HIV/AIDS Case-Finding In Family Planning Clinics

1. HIV/AIDS Case-FindingIn Family Planning Clinics Midwest AIDS Training & Education Center Health Care Education & Training, Inc.

2. Section 6: Considerations for Implementation

3. Objectives for Section 6 • List major aspects of integrating HIV services into family planning clinics • Discuss Title X Program Guidelines • Discuss HIV risk behaviors during patient’s sexual/medical history • Describe the importance of knowing your community • Describe an effective referral system

4. Objectives for Section 6 (Continued) • Describe protocols for referral or deferral of testing • List basics for chart documentation • Identify basic training needs for staff delivering services • Describe a tool for enhancing efficiency when integrating services

5. Aspects of Integrating HIV Services • Incorporation of HIV risk behaviors into your patient’s sexual/medical history • Referral/deferral for testing • Chart documentation • Basic staff training needs • The use of a tool to ensure efficient integration

6. Goal of Providing HIV Services in Family Planning Clinics: Ensure all women have the opportunity to know their HIV status.

7. 2001 Title X Program Guidelines HIV Requirements • Education services must provide clients with the information needed to…reduce risk of transmission of sexually transmitted infections and HIV • Persons found to have behaviors which currently put them at risk for STIs/HIV must be given advice regarding risk reduction and must be advised whether clinic evaluation is required

8. Title X Guidelines (continued) • All projects must offer, at a minimum, education about HIV infection and AIDS, information on risks and infection prevention, and referral services • On an optional basis, clinics may also provide HIV risk assessment, counseling and testing by specially trained staff. • Provide client with list of providers who can provide the above services.

9. Title X Guidelines (continued) • History Taking (must include): • Partner History (injectable drug use, multiple partners, risk history for STIs and HIV, bisexuality) • Female History (sexual history, STI history, HIV history)

10. Title X Guidelines (continued) • Under physical assessment of female • Clinics must provide and stress the importance of the following to all clients: -STI and HIV screening, as indicated. • If client declines or defers…this should be documented. • Counseling must include information about health risks associated with declining or delaying preventive screening tests or procedures

11. Title X Guidelines (continued) • HIV testing must be provided to clients either on-site or by referral • Consistent or correct use of condoms should be encouraged for all persons at risk for STIs and/or HIV • Safer sex practice options to reduce risks for STI/HIV…must be discussed with all adolescents • Comply with state and local reporting requirements

12. Musts: Analyze HIV risk of all clients Offer education and counseling on HIV Include HIV risks in medical history taking Do risk reduction counseling Decisions for agency: On-site testing: Anonymous? Confidential? Referral for Testing How and what training for staff Decisions, Decisions, Decisions

13. Patient’s concerns Pregnancy history Artificial insemination Blood exposure Blood treatment Pregnancy prevention methods used Prevention of STIs Drugs/alcohol usage # of sex partners Type of sex partner(s) Type of sex (anal, vaginal, oral) STI history Hepatitis history Past HIV testing Sex in exchange Partner’s drug/alcohol usage Partner’s sex history Partnerex-offender Client Risk – An Integrated Risk Assessment

14. Drug/alcohol usage in what age groups? Proportion of older patients widowed, divorced, single, etc. Proportion of adolescents Prostitution: where and in what sub-groups Prevalence of STIs Unintended pregnancy rate Ex-offenders: how many in population, release rate Interstate truck stops/rest areas Other gathering places where high-risk behaviors take place Community Risk - Integrate Community Factors

15. Youth Risk - Understand Youth Risk Behaviors Illinois Female YRBS 1999 grades 9-12 38.1% have had intercourse 8.1% >4 partners 26.4% sex in past 3 months 16.9% used alcohol/drugs during most recent episode 42.9% did not use a condom during the last episode

16. Decision to Provide Confidential and/or Anonymous Testing • Confidential testing: • test results linked with patient’s name • patient can be contacted about test results • risk of improper disclosure • Anonymous testing: • test results linked with number • facility cannot contact patient • patient has to return for test results • risk that patient won’t return for results

17. Decision (Continued) • Consider gender differences for medical services • Consider the culture of your practice: • Do your patients expect to hear from you: Is “no news, good news”? • HIV test results should only be given in person, rather than on phone or with a postcard

18. Patients can accept or decline testing But, individualized HIV education must be done with all patients In addition, a risk-reduction plan should be done with all patients Referral / Deferral of Testing

19. If Patients ChooseTesting • Deferral of testingclinic should have guidelines for when appropriate • Referral for testingclinic should develop guidelines and a list of referral sites • Document

20. Title X GuidelinesClient Records • “HIV information should be handled according to law, and kept separate whenever possible.” • Consult your state health department (HIV Section) to learn about your state’s laws • Confidential testing information does not have to be kept separate, but all HIV testing requires special releases

21. Risk Assessment Risk Reduction Plan Referrals for Testing Deferralsreason Medical Record Release (HIV specific) Informed Consent Other Referrals & ID Need (medical or psychosocial) Summary of Chart Documentation Pieces

22. Documentation if PatientTests Positive • Method of Partner Notification • Partner Notification (separate records) • Follow-up efforts to reinforce the patient’s risk reduction plan • State Case Report

23. Ongoing StaffTraining Needs • Community risk factors • Client-centered counseling training • Types of HIV tests • Needle safety • Legalities of HIV-related consent forms • Legalities of testing • Notification/partner notification