New HIV Diagnosis

John McAllister: HIV Clinical Nurse Consultant, St. Vincent's Hospital, Sydney


In 2017, 963 Australians received a diagnosis of human immunodeficiency virus (HIV) infection[1]. For all of these people, this was a life-changing event. Pretest discussion may have been limited or may not have occurred at all. Newly diagnosed people with HIV (even those well prepared during pretest discussion) may respond with a wide range of feelings and questions (Table 1).

 Table 1: Some emotional responses and questions to testing HIV positive
  • Shock
  • Disbelief
  • Puzzlement
  • Relief
  • Numbness
  • Fear
  • Panic
  • Guilt
  • Anger
  • Shame
  • Despair
  • Hopelessness
  • Feeling overwhelmed
  • Relief
  • Expression of self-harm (rare)
  • How did this happen to me?
  • Will I die?
  • When did I get the infection?
  • What happens now?
  • What changes do I have to make in my life?
  • How can I help myself?
  • What should I avoid?
  • Can I have children?
  • Is there a cure?
  • Who do I have to tell?
  • Do I have to tell my employer?
  • How is HIV treated?
  • How much does treatment cost?
  • For patients without access to Medicare
  • Will you tell the Department of Immigration?
  • Will I be deported?
  • How will I pay for tests and treatment?

Nurses are often involved at (or shortly after) the time of diagnosis. The initial (and subsequent) encounters present a unique opportunity to enable a healthy adjustment from being a person without HIV infection to being an HIV-positive person. All but a few newly diagnosed people make this adjustment, usually over a period of 6 months or less. Those who don’t are often identifiable by one or more of the characteristics discussed under service engagement (Table 2). Commonly these may be:

  • Alcohol and other drug use
  • Significant mental health issues
  • Younger age
  • Heterosexual
  • Belonging to a religious or ethnic group or culture where pre- or extramarital sex, injection drug use and homosexuality are taboo
  • Denial.

The single most important nursing function at the initial encounter with a newly diagnosed patient is to foster engagement.