One of the most important elements of my role in the treatment and care of those who have just tested positive for HIV is time. Time for them to process the news of their diagnosis; time to digest what it means for them; time to feel and think how they will tell those who need to be made aware.

A common misconception which still prevails is that being HIV positive means impending death. I am able to dispel this and many of the other myths and share how people living with HIV can go on to live long and healthy lives. It’s not a death sentence, lifelong medication can reduce the virus to undetectable levels which means it cannot be passed on to sexual partners.

At what can be a distressing and fragile time for the individual, a time which is effectively the start of their journey to manage the virus, my role gives me the time and flexibility to offer reassurance and move at their pace.

In London everyone over 18 years old (or 16 in some departments) who visits the emergency department (ED) and has blood tests is also tested for HIV, hepatitis B and C. This is part of the NHS’ blood borne virus (BBV) ED opt-out testing programme. Patients are informed through information displayed throughout the departments and can opt out if they choose – few do. It is designed to identify anyone who may not know they have the virus as well as those who may be aware but are not accessing care and treatment.

In my role, I see people after the initial ED testing has given a positive result. I let them know the result and the need to confirm it with a follow up one. Almost everyone comes in for that. I am able to offer a point of care test – results are immediate and if positive again, we conduct all our baseline testing. In some cases, if appropriate, we can even start treatment the same day. I then link them to a peer support worker; the care package is holistic and tailored to their needs. This is one of the most crucial parts of their care pathway and is hugely impactful in those who engage. The diagnoses, conversations and information being provided is hard to take in. Talking to someone with lived experience of what they’re going through and may well go through is invaluable; someone they can share their anxieties and fears with is powerful and reassuring. It can have a huge influence on whether someone will take treatment and engage with HIV services.

At that same appointment, it is important I understand what they know about HIV and AIDS and where their information has come from, as often they’re misinformed. This offers the opportunity for me and our peer support workers to dispel myths and misunderstandings, to set the record straight if you like.  Most patients I see are in their 50’s and 60’s, women and men. They usually remember the 1980’s fatalistic and harsh advertising campaigns and the stigma attached to HIV and AIDS or have lived through the horrific early years of the epidemic in their home countries. We try to restore some confidence and assure them that the stigma and the barriers are slowly being brought down through programmes such as the BBV opt-out testing in EDs where people are being re-educated and relearning the truth about HIV and AIDS in the present day.

We work together to identify contacts who need to be informed and tested, and I inform them of the different ways this can be done. They might choose to bring a partner to our clinic for testing, or they may opt for an anonymous method whereby we or another service reaches out on the patient’s behalf without revealing their identity.   This is another hugely important part of my role, as those of us working in this specialist area work hard to meet the UK governments target of no new HIV transmissions by 2030.

This World AIDS Day it has been great to reflect on the huge success of the NHS blood borne virus ED opt-out testing programme. It has done a great deal to normalise testing and treatment of a very manageable long-term health condition. I think it’s helping to re-educate the public as well as health care professionals. However, the largest positive impact I see is on my patients who are going through the treatment and care pathway and are grateful of the time and support provided to move forward with their lives as they learn to live well with HIV. I consider that a job well done and a phenomenal NHS programme!