Public health counselling following an HIV diagnosis among men who have sex with men: tensions between individual needs and health protection mandates.

Abstract

In Ontario, provincial regulations stipulate that public health units must complete post-test counselling with all persons newly diagnosed with human immunodeficiency virus. Public health nurses conduct this follow-up and are responsible for ensuring appropriate surveillance and management of human immunodeficiency virus with the primary objective of reducing ongoing human immunodeficiency virus transmission in their health jurisdiction. To date, little research has explored the effectiveness of this mandatory public health counselling from the perspective of patients - the majority of whom are men who have sex with men. To address gaps in public health nursing practice, a pilot study was conducted with men who have sex with men in Ottawa to explore their attitudes and experiences of receiving mandatory human immunodeficiency virus follow-up after their diagnosis. Qualitative interviews were conducted and interpreted using thematic analysis. This analysis revealed a contrariety between the needs of individuals and of public health units, with patients' perceiving their personal wishes to be secondary to public health mandates - and led patients to simultaneously want to evade, and be assisted by, public health nurses. Public health units and nurses should consider adopting a more patient-centered approach to HIV case management, which incorporates patients' experiences of receiving an HIV diagnosis.