History Taking · Foundation · Infectious Diseases

Testing for HIV - Risk Assessment

Practise this PLAB 2 history taking station on HIV Testing Request. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in a GP surgery. Iqbal, a 28-year-old man, has come to see you requesting an HIV test. He reports having had unprotected sexual contact with a new partner and is concerned about his status. Please take a focused history, discuss testing, counselling, and the window period.

Background notes: PMH: Healthy, no chronic conditions, no previous STIs

What this station tests

  • Non-judgmental sexual history: partners, practices, protection, using the correct framework sensitively
  • Window period knowledge: 4th generation tests detect antigen and antibody, 45-day window for definitive result
  • Reframing HIV as a manageable chronic condition: people on treatment live normal lives and cannot transmit (U=U)
  • PrEP discussion: over 99% effective at preventing HIV, offered proactively for ongoing risk
  • Full STI screening alongside HIV: syphilis, hepatitis B/C, gonorrhoea, chlamydia

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself, confirm identity, open question. 'What's brought you in today?'
  • 1-4 min — Systematic History: Presenting complaint detail (SOCRATES for pain, timeline, severity). Systems review. PMH, medications, allergies.
  • 4-6 min — Context and ICE: Social history (smoking, alcohol, occupation, living situation). Family history. Ideas, Concerns, Expectations.
  • 6-7 min — Summary and Plan: Summarise findings back to patient. Share differential/working diagnosis. Outline investigation and management plan.
  • 7-8 min — Closing: Safety netting with specific red flags. Arrange follow-up. Check for questions.

Consultation approach

The opening

HIV testing counselling requires a non-judgmental, supportive approach that covers pre-test discussion, risk assessment, window period, and what happens with the result. Iqbal is 28, gay, requesting an HIV test after unprotected sex with a new partner. He is anxious but rational. Open with: 'Iqbal, thank you for coming in. Everything we discuss is completely confidential. Tell me what has prompted you to request the test.'

Core approach

Take a sensitive sexual history. He recently separated from a long-term partner and has had new sexual encounters with minimal protection. One specific encounter involved unprotected receptive anal intercourse (highest risk sexual activity for HIV transmission). Establish when this occurred: the window period for 4th generation HIV tests is 45 days (tests for both antigen and antibody).

Assess for symptoms of acute seroconversion. Fever, rash, lymphadenopathy, pharyngitis, arthralgia occurring 2 to 6 weeks after exposure may indicate acute retroviral syndrome. Ask about these. If present, this increases the urgency of testing.

Pre-test discussion. Explain the test: 'This is a blood test that checks for HIV antibodies and antigen. If done more than 45 days after your last risk exposure, it is highly accurate.' Explain what a positive result would mean: 'If the test is positive, HIV is now a manageable chronic condition with excellent treatment. People on treatment live normal, healthy lives and cannot transmit the virus to partners.' This reframing reduces test anxiety.

Offer full STI screen alongside: syphilis, hepatitis B and C, gonorrhoea, chlamydia. Discuss PrEP (pre-exposure prophylaxis) for ongoing risk reduction.

Closing and safety netting

Arrange the test. If within the window period: test now (may detect early antigen) but repeat at 45 days for definitive result. Offer support while waiting: 'The wait for results can be anxious. We have support available if you need to talk.' Results typically within a few days.

PrEP discussion: 'There is a medication called PrEP that, taken daily, is over 99% effective at preventing HIV. If you continue to have unprotected sex, this could significantly reduce your risk.' Refer to sexual health clinic for PrEP initiation if interested.

Safety net: 'If you develop a fever, rash, or sore throat in the next few weeks, come in as this could indicate early infection and would change our testing approach.' Condom use advice for interim period. Follow-up for results and repeat test if within window.

How examiners mark this station

Examiners will focus on the thoroughness and structure of your history taking for hiv testing request. Domain 1 (Data Gathering) carries the most weight: expect marks for systematic coverage of presenting complaint, red flags, PMH, medications, social and family history. Domain 2 (Clinical Management) requires a clear differential, appropriate investigations, and a safe management plan with safety netting. Domain 3 (Interpersonal Skills) is assessed throughout: genuine exploration of ICE, active listening, empathic responses, and clear communication without jargon.

Domain 1: Data Gathering, Technical and Assessment Skills (Primary focus)

Scores well: Sensitive sexual history (partners, practices, protection). Risk assessment (receptive anal, unprotected). Window period calculated. Seroconversion symptoms screened. Full STI screen offered.

Costs marks: Judgmental history-taking. Not assessing risk level. Wrong window period. No full STI screen.

Domain 2: Clinical Management Skills (Primary focus)

Scores well: Test arranged with correct window period understanding. Full STI screen. PrEP discussed proactively. Seroconversion safety netting. Condom advice. Follow-up plan.

Costs marks: Wrong window period. No PrEP discussion. No full screen. No follow-up.

Domain 3: Interpersonal Skills (Primary focus)

Scores well: Non-judgmental throughout. Confidentiality established. HIV reframed as manageable. Anxiety about waiting acknowledged. Support offered.

Costs marks: Judgmental. Not establishing confidentiality. Catastrophising HIV. Not acknowledging anxiety.

Common examiner feedback (and how to fix it)

Did not gather sufficient information to make an adequate assessment of the patient's condition

Fix: Use a consistent framework for every history. After covering the presenting complaint, systematically move through PMH, drug history, social history, family history, and ICE. Keep a mental checklist.

Did not identify the patient's problems and/or did not develop a management plan adequately

Fix: Reserve the final 2 minutes to summarise your findings, share your working diagnosis with the patient, and outline your investigation and management plan including safety netting.

Common mistakes in this station

  1. Being judgmental about unprotected sex. He is already anxious and feeling guilty. Judgment will prevent future health-seeking behaviour. Candidates who express disapproval, even subtly, fail the interpersonal dimension.
  2. Not knowing the window period. The 45-day window for 4th generation tests is commonly tested. Candidates who say 'come back in 3 months' use outdated guidance (3 months was for older antibody-only tests).
  3. Not discussing PrEP. A young gay man with ongoing HIV risk should be offered PrEP proactively. Candidates who test without discussing prevention miss a crucial public health intervention.

Resitting PLAB 2?

If you have previously struggled with history taking stations, focus on building a consistent systematic framework that you apply to every case. Practise structuring your history into clear phases (presenting complaint, systems review, PMH, social, ICE) so that even under pressure, you cover all domains. Many resitters lose marks not on knowledge but on organisation and time management.

Example opening

Good morning/afternoon, my name is Dr [Name], I'm one of the doctors here today. Could I confirm your name and date of birth please? Thank you. So, what's brought you in to see me today?

Frequently asked questions

How do I approach the consultation in this HIV testing request station?

HIV testing counselling requires a non-judgmental, supportive approach that covers pre-test discussion, risk assessment, window period, and what happens with the result. Iqbal is 28, gay, requesting an HIV test after unprotected sex with a new partner. He is anxious but rational.

What does a strong performance look like to the examiner in this station?

Strong performances show: Sensitive sexual history (partners, practices, protection). Risk assessment (receptive anal, unprotected). Window period calculated. Seroconversion symptoms screened. Full STI screen offered. Weak performances: Judgmental history-taking. Not assessing risk level. Wrong window period. No full STI screen.

What is the biggest pitfall in this HIV testing request station?

Being judgmental about unprotected sex. He is already anxious and feeling guilty. Judgment will prevent future health-seeking behaviour.

How should I prepare for HIV testing request if I have never seen it in practice?

Structure beats experience here. Focus on window period knowledge: 4th generation tests detect antigen and antibody, 45-day window for definitive result. The written guidance on this page covers the full approach, and practising the consultation aloud builds the fluency the examiner is listening for.

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