Discuss who has access to the test results, including state mandatory reporting regulations. Be aware that reporting guidelines vary from state to state.

All states have mandatory name reporting when a patient is diagnosed with AIDS.

Some states mandate reporting the names of individuals who test HIV positive.

Clarify distortion (e.g., “a negative test still means you could contract the virus at a future time; it does not mean you are immune from AIDS”).

Ask questions about the patient’s understanding and emotional reaction to the test result.

Strongly encourage patient to inform current, previous, and prospective sex partners or persons with whom needles were shared of their infection with HIV, so appropriate precautions can be taken. If a patient has not disclosed their HIV-positive status to a partner and continues high-risk behavior, it may be ethical to notify identifiable sexual partners or other at-risk individuals. However, it may not be legally permissible and psychiatrists should consult with risk management before breaching confidentiality.

HIV-positive patients often need access to a mental health team (assess need for inpatient versus outpatient care; consider individual or group supportive therapy). Common themes include the shock of the diagnosis, the fear of death, and social consequences, grief over potential losses, and dashed hopes for good news.

Also look for depression, hopelessness, anger, frustration, guilt, and obsessional themes.

Activate supports available to the patient (e.g., family, friends, and community services).