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 the infection may be more difficult to treat; you may also pass on the infection to others
- If someone is infected with HIV it can usually be detected after four weeks, although it can take up to three months - this means that if you had a risk less than three months ago you may need to repeat the test at a later date
- HIV is not passed on every time someone with the infection has sex. Therefore, just because you have a negative result it does not mean that your partner will too. This is why everyone needs to have a test.
The difference between HIV and Aids
HIV stands for Human Immunodeficiency Virus. It is a virus which attacks certain cells, called 'CD4' cells, in the person's immune system. The immune system fights off infections and cancer.
If someone has HIV, the virus attacks their CD4 cells. The immune system tries to fight back by making new CD4 cells.
However over a period of about 8-10 years, the HIV gradually 'wins' and the number of CD4 cells falls to low levels.
Below a certain level, the person becomes more likely to fall ill with infection or cancer. When the person becomes sick the doctors say he/she has reached the stage of AIDS.
Living with HIV
If someone knows they have HIV they can get regular blood tests to monitor the level of the CD4 cells. This means they can start anti-HIV treatment at the right time to prevent illness and stay well. If treatment is taken correctly, then life expectancy is near normal. They can also be extra careful not to pass HIV on to anyone else. 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:
by vaginal fluid, menstrual period blood, semen, or pre-cum during unprotected vaginal or anal sex, ie without a condom or Femidom
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 picking up 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 about three months.
The HIV test involves taking a small sample of blood and then testing for these antibodies in the laboratory.
If the antibodies are found, the result will say that the person is HIV (antibody) positive. This means the person has got HIV. It does not mean the person has AIDS or is ill.
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 till three months before the time they took the test. Everyone who attends this clinic is offered an HIV test.
Taking a test
The HIV test is a simple, routine blood test. HIV testing is available at any of our clinic sessions and results are ready in a week. Same-day HIV testing is available by appointment on Thursday mornings. In this case, results are ready by late afternoon.
How to get the result
It normally takes four working days for the HIV result to come in. Your results can be texted to you or will be passed on to you by a health adviser, who will offer additional information and help you decide how you wish to receive your result.
If the result is negative
If you have had unprotected sex in the last three months, 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 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 Venereal Diseases Acts. Information is not given to anyone outside the clinic without signed consent. 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, then a charge of £30 per test is made.
The HIV care pathway
If you are 'HIV positive' this doesn't necessarily mean that you are ill, or that you have AIDS, or that you are dying.
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.
At some stage you may need drug treatments to stay in good health. They can stop HIV reproducing, and so limit the damage to the immune system.
'AIDS' is different from HIV. AIDS is an advanced stage of infection when the immune system is very weak. Thanks to medicines, few people now get AIDS, and they can often recover from it.
My test is positive
If you are given an HIV positive result, you will:
- Have a post-test 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 and perform a general examination.
- You will see the HIV nurses again. They will do some more blood tests to check the viral load level in your blood as well as your Immune system.
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.
You'll probably be asked to have these tests done every few months. They will help you and your doctor make decisions about your health.
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.
Not everybody with HIV needs to take combination therapy straightaway.
It's different for different people:
- If your CD4 count is high and HIV is not making you ill, then treatment may not be recommended.
- If your CD4 count is low or HIV is making you ill, your doctor may recommend that you start treatment.
If HIV is making you ill, doctors call this 'symptomatic'. If it's not making you ill, it's 'asymptomatic'. Deciding to start treatment also depends on your feelings. Give yourself enough time to find out about your options and make your own mind up.
If we find that your CD4 is less than 200, you will be given some antibiotics to protect you from a serious chest infection.
Your CD4 and viral load results will determine whether or not you need to start treatment or not, as well as your future care.
Some people do not need treatment for many years.
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 infomation 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 minimise 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 for example if your condition progresses to needing to start treatment.
Diet is an important consideration for people with HIV infection as good nutrition can have a positive benefit in many ways. The dietician can provide a complete nutritional assessment or give advice on individual issues such as:
- Achieving a balanced diet
- Managing symptoms such as loss of appetite, diarrhoea and weight loss
- Food hygiene and safety
- Complementary dietary practices
- Use of vitamin and mineral supplements
- Use of prescribed and nutritional supplements
- Nutrition and drug therapy
- Eating well on a limited budget
If you would like to make an appointment please speak with the doctor, health adviser or nurse.
HIV nurse practitioner and nurses
The HIV nurses routinely sees patients requiring:
- Blood tests, eg CD4 and viral load tests
- Routine assessments, eg sexual health screening
- Hepatitis vaccination
- To collect/arrange medication
- Nebulized pentamidine
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 e.g. the dietician and community nurses. 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. Read more about this service.
The community specialist nurse works in the community to meet your health needs. She can advise you on general health matters related to HIV. Many people want their general practitioner kept informed of their health status and this can be particularly important if you are on any HIV medications.
If you are happy for your GP to be kept informed of your HIV medical care the consultant can provide a confidential summary of your medical care. Alternatively, with your permission, the specialist nurse can liaise between the clinic and your GP when necessary. She can help you find and register with a local GP if you do not already have one.
Regular dental check-ups help minimise the risk of oral problems if you are HIV positive. If you feel unable to tell your dentist that you are HIV positive we can arrange for you to attend a confidential HIV dental session with a community dental practitioner. For further information ask any team member.
Social services are provided by a specialist care manager for the borough in which you live. People can speak to them direct and in confidence. Help available includes help to live independently at home, personal care, direct payments, equipment and help with travel.
Sutton residents should call 020 8770 4418
Merton residents should call 020 8545 4528
The South London Partnership
The South London Partnership offers four main services:
- Advice and advocacy-offering
- free, impartial and independent advice on housing, welfare benefits, employment, debt and immigration
- Counselling: one to one, couple or family therapy sessions
- HIV health support service where you can gain more knowledge about HIV, its effects on your body and how treatment works.
Visit the South London Partnership website for more infomation or ask the clinic staff for details.
Access to services
There is normally someone available to answer the clinic telephones Monday to Friday 9am - 5pm and on Tuesday from 9am - 7pm. However sometimes answer machines are in use in busy clinic sessions or if staff are seeing patients.
For the latest clinic information, please visit Sexual Health Sutton (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 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.
The GUM department at St Helier Hospital is part of Epsom and St Helier University Hospitals NHS Trust, and inpatient facilities are provided at St Helier Hospital. If inpatient care is necessary either for further investigations or treatment, then your doctor will arrange admission to one of the wards. The clinic team will liaise closely with the doctors on the ward to co-ordinate your care.
With some health conditions, we may need to transfer people to the clinical infections unit at St George's Hospital in Tooting for specialist care.
Links to useful websites
All links open in a new window.
First Point (opens in a new window) provides HIV health support, counselling, peer support and advice and advocacy (dealing with immigration and housing/money issues). Every Thursday, one of their support workers runs a client clinic here at St Helier Hospital.
Milestones (opens in a new window) is a peer support group which is very popular with our clients.
The Terrence Higgins Trust (opens in a new window) provides loads of patient info, advocacy and support.
NAM (opens in a new window) provides up to the minute info on all aspects of treatment and care.
Positive Parenting and Children (opens in a new window) is an organisation for children and families living with HIV and AIDS. They offer support, advice, befriending and short breaks.