National Guidelines for the Management of People with HIV Who Place Others at Risk

Level One: Counselling, education and support

Page last updated: April 2008

Level

Likely Pathway

Services to consider

Decision, decision maker and action

One: Counceling, education and support

Management in the community by client’s primary health care provider, without the formal involvement of the HIV Advisory Panel or the Chief Health Officer or equivalent.
Individual’s behaviour has been recognised by primary health care provider as demonstrating a degree of risk the provider is concerned about – client may not seem willing or able to protect sexual or needle-sharing partners.

This should be reported to the nominated public health authority as appropriate for the arrangements in each State or Territory.

Following discussion between the Panel Chair or Chief Health Officer or equivalent and the primary health care provider, however, provider agrees to continue management of client, at least in first instance, possibly with follow up and support.

Review at initiative of primary health care provider, that is, if concerns continue.
HIV Clinical care.

Mental health and drug and alcohol services as needed.

Counselling, education.

Support services, housing.

Referral to case management services.
Decision is not to admit to management at Level 2 or above under Guidelines at this initial stage.

Made by either the Panel Chair or Chief Health Officer or equivalent (depending on individual jurisdictional protocols), in consultation with primary health care provider.

Chair of Advisory Panel or Chief Health Officer or equivalent makes note of conversation and tables this at next meeting of HIV Advisory Panel.

In cases where there is no suitable health care provider, admit client to Level Two and appoint a person responsible for management.
  1. The first steps in the management of a person with HIV who is behaving in a way that endangers or is likely to endanger others are counselling, education and support. Usually this will be best undertaken by the local clinician who is also responsible for supporting maintenance of compliance with HIV treatment. Counselling with an experienced sexual health / HIV counsellor may also need to be regular and even intensive and other service providers may also need to be involved.
  2. A case conference of local services engaged with an individual is often useful in developing a plan with the individual client. In the case of people with HIV who have complex needs often associated with cognitive / behavioural and / or mental health problems, specialist tertiary services should be involved in assessment and management for the client.
  3. Contact tracing in accordance with appropriate ethical and legal standards should be considered.
  4. Wherever possible and appropriate, a community organisation with peer group involvement should be involved to support appropriate behaviour by the person with HIV. Peer-based support and education is a demonstrated evidence-based means of providing assistance to individuals with HIV around coping with a diagnosis of HIV infection, disclosing their HIV status to others, and understanding HIV transmission risks, means by which HIV transmission can be prevented and peer-behavioural norms.
  5. A supportive environment should be created where health promoting messages are clearly and frequently reiterated and the consequences of behaviour that places others at risk are spelt out. The means of prevention (including for instance, condoms, needles and syringes, and information) should be readily and easily accessible, along with access to regular health checks, testing and treatment.
  6. At any stage, the nominated public health authority can be contacted for advice. It is important that service providers and local clinicians feel free to contact the nominated public health authority for advice if they feel that they are not able to manage the individual client’s behaviour or if they feel that the matter should otherwise be brought to the nominated public health authority’s attention.
  7. Contacting the nominated public health authority will not automatically lead to the client being managed under the Guidelines at Level 2 or above. It may lead to the provision of advice or contacts with other professionals able to provide support. The Advisory Panel Chair or Chief Health Officer or equivalent may, however, judge it advisable to involve the HIV Advisory Panel, deciding that the client should be managed under the Guidelines at Level 2 or above.
  8. In determining whether to accept the client for management under the Guidelines at Level 2 or above, the Chair or Chief Health Officer or equivalent will consider a range of matters including:
  • the nature of the information provided, including in relation to the imminence of risk to the public;
  • the credibility of the information provided and the source of the information, including the basis on which conclusions have been drawn regarding the client having HIV infection and placing others at risk or being likely to place others at risk;
  • the outcome of any inquiry into the information that may be undertaken by the nominated public health authority or their nominee;
  • an assessment that the risk is or may be ongoing;
  • an assessment of the bearing that a client’s capacity or competence (or lack thereof) or co-morbid presentations (such as problematic drug or alcohol use or mental health presentations) may have in relation to management of the client’s behaviours;
  • the range of and sufficiency of steps taken by the local clinician / service provider to manage the client’s behaviours, and the prior involvement of appropriate services; and
  • an assessment of the likelihood that local actions may succeed if allowed to continue to progress.
  1. The above matters provide a framework only. Acceptance of clients for management under the Guidelines at Level 2 or above will be determined by the Chief Health Officer or equivalent or Chair of the HIV Advisory Panel on a case-by-case basis. Convenience to local clinicians / service providers will not be a factor in determining management under the Guidelines and in all instances local clinicians / service providers will be expected to remain active in the management of the client. However, consideration can be given to whether a local clinician has the capacity and resources to effectively manage a client who may be at risk of infecting others and alternative arrangements made where required.
  1. The Chief Health Officer or equivalent or Chair of the HIV Advisory Panel will maintain a file note of any discussions and the advice provided. It is not necessary that such individuals’ identities be recorded, although the identity of the person making the approach and the date must be recorded.
  1. The Chief Health Officer or equivalent or Chair of the HIV Advisory Panel will make a report of such advice provided to local clinicians / service providers to the HIV Advisory Panel on at least a four monthly basis.