Biktarvy side effects reviews special needs of children with HIV infection. Although reproductive decisions are the women's choice, the Department recommends that HIV+ women considering pregnancy should defer pregnancy until more is known about perinatal transmission of HIV infection and the effects of pregnancy on the progression of HIV disease in women.

A seropositive pregnant woman must be provided with information on the risks to herself and her child, and she should have access to the full spectrum of health care options in a non-judgmental and non-coercive context. Notes on IVDUs Entering Drug Detoxification Programs Intravenous drug users who have shared needles or "works" are at high risk for HIV infection. It may not be appropriate, however, to encourage HIV testing at the same time individuals enter drug detoxification programs or are in early recovery.

The Department recommends that individuals entering drug and alcohol treatment services be counseled aggressively on safer sex and other behavior modifications that can prevent the spread of the virus. Biktarvy side effects reviews Except in the face of HIV-related symptoms requiring treatment, high risk IVDUs entering detoxification programs should be tested for HIV infection after completing the initial phases of recovery. This same caution may apply to alcoholics and drug abusers who are not intravenous drug users when they enter detoxification and other treatment services.

Drug treatment programs often advise recovering drug users to delay HIV testing until they are prepared to abstain from drug use and to continue recovery when they learn their HIV status. Individuals diagnosed with an HIV infection are at high risk of resuming drug use and other high risk behaviors that spread HIV infection. Biktarvy side effects reviews Conditions Which Apply to Testing The following conditions apply to HIV antibody testing: Voluntariness Testing must be voluntary and may be either confidential or anonymous.

Confidentiality Like other medical records, those related to HIV infection are confidential. Like records related to drug treatment and mental health matters, those dealing with HIV infection should not be shared except under the specific order of a court of competent jurisdiction. The anonymous test sites keep no record whatsoever of the patient's name or other identifying markers. Chapter 111, section 70(f), of the Massachusetts General Laws provides that a physician, health care provider, or health care facility cannot test for HIV, or disclose test results or even the fact that a person has been tested, without the informed written consent of the person.

Delivering Test Results Test results should be delivered in person, preferably by the same person who provided pre-test counseling. HIV test results should never be provided over the phone or within earshot of anyone other than the patient and someone of his or her choice. A Special Note on the Recording of HIV Test Results. Many patients will be particularly anxious about knowing how the confidentiality of their test results will be protected.

As a result of real and perceived problems related to discrimination against the HIV infected, health care providers should seriously consider not including HIV test results (or the fact that a test was done) in regular medical files. Biktarvy side effects reviews This procedure is especially true of initial test results of asymptomatic persons, and certainly applies to a patient's self-reporting of HIV infection. In asymptomatic persons, there will be time enough to enter these results on the regular medical record after the patient has had an opportunity to adjust to the psychological and financial realities of a positive test. Some practitioners keep HIV results in separate files.

Others include this information in an envelope attached to every patient's file; this envelope contains all of a patient's confidential information. Counseling Both pre- and post-test counseling must be provided to persons seeking HIV testing (Appendix II). Physicians are strongly encouraged to participate in the ongoing HIV counseling and training sessions offered by the Department of Public Health. Many of the HIV+ patients who come to the physician's attention may not be people tested by their health care provider.

They may have learned their antibody status from one of the Commonwealth's testing sites, from the Red Cross or other blood collecting agency, or from an insurer. In cases such as these, the physician should repeat the post-test counseling protocol suggested in Appendix II below. Informed Consent Written informed consent is required before HIV testing is permitted in Massachusetts. The consent form must be signed by the person to be tested or by the parent or other person having the capacity to consent to medical care. At MDPH Anonymous Testing Sites, the written consent can be obtained without an identifying signature. All consent forms must include the following information: . An explanation of the test, its purpose, and the meaning of the results. .

An explanation of the testing procedures that will be followed, as well as the information that the test is voluntary, that consent may be withdrawn at any time, and that anonymous testing is available. . Biktarvy side effects reviews An explanation of confidentiality protection and allowed disclosures. (See Appendix VIII for the consent form used by MDPH.) Pre-Test and Post-Test Counseling Physicians traditionally counsel patients on a variety of topics; the MDPH recommends that HIV/AIDS counseling be incorporated into the physician's established pattern. Pre-Test Counseling Before the consent form is signed, pre-test counseling must be provided.

The physician should assess the patient's understanding of the test and its implications, and his or her ability to deal with the results and benefits from the information. If there are emotional contraindications to testing a patient, counseling should nevertheless be provided on how to reduce the risk of HIV transmission. It is important to note that prevention efforts are strengthened when an individual has exercised choice and personal responsibility in seeking counseling and testing.

Because patients who receive a positive HIV test often cannot fully comprehend new information at the time of receiving test results, and because some patients may not return to get their test results, good counseling practice suggests covering the following information in the pre-test session: 1. Explain the nature of AIDS and its related illnesses. -6- 2. Explain the advantages of knowing one's antibody status in terms of medical management of HIV infection and other conditions. 3. Explain which behaviors put one at risk for HIV infection. 4. Ascertain the patient's understanding of how he or she can reduce the risk of infection, including the use of condoms. 5. Try to understand what, if anything, prevents the adoption of these risk-reduction practices. 6. Explain what an HIV antibody test result means. 7. Learn what the patient expects his/her test results to be. 8. Ask how the patient plans to change his/her behavior. 9. How will the patient cope with psychosocial ramifications of a positive test result? Biktarvy side effects reviews.

Does the patient have health insurance? Should he/she obtain health insurance before being tested? 10. If positive, how will the patient tell his or her partners? 1 1 . Discuss the importance of partner notification and the availability of the Department of Public Health to help with this task. 12. Discuss the possibilities for discrimination that may result from disclosure of a patient's antibody status. 13.

Finally, your patient should be encouraged to identify: a. one person who knows the patient is being tested. b. one person with whom he/she can discuss the test. c. what he/she plans to do in the 24 hours immediately following receipt of the test result. Post-Test Counseling Post-test counseling should always be provided, regardless of the test result. It is an opportunity Biktarvy side effects reviews for the physician to emphasize the importance of risk-reduction practices (such as the use of condoms) to both seropositive and seronegative patients.

For persons who test positive, post-test counseling offers the patient the opportunity to express his or her feelings and concerns, and permits the provider to clarify Biktarvy side effects reviews are many and the implications for the patient's health and to plan for medical follow-up and management.

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