BASHH | Adolescents living with HIV

This guideline is aimed at paediatric doctors, rather than us. However, it is a really good reminder of how to approach taking a sexual history from adolescents. I’m not going to summarise it as there really isn’t much new, but there are a few bits I wasn’t aware of, so I shall list these. If you have an affected patient, this is worth looking at.

 Adolescents with HIV:

Transmission. Risks depend on the number of exposures and the route, but advice is to always use a condom / oral dam.

  • Legal Issues. If a patient knowingly doesn’t use protection and if their partner gets HIV, then the patient could be prosecuted. A patient doesn’t have to disclose their HIV status if they are engaging in safe sex, but ideally they should be encouraged to.
  • Vaccination. All HIV positive patients should have Hep B vaccination and boys as well as girls should have quadrivalent HPV vaccination.
  • Cervical Smears. Girls should have annual smears once sexually active (as risks are higher).
  • Fertility – refer before conception for advice on how to achieve this safely (eg sperm-washing or self-insemination). If they don’t conceive within 6-12m, refer as fertility may be reduced because of the HIV.
  • Pregnancy – risk of transmission is less than 1% if properly managed.
  • Emergency contraception – ideally use a copper coil if on enzyme inducers (otherwise use 3000mg Levonelle).

Taking a sexual history from an adolescent:

  • Offer to talk to them alone.
  • Keep the language simple.
  • Don’t overload them with questions.
  • Ask them what they want to know / if they have questions.
  • Don’t assume they are sexually active or not, nor make assumptions about their sexual orientation.

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton.

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