Upscaling HIV and hepatitis C testing in primary healthcare settings: stigma-sensitive practice

Abstract

Increasing testing for viral hepatitis and HIV is central to meeting World Health Organization and Australian targets to eliminate blood-borne viruses as public health priorities by 2030. In this paper we draw on findings and recommendations from a Victorian consultation with 40 health and community practitioners engaged with blood-borne virus testing. The consultation focused on identifying what constitutes best practice in pre- and post-testing discussion in the current era of highly effective treatments for HIV and hepatitis C. Overall, the consultation found that the pre- and post-test discussion remains an important feature of testing, but, given that stigma continues to impact the lives of people affected by these viruses, sensitivity to this issue needs to inform how these discussions take place. We describe how primary healthcare settings can support the goal of upscaling HIV and hepatitis C testing in a way that delivers safe and stigma-free testing encounters. We offer the notion of ‘stigma-sensitive practice’ as a term to describe this approach to pre- and post-test discussions.

The trouble with normalisation: Transformations to hepatitis C health care and stigma in an era of viral elimination

“…This was done partly in order to protect individuals from any stigmatisation that might arise from testing and diagnosis, and it included provisions to make testing confidential and voluntary and to include pre‐ and post‐test counselling. In most Australian jurisdictions, pre‐ and post‐test counselling was legislated, partly to ensure that medical practitioners would sufficiently explain the risks of onward transmission and the legal obligations of HIV disclosure, as well as to ensure informed consent was gained (Lenton et al., 2021, pp. 255–256).…”

“…In this way, HIV normalisation is entangled with—and has come to effect—changes to the biomedical and social meanings of HIV infection, including its status as a heavily stigmatised virus. Some have argued that elements of exceptionalism must remain, including explicit informed consent in testing and in ‘stigma‐sensitive practice’ (Lenton et al., 2021). As we explain in the next section, understandings of and interventions into hepatitis C in Australia were developed through close association with HIV responses (Rhodes & Treloar, 2008) and have included elements of exceptionalism and, more recently, normalisation.…”

“…Although pre‐ and post‐test counselling for hepatitis C was never legislated in Australia (as they were for HIV), testing guidelines have routinely recommended them. Guidelines have also recommended specific informed consent procedures (see Lenton et al., 2021). A crucial difference involves public health notifications: For hepatitis C, government case reporting has generally included people’s names, contact details, demographic and clinical data, risk factors and the likely mode of transmission (Australian Government Department of Health and Aged Care, 2015).…”