or a generic form) to protect themselves from getting HIV before they are exposed to the risk of getting HIV, i.e., pre-exposure. Some people take PrEP because they know their sexual partner has HIV and they want extra protection. Other people take PrEP because they have lots of casual sex and they want extra protection in case one of their partners has HIV. Truvada can only be purchased from chemists or online, with a doctor’s prescription. PrEP isn’t for everyone – for PrEP to work, the person must take their doctor’s advice about dosage. Also, PrEP only works for 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 or post-exposure prophylaxis is easily confused with PrEP but is very different. 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. If PEP is given within 72 hours of exposure, it can kill off any HIV on the system and prevent the person from getting HIV.
  • Treatment as prevention (TasP)’ refers to the fact that people with HIV who are on treatment can have so little HIV in their blood that it is undetectable in tests. This is called ‘undetectable viral load’ or UVL. Research studies have shown that when a person with HIV has an undetectable viral load it is highly unlikely that HIV will be transmitted during sex or sharing injecting equipment – their UVL is acting as a type of prevention. The effect of this is that if most people with HIV can access treatment and reach UVL, new HIV transmission rates will go down dramatically.
  • Needle & syringe programs or 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 – called pharmacotherapies. 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.