"I Have Bad News..."

If you have ever wondered how you were going to handle patient inquiries regarding AIDS testing, Florida's Department of Health and Rehabilitative Services (HRS) has drafted a comprehensive advisory pa­per to help guide you through these uncharted waters.

Pretest

The advice and recommendation has generally been broken down into pre­test and post-test recommendations.

Testers initially are advised to em­phasize the confidentiality of the interview and the test results. They also should explain to the patient that most of the people infected with the virus are not sick but can pass the AIDS virus through sexual activity, needle sharing or in child birth.

The patient should be queried as to whether ornot he is atrisk for exposure. In other words, he should be asked if he has:

• Had a blood transfusion prior to March of 1984;
• Had more than one sexual partner in the last two years;
• Had sex with someone who is bi­sexual, homosexual or an intravenous drug user;
• Shared needles and/or syringes with anyone;
• Ever had hepatitis B;
• Ever had sex with anyone in these categories;
• Had a child born to a woman in any one of these risk categories.

A positive answer to any of these questions warrants the test to determine if the patient has antibodies to the virus. HRS advises that if the patient declines to be tested at this point, the patient should be provided with information on prevention and should be referred to one of the anonymous HRS county or state AIDS testing sites.

On the other hand, if the patient agrees to the test at this point, a consent form should be signed and placed in the patient's record. It is also advised that the patient be queried as to:

• What he has heard about AIDS;
• Why does he want to take the test;
• What does he think he is currently doing to reduce his chances of exposure to the virus;
• What does he consider safe sex;
• When and where does he think he was exposed to the virus.

HRS officials stress that it is essential the patient fully understand the difference between HIV and AIDS and the meanings and implications of the test results. A patient should be advised that if he has had sex or shared needles with an infected person very recently, it may take two weeks to six months to develop a positive test. Therefore, anyone at risk should be retested in six months.

Prior to receiving the test results, HRS also requests that the patient be queried as to his expectations about the test results. He should be asked what a posi­tive test would mean to him and what changes he would make in his lifestyle if he tests positive; also he should be asked what a negative test result would mean to him and what changes he would make in his life if he tests negative.

The patient should be asked how his partners should be notified if he tests positive on the exam, and it should be stressed that the patient should be careful when considering who he shares the test results with.

Post-test

If the patient tests positive, the test giver should once again reinforce all of the preventive measures that should be taken including:

• No donations of blood, plasma, sperm, body organs or other body tissues;
• When having sex, avoid passing or receiving body fluids and always use condoms;
• Avoid sex with people who have AIDS or who may be infected with the virus;
• Reduce the number of sex partners and know your partners;
• Do not use drugs or share needles;
• Do not use amyl and butyl nitrate inhalants;
• Know the signs and symptoms of AIDS virus infections;
• Do not share personal items such as tooth brushes or razors which could transmit the virus;
• Wash any spill of blood with a solution of one part household bleach to ten parts water;
• Inform your physician, dentists and dental hygienist of your positive anti­body results;
• Avoid pregnancy.

Referral

In an effort to control the spread of the virus, patients should be encouraged to notify their sex and/or needle sharing partners. A physician or other tester should begin with an assessment of the patient's potential response. Start by asking the patient what he thinks would be his partner's response.

After the test has been given, but before the test results hqve been received, the test giver should question the patient as to how he plans to conduct himself during this interim and what plans he has made to tell anyone about his decision to take the test.

The law now states that a return visit to receive the results in person must be scheduled at the time the test is given. HRS recommends that test givers em­phasize to the patients that the results cannot be given out over the phone or by letter and that they can only be given in person. Therefore, the patient should be given an idea as to when he can return for the test results and he should be advised if someone other than the test giver will be giving him the results.

Counseling

HRS believes that the process of disclosing the test results is critical for a number of reasons:

• If handled sensitively, it will help the patient cope with the immediate. psychological reactions to the results;
• Patients need to develop a plan for coping with the test results and managing the test information; and
• The patient should develop a health plan.