Re: New HIV testing guidelines in BC

The First Nations Health Authority (FNHA) supports frequent HIV testing for Aboriginal people in BC. The new BC HIV testing guidelines urge health care providers to include HIV testing when sending their adult, sexually active patients for other blood tests every year for “all patients aged 18 to 70 years who belong to populations with a higher burden of HIV infection” compared to every 5 years for the general population.[1,2] Aboriginal people are included in “populations with a higher burden of HIV infection,” together with gay men, people who inject drugs, people who work in the sex trade, and people from endemic countries.

The new guidelines promote testing all British Columbians to determine their status, and if individuals are positive, aim to ensure they are informed and counseled to facilitate engagement and benefits from treatment over the long term.

A large body of research suggests that HIV and AIDS stigma is a barrier associated with lack of disclosure and negative health outcomes impacting HIV preventive behaviors. Studies have shown how stigma and discrimination toward people with HIV is manifested in health care settings to include differential treatment, moral judgments, neglect, testing and disclosure without consent, and denial of treatment.[3] The need for culturally competent routine offers of HIV testing should promote health professionals’ awareness that “adapting [their] practices will actually save time in the long run and that giving the patient more time is an investment in the care.”[4]

We urge implementers of BC’s new HIV testing guidelines to consider culturally competent practices, including:
•    Use of tools to assist clients along the cascade of HIV prevention, testing, and care.
•    Recognition that BC’s Aboriginal population is diverse, not homogeneous, and has a range of HIV prevalence.
•    Seeking an appropriate level of cultural understanding and using this understanding to tailor communications to the specific situations and case histories of their patients.
•    Identifying methods of measurement to evaluate culturally safe Aboriginal engagement, linkage, and retention in HIV care and lifelong treatment.
•    Research to identify the most effective ways that Aboriginal people in this province can be provided care that ensures ultimate success in reducing and preventing transmission of HIV.

The consequences of culturally unsafe HIV testing may lead to avoidance of prevention, testing, and treatment services. The ability of health care providers to talk to, develop, and keep a trusting relationship with their patients will depend on an appreciation of the reasons for possible nondisclosure of risk even if people understand the benefits of long-term treatment for them and those close to them.

Efforts by health care practitioners will help to achieve culturally safe and appropriate routine HIV testing and strong, effective linkages to treatment and retention in care. The FNHA urges health care providers to ensure they have the training and cultural competency, such as the Provincial Health Services Authority’s Indigenous Cultural Competency training,[5] to ensure testing, follow up, and treatment is carried out in a beneficial way.

References

1.    Gustafson R, Ogilvie G, Moore D, et al. New HIV testing guidelines in BC. BCMJ 2014;56:172-173.
2.    Gustafson R, Steinberg M. Expanding provider-initiated HIV testing. BCMJ 2011;53:13.
3.    Nyblade L, Stangl A, Weiss E, et al. Combating HIV stigma in health care settings: What works? J Int AIDS Soc 2009;12:15. doi:10.1186/1758-2652-12-15.
4.    Wilson D, de la Ronde S, Brascoupés, et al. Changing outcomes through culturally competent care. J Obstet Gynaecol Can 2013;35:S38-S41.
5.    Provincial Health Services Authority. Indigenous cultural competency training program. Accessed 5 August 2014. www.culturalcompetency.ca/training.