3. Promoting HIV Testing in Diverse Populations
Case Studies
Joanne
Joanne is a 22-year-old street prostitute. She has made her living this way since she ran away at age 14. For the last year, she has always used condoms during sex. Prior to that she had frequent unprotected sex. She has never had an HIV test. She believes she must be safe now, since she always uses condoms. She has come to your clinic complaining of a severe rash. She asks for a flu shot “because I have the flu and it’s not going away.” When you tell her your clinic routinely screens for HIV, she says she does not want the test, “It’s too scary. I can’t think about it.”
Discussion Questions
- How would you proceed?
- What are some approaches that might encourage Joanne to be screened for HIV?
- What clinic policies and practices could help you to deliver optimal care to Joanne?
- If you are unable to convince Joanne to test at this visit, is there anything else you can do to encourage her to test?
Dennis
Dennis is a 45-year-old Chinese-American man. He is married and has two children. Since he was 25, he has gone to gay bars a few times a year. He binge drinks and smokes at the bars, and occasionally has casual sex with men he meets there. He does this impulsively and, because of denial, does not bring condoms. Unless the partner supplies condoms, the sex is unprotected. Dennis does not consider himself gay and does not share this part of his life with anyone, including his doctor. Last Saturday he had unprotected sex with an HIV-positive partner. He does not know. Four days later, he has made an appointment with you, his primary care clinician, for an annual check-up and preventive screenings.
Discussion Questions
- Would your current practice approach lead you to learn about this patient’s risky behaviors and HIV status?
- What practices could help to learn about this patient’s risky behaviors and HIV status?
- How could CLAS training and standards help you and your facility to provide Dennis with optimal care?
- How might cultural and language factors affect this case? Would your answers to earlier questions change if Dennis were Latino or African American? If so, how would they change?
