Yasmin Williams - HEALTH-WISEONE OF the recent articles in this series on HIV, highlighted the fact that many of the early symptoms of HIV infection are non specific and therefore persons whose previous or current behaviour puts them at risk should do an HIV test. In some instances, a person's behaviour may not put them at risk but the behaviour of their sexual partner does.
Not very long ago, the National HIV/STD Control Programme documented the following specific indications for HIV testing in Jamaica:-
1) clinical suspicion: for example, oral thrush, significant weight loss (less than 10 per cent of body weight), chronic cough/diarrhoea.
2) history of high risk behaviour IV or other drug abuse, multiple sex partners, sex with a prostitute
3) Sexual or blood exposure to a HIV-positive person
4) Persons with tuberculosis
5) History of repeated sexually transmitted diseases or STDs
6) Presence or history of genital ulcer and warts.
7) Presence of malnutrition
8) Children of HIV-infected mothers
9) History of bruising during sex
When there is no history of risk factors and there are uncommon infections and cancers associated with HIV/AIDS, the Ministry of Health requires that the patient be asked to give consent to HIV testing.
Any person doing a HIV test should have 'pre test counselling'. The pre-test counselling should involve the following:-
a) The client and the practitioner discuss the given reason(s) for doing the test. The practitioner adequately educates the client and allows the client to assess his or her risk and identify measures to reduce the risk.
b) The basic facts about HIV infection as outlined in the last article must quickly be reviewed with the client.
c) The client must understand that the test will indicate whether he or she has become infected with the virus HIV, but it will not indicate whether he or she has AIDS. AIDS occurs when the virus overwhelms the immune system leaving a person susceptible to infections and cancers which do not commonly occur.
d) The client must be made to understand the various strategies available to prevent the progression of HIV infection to AIDS.
e) The client must understand about the 'window period', which is the time between becoming infected with the virus and the HIV test becoming positive. The medical jargon is that the person seroconverts (from negative to positive). This time averages 14 to 22 days with the current test. Some persons may convert at six to eight weeks but almost all persons will seroconvert within six months of exposure.
f) The client is encouraged to explore the implications of a positive result. For example, with whom could he or she comfortably share this new information and where could he or she get the support that would be needed.
g) The practitioner must end by reassuring the client about how the health system endeavours to maintain confidentiality. Persons would only be informed on a 'need-to-know basis'.
The standard HIV test is a serology test for detecting the antibody which a person's body makes in response to the presence of the virus HIV. The presence of HIV can also be detected using methods which detect elements of the virus itself. The HIV1 DNA PCR is said to be the most sensitive of this type of testing. This type of testing is often used in research settings, when there is need to clarify an indeterminate serological result, sometimes in neonatal HIV infection, in the acute retroviral illness at the start of the HIV infection, in cases of agammaglobulinemia in which the body cannot make antibody and when the patient or client is in the window period.
Dr. Yasmin Williams is a Family Doctor and Public Health Specialist.
