HIV testing for adults in healthcare settings

Human immunodeficiency virus (HIV) can be transmitted through:

• vaginal and anal sex without a condom
• sharing needles
• pregnancy, childbirth and breastfeeding
• direct blood-to-blood contact with someone living with HIV.

While there is no cure for HIV, highly effective funded treatment is available. This is available to anyone living with HIV in Aotearoa New Zealand, regardless of residency status.

Without treatment, HIV causes a chronic progressive immune deficiency. This leads to acquired immunodeficiency syndrome (AIDS).

With early treatment, people with HIV:

• will stay well and not progress to AIDS
• are expected to have a similar life expectancy to people without HIV.

Once a person is stable on treatment, with an undetectable viral load for at least 6 months, there is zero risk of sexual transmission. This is known as U=U (undetectable = untransmittable).

The New Zealand Sexual Health Society (NZSHS) STI guidelines include guidance for clinicians in diagnosing and caring for people living with HIV.

HIV guidelines — NZSHSexternal link

Testing is recommended:

• when a patient requests it
• when a person has signs or symptoms that could be consistent with HIV, even if they are considered to be low risk
  HIV clinical indicator conditions — ASHMexternal linkPDF
• as a routine part of a sexual health check
  Sexual health check — NZSHSexternal link
• for people with possible signs or symptoms of a sexually transmitted infection (STI), as part of a sexual health check
• for sexual contacts of people with an STI, as part of a sexual health check
• in pregnancy
• for people with a recent change in sexual partner, or multiple sexual contacts, as part of a sexual health check
• for men who have sex with men (MSM) — test at least annually as part of a sexual health check, or every 3 months if there is frequent partner change or they are on PrEP
  Men who have sex with men — NZSHSexternal link
• for people using HIV pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP)
  PrePexternal linkPDF
  PEPexternal linkPDF
• after a non-consensual sexual encounter
• for people who inject drugs
  People who use drugs — NZSHSexternal link

Where possible, testing for HIV should be combined with testing for other infections with similar routes of transmission, for example:

• chlamydia
• gonorrhoea
• syphilis.

Consider testing for hepatitis B and C.

If a person does not have symptoms but is concerned about a specific recent risk event, the recommended testing interval is 6 weeks from time of last risk.

People should know what they are being tested for, and give verbal consent to testing. But extensive pre- and post-test counselling is not required unless the person indicates they need it, or the result is positive. 

If the HIV test result is positive, it is best you tell the patient in person. A result is only considered positive if confirmatory testing has been done. It is useful to discuss a positive result with an infectious diseases or sexual health specialist before speaking with the patient, to make sure you have all information you need.

If the HIV test is negative, this gives you an opportunity to discuss HIV prevention. This might include:

• using condoms
• taking HIV pre-exposure prophylaxis (PrEP)
• using needle exchange services.