We test everyone for HIV unless you ask us not to. We always do this because:
- HIV is a virus that damages the immune system
- Someone can be infected with HIV and not have any symptoms, sometimes for many years
- If you have HIV, medical treatment can keep you well, so it is good to know your HIV status
- If you have HIV and do not know about it you could become ill and also pass on the infection to others.
- If someone is infected with HIV it can usually be detected after four weeks.
- Treatment for HIV can prevent onward transmission of HIV to others
- Just because you have a negative result it does not mean that your partner will too. HIV is not necessarily passed on every time someone with untreated infection has sex. This is why everyone needs to have a test.
What is HIV?
HIV stands for Human Immunodeficiency Virus. It is a virus which attacks certain cells, called 'CD4' cells, in a person's immune system. The immune system helps fight infections, heart disease and cancer.
If someone has HIV, the virus attacks their CD4 cells and over a period of months to years, the HIV gradually 'wins' causing the number of CD4 cells to fall to low levels. At this stage, the person becomes more likely to fall ill with infection, heart disease or cancer.
Living with HIV
If treatment is taken correctly, then life expectancy is near normal. The aim of treatment is to reduce the HIV viral load to undetectable. If the HIV viral load is undetectable then HIV cannot be passed on to others (Undetectable = Untransmissible. Partners, ex-partners and sometimes children, can be offered an HIV test.
Risk of infection
HIV can only be passed on if the virus gets from one person's body fluids into the bloodstream of another person.
This only happens in certain ways and only if the HIV viral load is detectable:
- by vaginal fluid, blood, semen, or pre-cum during unprotected vaginal or anal sex, ie without a condom
- by blood through sharing drug injecting equipment
- by blood transfusion (all blood products have been screened in the UK since 1985)
- from mother to baby, during pregnancy, at birth, or through breastfeeding.
The risk of getting HIV from oral sex (either giving or receiving) seems to be very small, but there are a few cases where it does seem to have been passed in this way.
HIV antibody test
When someone picks up HIV, their blood will react to the virus and make chemicals called antibodies, usually within four weeks.
The HIV test involves taking a small sample of blood and then testing for these antibodies in the laboratory or doing a finger prick test.
If the antibodies are found, the result will say that the person is HIV (antibody) positive. This means the person has got HIV.
If no antibodies are found, the result will say HIV (antibody) negative. This means the person had not picked up HIV in all their life up until four weeks before the time they took the test. Everyone who attends The Rosehill Clinic is offered an HIV test.
How to get the result
It normally takes up to 4 working days for the HIV result to come in. Your results can be sent to you by text or will be passed on to you by a health adviser.
If the result is negative
If you have had unprotected sex in the last four weeks, then there is a chance you could have HIV, even though the result is negative.
This is because you could have picked up HIV but there was not enough time for the antibodies to appear by the time you took the test.
If the result is positive
In this case we will need to do further tests to confirm the result, as well as starting some investigations, including measuring the number of CD4 cells and the amount of HIV in the person's blood - the HIV viral load.
If the result is 'equivocal'
Rarely the laboratory will tell us that the results do not clearly say whether the test is positive or negative. In this case we will need to do further blood tests to try to clarify the situation.
Your clinic notes are protected by the NHS Trusts and Primary Care Trusts (Sexually Transmitted Diseases) Directions 2000 (England). Information is not given to anyone outside the clinic without consent except in exceptional circumstances. If you test HIV antibody positive it is your choice whom you inform and when.
What about life insurance and mortgages?
The Association of British Insurers recommends its member companies not to ask, when someone is applying for life insurance, if he/she has had an HIV test, but only to inquire if someone knows they are HIV positive. Thus most people who have had a test and are negative will be able to truthfully answer, 'No', without saying whether they have had a test or not.
Is there a charge for having a test?
If the test is being done for individual health reasons it is completely free, but we do not issue a written copy of the result.
However, we make a charge if the test is for 'official reasons', and you ask us to provide a letter or certificate. This might be to support an application for a travel visa, occupational risks or life insurance, or if it has been requested by a private health doctor.
The HIV care pathway
If you are 'HIV positive' this doesn't necessarily mean that you are ill.
HIV slowly attacks the immune system, which is the body's natural defence system against infections. If the immune system is weak, there is a risk of getting ill from different infections.
You will be started on medication at one of your first appointments. This will stop HIV reproducing, and so limit the damage to the immune system.
My test is positive
If you are given an HIV positive result, you will:
- Have a discussion with a health adviser where any questions you have will be addressed. You will be given reassurance and information, and we will also tell you how your care from this point will continue.
- If you feel able to cope on that day, you will also meet the HIV nurses who can offer further information, reassurances and who will take some baseline blood tests so we can assess your general health.
- You will be given an appointment in two weeks’ time to see a doctor. At the appointment, your doctor will discuss your blood test results, perform a general examination and discuss starting treatment.
- You will also see the HIV pharmacist who will discuss the treatment in more detail.
Keeping an eye on your health
From someone's physical appearance, you can't tell if they have HIV or not. And you can't always know how good their health is.
But blood tests can show how HIV is affecting your health. Even if you're not taking treatments, it's important to have two blood tests done regularly.
The first is called the CD4 count and is a measure of the strength of your immune system. When the immune system is strong, the CD4 count is higher.
The second is the viral load test. It's a measure of the number of copies of HIV in a sample of blood. The lower it is the better.
Do I need to take treatments?
The drugs used to treat HIV are often called 'combination therapy'. That's because people usually take a combination of three drugs at the same time.
We recommend that everyone who has HIV starts taking combination therapy straightaway regardless of their CD4 or viral load.
If we find that your CD4 is less than 200, you will be given some antibiotics to protect you from a serious chest infection.
Importantly, we need to monitor you regularly - whether you are on treatment or not - and it is essential that you attend further appointments.
Services for HIV Positive people
Medical needs vary for different people at different times. The doctor who sees you can provide:
- More information about HIV and current recommendations for follow-up and treatment.
- A full medical assessment including history, examination, routine blood tests and any other investigations required.
- Explain the results of your tests and advise you on the most appropriate action and follow-up.
- Discuss the possible options for starting or changing anti-HIV therapy.
- Provide practical support to minimize side effects and help adherence to treatment regimes.
- Assess any problems that arise which may be related to HIV or HIV treatments.
- Sexual health screening and advice.
- Arrange appropriate referral to other specialists.
- Arrange inpatient care for investigation and treatment if this is required.
The doctors work closely with the other clinical staff so you should feel free to approach any staff member if you have any medical concerns.
The HIV pharmacist works closely with your doctor and routinely sees people for medical and practical information about HIV and anti-HIV treatment. They can discuss the possible options when starting or changing anti-HIV therapy and provide practical support to minimise any side effects and help adherence to treatment regimes. They have a wide range of resources to help support people in taking their medication.
The health advisers see:
- All newly diagnosed clients
- New clients transferring their care to the clinic
They are able to provide health advice on issues such as lifestyles and safer sex. There are many organisations providing services and information for people affected by HIV. The health advisers can assist you in finding the most appropriate service for your needs.
The health advisers can also provide support and information to partners, family members and friends of HIV positive clients.
Living with HIV can be both emotionally and physically demanding. If appropriate they can refer you to the clinic's Clinical Psychologist, or re-assess your needs whenever things are difficult.
HIV nurse practitioner and nurses
The HIV nurses routinely see patients requiring:
- Blood tests, eg CD4 and viral load tests
- Routine assessments, eg sexual health screening
- Hepatitis vaccination
- To collect/arrange medication
They will advise about all practical aspects of HIV management and answer any queries you have in relation to your care, as well as liaising with other team members. If your condition is stable you may have some of your regular monitoring and check-ups done by the HIV nurses rather than the doctor.
If you are feeling upset, anxious or depressed, talk to your doctor, nurse or health adviser about seeing the clinical psychologist. The clinical psychologist will arrange a time to meet with you and talk about the difficulties that you are having.
The clinical psychologist can help by offering guidance and advice on ways for you to tackle the problems that you are having.
Access to services
There is normally someone available to answer the clinic telephones Monday to Friday 10am - 4pm. However sometimes answer machines are in use in busy clinic sessions or if staff are seeing patients.
For the latest clinic information, please visit https://www.suttonhealthandcare.nhs.uk/ (opens in a new window).
Access to medical care at the clinic
Routine HIV appointments are available by appointment only. If you wish to arrange an appointment then remember to ask for an "HIV appointment" as this will ensure the correct doctor sees you.
If you have an urgent problem then telephone the clinic on 02082962543 and ask to speak to the HIV nurse or a health adviser.
For non-urgent problems contact your GP or the clinic at St Helier Hospital on the next working day.
If you need urgent medical advice when the clinic is closed you should contact your GP, or attend your local accident and emergency department. They can contact the on call HIV team if necessary.
Inpatient facilities for HIV related care are provided by the Clinical Infections Unit at St Georges Hospital, Tooting. If inpatient care is necessary either for further investigations or treatment, then your doctor will arrange admission. The clinic team will liaise closely with the doctors on the ward to co-ordinate your care.
Links to useful websites
The Terrence Higgins Trust provides loads of patient info, advocacy and support.
NAM provides up to the minute info on all aspects of treatment and care.