CPD: Prevention and management of HIV in primary care

In this case-based module, sexual health specialist nurse Jodie Crossman explains key issues in the prevention and management of patients with or at risk of HIV in primary care. Read the full module on Nursing in Practice 365 today.

HIV (human immunodeficiency virus) is an infection which causes damage to the immune system.¹ Although there is currently no cure for HIV there is highly effective treatment which, with early detection, will ensure someone living with HIV stays well and has a normal life expectancy.

HIV is transmitted through bodily fluids including semen, vaginal fluid and blood. If someone is diagnosed with HIV and is on effective treatment, they are unable to transmit the virus to anybody else. This is known as U=U, for Undetectable = Untransmittable.²

Just over 100,000 people in the UK are living with HIV – about 1 in every 600 people.¹ Of these, around 5,000 are undiagnosed. Of those who are engaged in care, almost half are aged over 45 and many experience age related co-morbidities such as hypertension and hyperlipidaemia.³

Nurses in primary care can play a valuable role in supporting people living with HIV by sharing care with their HIV team. This may involve facilitating management of comorbidities, offering opportunities for vaccination and supporting mental health. They are also ideally placed to identify people who might benefit from the preventive treatments that are now available and support them into care.

People living with HIV do not require any additional and should not be treated differently from other patients.

Learning objectives

This module will enhance your understanding of:

The role of primary care in HIV management and re-engagement.
Indications for HIV pre-exposure prophylaxis (PrEP) and refer appropriately.
How to identify opportunities and indicators for HIV testing and reduce stigma in consultations.
Providing person-centred support and signpost to HIV services.

Case 1: Person living with HIV lost to follow-up

Scenario: Sam, aged 42, attends your clinic for management of his hypertension. When discussing his medical history, Sam tells you that he was diagnosed with HIV ‘a long time ago’ but since moving house in 2021 has not had a chance to register with a new HIV care provider. He did have some medication on repeat prescription, but has not taken any for over a year. Apart from occasional headaches he is feeling well.

1. How would you talk to Sam about this?

Firstly, it’s important to use non-judgemental language. People disengage with care for a variety of reasons. Because HIV is still highly stigmatised, people may feel shamed or judged for their infection. You can help create a safe environment by first acknowledging that disclosing their disengagement from HIV care may have been difficult for them.

This can be done by responding in a way that will also help Sam feel supported and validated, for example: ‘Many people find it hard to keep up with appointments, especially when life is stressful. You’re not alone in that. My role isn’t to judge or tell you off – it’s to support you in whatever way you think will be helpful.’

Inviting Sam to share what has been going on can then help you to make a plan together which will work for him.

2. What should be the next steps for Sam’s HIV care?

You will need to arrange an urgent HIV clinic referral. It is really important that Sam is encouraged to re-engage with care as soon as possible, as without treatment Sam’s immune system may be compromised and there is also a risk that he may be able to transmit HIV to others.

With Sam’s consent, a referral can be made to the nearest HIV specialist clinic. Some people may just need a referral to re-engage with care, however some may need a bit more support. HIV services will usually have community or outreach staff who are able to work with people living with HIV to get them back into care. For some, a referral may be enough to re-establish care. Others may need a bit more support from the clinic via community specialist nurses or health advisers. If Sam doesn’t consent to being re-referred, the HIV team could still be consulted for advice on how to manage this. Careful documentation will ensure that each time Sam visits the GP they can discuss re-engagement with care.

Note that it is really important that Sam’s previous antiretroviral therapy (ART) is not simply restarted without specialist advice. With incorrect management, people can develop resistance to HIV treatment. It is important that HIV treatment is reestablished with the support of a specialist HIV care team to ensure that treatment is optimized.

Click here to complete the full module on Nursing in Practice 365

Jodie Crossman is Clinical Nurse Specialist in genitourinary medicine at Brighton Sexual Health and Contraception services and co-chair of the STI Foundation

References

Lewis A et al. National HIV Testing Week 2023. House of Commons Library. 2023
Terrence Higgins Trust. Can’t Pass It On. 2021
British HIV Association. Shared Care: how can we do it? Findings from the BHIVA Primary Care Project – BHIVA. 2025