FOCUS
New HIV prevention tools for nurses By Zindia Nanver and Melinda Hassall
HIV transmission in Australia can be prevented through an everexpanding suite of strategies, including the use of condoms, clean injecting equipment, Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), frequent HIV testing and HIV treatment as prevention. Nurses have a significant role to play in the prevention of HIV transmission through increasing their knowledge of current prevention strategies and by providing care that is free of stigma, discrimination and judgement. Frequent testing and treatment of HIV are important strategies to prevent HIV, which nurses are increasingly involved with in general practice and sexual health clinics, evidenced by the evolution of nurse/NP-led clinics for testing and routine monitoring. Frequent testing enables early diagnosis, early access to HIV treatment and reduced possibility for transmission. When a HIV positive person is on treatment the viral load can be reduced to an undetectable level. When someone has an undetectable viral load they cannot sexually transmit HIV to someone else, a prevention strategy acknowledged internationally as Undetectable=Untransmittable. If a patient has had a HIV risk exposure they can still prevent HIV by taking PEP. This can be provided by most sexual health and emergency departments, or via a HIV s100 prescriber and must be taken within 72 hours of the exposure to minimise risk of transmission. Nurses also play a key role in educating patients about prevention, testing for HIV, monitoring patients who are on treatment, screening for sexually transmissible infections (STIs), and ascertaining sexual history. Discussing sexual health and risk behaviour can often seem challenging and might be easier with some patients than others. There are skills you can develop to make you feel more confident to talk about sexual health. You might use ‘hooks’ to start the conversation such as “We ask all our new patients in this clinic some sexual health questions”, or “We are doing a sexual health
52 Jan–Mar 2020 Volume 26, No. 9
screening month, is it okay if I ask you some questions?”, or “You mentioned that you are travelling overseas, have you also considered your sexual health?” When you have broached the topic, it is important to stay non-judgemental and provide space for the patient to feel comfortable talking about this topic. Normalise talking about sexual health and be prepared for the answers you might receive. Ask open questions such as “Do you have sex with men, women, or both?”, “When was your last sexual contact?” “Do you use condoms?” Consider asking questions in a culturally appropriate way when needed and assure confidentiality. You can also display posters in your service to encourage patients to ask about these topics. When discussing sexual health, you can investigate their risk for HIV. Don’t assume people are at risk for HIV, and don’t guess their sexuality. When a patient is considered to be at risk for HIV they can consider PrEP. PrEP can be prescribed to those who have had a past and/or future risk for HIV which can include men who have sex with men, heterosexual, trans and gender diverse people, and people who inject drugs. PrEP is also safe for women who wish to become
pregnant but are at risk of acquiring HIV. PrEP is a co-formulation of tenofovir and emtricitabine, which can be taken daily or on-demand and can prevent a HIV negative person from acquiring HIV. PrEP has been available on the Pharmaceutical Benefits Scheme (PBS) since 1 April 2018 and can be prescribed by a GP or Nurse Practitioner (NP) to any eligible person living in Australia (Update on PrEP for HIV Clinicians). If the patient is Medicare ineligible, PrEP can be imported via the personal importation scheme. So how does PrEP work? A HIV negative individual takes a sufficient dose of antiretroviral drugs (ARVs) to establish high levels of ARVs in their blood, genital tract and rectum before any exposure to HIV. If HIV exposure occurs, the ARVs stop the virus from entering cells and replicating. PrEP has been proven to be 95-99% effective when taken daily. Nurses are also key in monitoring patients while on PrEP. People require screening every three months while on PrEP. During this assessment they will undergo STI screening, HIV testing, and a medication review to ensure there are no drug-drug interactions. It is also necessary to discuss adherence to PrEP and discuss methods to improve this. The three monthly check-up