Contextualise the legal requirements

There are some mandatory questions that must be asked when making a new HIV diagnosis. They are very personal questions being asked at a time of heightened emotion, and people with HIV often report finding these questions invasive or stigmatising.

Contextualise the questions. Explain the purpose of the questions, that they are legal requirements, and they are not coming from a judgmental place.

Notification questionnaire

In each state and territory the health department publishes a form that must be used to notify the condition. This involves taking a sexual history and asking sensitive questions about often-stigmatised practices, such as sex work and drug use. People with HIV describe feeling that some of those questions were invasive or judgmental.

Explain why the questions are being asked. For instance, we ask about sex between men, because knowing the number of cases involving men having sex with men can help us plan for education campaigns and services for people in this community.

Understand why privacy matters. Some people with HIV are migrants from countries whose countries of origin maintain government databases of people in stigmatised groups. These databases may be used to determine who gets access to public services, including protection by police. Temporary residents may also fear that notification of an HIV result to a state or territory government will be communicated to the Commonwealth Government, affecting their eligibility for residence.

Explain that results are kept confidential. They are only held by the health department, and recorded without the patient’s name and personal details attached. The only reason these records might be shared is if there is a court order for their release, which may happen if there has been a police complaint made against the person.

Contact tracing

Contact tracing means contacting past sexual contacts of the patient (and other people who may have been exposed to HIV, e.g. via injecting drug use).

This needs to happen soon after diagnosis. However, it can be scary for the person with HIV, as it suggests their status will be disclosed to other people at a time when they are still digesting what it means.

Contact tracing may be deferred to a later appointment if the patient is confident they can avoid sex or use condom protection until they achieve suppressed viral load.

It is common for the patient to do contact tracing themselves. The GP and the state or territory health department can provide support.

More information: the Australian Society for HIV Medicine has a training resource for clinicians focused on contact tracing.

When does my patient need to disclose their status?

Telling people before sex: If a person is using effective protection, it is their choice whether to tell a potential sexual partner before getting it on. There is no legal obligation in Australia to tell anyone your status as long as you are using effective protection. Following a new diagnosis, protection can mean using condoms — or the HIV-negative partner using pre-exposure prophylaxis (PrEP) — until the person with HIV has attained suppressed viral load for six months. Then it is safe and effective to rely on suppressed viral load alone if that’s what the person prefers. Of course, it is fine to use this approach in combination with other strategies including PrEP and condoms.

Telling potential relationship partners: There is no legal obligation to do so. People with HIV have to make decisions about when or whether to tell potential sexual and relationship partners. Some prefer to ‘get it out of the way’ early, so there’s less hurt feelings if they are rejected. Others wait until they feel like they can trust the person they are telling. Some do it in person and some people do it online. There’s no right answer and no one strategy that can avoid heartbreak altogether. But it definitely helps to talk with other people with HIV about how they approach disclosure.