The second postpositive result consultation 12 weeks later

• Give results of repeat HIV test and base-line tests.

• Explore patient's understanding, feelings, coping abilities and spiritual issues (if appropriate).

• Some of the common questions that patients with HIV infection ask are:

o Am I going to get sick? o How long will I live for? o Are there any treatments available? o Is there a cure around the corner? o What is going to happen to me? o Should I tell my friends? o Should I tell my family? o What are the social and legal issues?

It is worth pre-empting these questions and having ready appropriate answers for that particular patient.

• Give appropriate reassurance: prognosis may be much better, in respect of long remission, than appreciated.

• Discuss support systems.

• Check personal prophylaxis (safer sex and needle-sharing habits).

• Reinforce lifestyle strategies and suggest how patients can help themselves: give case examples.

• Recommend meditation and appropriate literature.

• Provide appropriate referrals (if needed):

o specialist counsellors o self-help and support groups o meditation classes

• Advise patients about their legal and ethical responsibilities not to pass on the infection to others.

• Organise contact tracing.

• Address the difficult issue of telling sexual partners.

• If the patient is unwilling to inform sexual partners or is uncertain of who they may be, then contact-tracing organisations run through state government offices are of assistance in tracing sexual partners who may be at risk.

• If a patient refuses to inform a sexual partner of the risk then the doctor may disclose this information to the patient's partner in the following circumstances: if there is a clear risk of transmission; if the patient has been given education and counselling and this has been ignored; or if the doctor in the case has sought advice from colleagues and institutional ethics committee and before disclosure discussed it with the medical defence organisation. The doctor then should provide the patient with written advice that the patient must notify the partner, and if the patient still refuses to do so then the doctor has the right to do so.

• Discuss 'safer sex' guidelines. Condom usage is essential to prevent further viral loading and this needs to be explained, as well as the reason of protecting others.

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