Question About HIV Counseling... How Hard Is It to Deliver THE Bad News

[VersatileBreeder]

Not entirely sure if this is the best section for this post, but I'm gonna give it a shot. I had an experience today that had me wondering how hard it is for doctors and HIV counselors to deliver the news to a person if they test positive.

To explain what happened earlier today that got me wondering...

Last week, I had a lot of pain in random joints in my body. I wasn't sure if it was an effect of the Stribild I'm on, the Doxycycline I was on (to clear an infected pubic hair follicle) or something else (like arthritis). When I couldn't take the pain anymore (as I could barely walk), I went to an urgent care clinic. The doctor there said my foot/ankle was inflamed and looked somewhat like arthritis, but wasn't sure. They drew blood for a four-panel test. I asked what they were testing for and she said different forms of arthritis, celiac, Epstein-Barr, Lyme, thyroid and a couple others. Nothing said about HIV. I didn't disclose that I was HIV+ because I didn't think it was relevant to what was going on.

This morning I got a call from the doctor. She said, "most of the tests came back okay, but there is one that I want you to come in to discuss." I asked her what it was. She paused and replied, "I really would rather discuss this in person." I thought to myself what test could have come back that is so bad? Thinking the worst, I thought "great... She's going to tell me I have arthritis."

I went in right away and she took me into an office to sit down to talk. She closed the door behind us. I could sense tension in the room. She started asking me about if in addition to the joint pain if I had any fever, rash, fatigue, etc, to which I answered "no." Then she started asking about my sexual practices- multiple partners, protected/unprotected, etc. It finally hit me and I started to see where the discussion was going.

She had a very sad and distressed look on her face and said, "one of the panels we ran is a variety of infectious diseases. I don't know how to say this and I am so sorry to tell you but... (pause).... one of the tests... (pause)..." I casually finished the sentence for her, "came back positive for HIV, right?" She looked at me and said, "yes, it was HIV positive. I am so sorry." I casually nodded and said, "I've already gotten that bad news months ago. I have been seeing a doctor for the past six months for HIV and on medication for the past three months."

She relaxed back in her chair and I could see a rush of relief come over her that she didn't have to be the bearer of bad news. She isn't really an HIV counselor, she is a clinician for general care, so I don't imagine that she's had to break HIV positive results out very much in the past. She said she felt bad that she had me come in for nothing. I apologized that I didn't mention it in the consultation that I was HIV+, but if I had known that was one of the tests, I would have cleared that out of the way.

So my question for guys who do this sort of counseling (as I know that there are a few on here that do)... As experienced as you may be in counseling and have had to deliver the bad news in the past, how hard is it to do? This doctor seemed like it was the hardest news for her to break. Also, does it get easier over time? Or is it always hard? Just curious what your experiences are/have been.

[bearbandit]

I'm a volunteer with myHIV, a subgroup of the British charity Terrence Higgins Trust, which is the main HIV charity in the UK. Because I live some distance from any of our testing centres, I'm not the one who gives the news. However, since we're an online community, and I'm judged too sick to work, I often pick up the the first email contact on our forums. If not the first email contact I end up filling in the blanks left by other volunteers as I'm one of the long term survivors.

It's difficult (especially knowing that some of our users will be reading this!): there are so many myths and rumours to dispel, to get to a truth that is basically "nobody knows". My late husband (he would have loathed the term!) was late diagnosed with a CD4 count of 80 and MAI (mycobacterium avium intracellulare, a relative of tuberculosis, since you ask) making a home for itself in his guts, and died four years after diagnosis. I have to bear in mind his experience of HIV as well as that of the kid who thought "once can't hurt".

I don't know if I could be the one to deliver the news, even though it's much less of a threat when I was diagnosed in 1987. I just help pick up the pieces and help the guy (or woman) put them back together again in some way that resembles their normality. It's a peer to peer situation: I can give details of how I handled a situation, without recommending my ways to the person I'm talking to (on the occasions I leave my house to go further than the village shop I'm liable to be wearing a cutoff that carries a lot of gay and HIV badges - something I wouldn't be wearing if I were meeting a "client").

Despite being pretty much housebound I do remember what it was like to spend a night in the pubs and clubs: my primary message there is "what do you want?" <reply> "go for it". I see my job as re-instilling confidence in people who've just been diagnosed and, being unable to work at a conventional job, I have the time to maintain an email relationship with someone as long as they need. Some have crossed over the line and become friends, in which case any counselling type questions I have to refer them on to someone else.

But yes, that first contact breaks my fucking heart.

[wood]

I've went through some clinical training, and actually delivered the news twice before when I really wasn't supposed to. (really understaffed place)

The best thing I can say it that you get a read on the person real quick. Each time for me, the guy had a look on his face of "I know what you are going to say" So I just went through standard protocol, going over risk factors, bodily fluids, etc. In the places I have been at they have said after the initial conversation just to let it out. "your test is should reactive...." I think for many people it doesn't hit until later anyway. The reason for not really waiting is because people start to freak out and make assumptions if they have to wait very long, so its best to do the session relatively similar regardless of the outcome of the test.

In contrast to when bearbandit found out I bet its a lot easier for the clinicians today. Its now a stumbling block not a death sentence.