'HIV tests for all' proposed

“UK experts call for universal HIV testing in a bid to reduce infections,” BBC News has said. This widely reported news is based on recommendations in the Health Protection Agency’s (HPA) annual report on HIV in the UK. The HPA says that the number of people living with HIV has reached an estimated 91,500, but more than 21,000 of these people may not know that they have the infection. It wants everyone who attends a sexual health clinic to be tested to reduce the number of people who are unaware that they have HIV.

In areas where rates of HIV infection are high, the HPA also wants tests for everyone who registers with a new GP or is admitted to hospital. The HPA recommends that people most at risk of HIV infection (such as men who have sex with men; black Africans; and people who inject drugs) should have an annual HIV test.

What did the news reports say?

The media focused on different aspects of the annual figures published by the HPA ahead of World AIDS Day on December 1. The Daily Telegraph and BBC News highlighted that one in five people who attends a sexual health clinic declines an HIV test. The Guardian focussd instead on the rate of new infections, which may still be rising in the UK, despite a fall globally. The Daily Mirror reported that half of people diagnosed with HIV are identified later and may have benefited from earlier treatment.

The news reports cited fear of getting tested as a reason for the low rate of detection. However, drug treatment for people diagnosed with HIV early can offer a similar-to-normal life expectancy. HIV tests are very straightforward, and some newspapers quoted a spokesperson for the National AIDS Trust, who said that it was time to eradicate people’s fear about getting tested for HIV.

How common is HIV in the UK?

Around 91,500 people are estimated to be living with HIV, with a quarter of these unaware of their infection. Estimates for 2010 suggest that:

Around 40,100 people living with HIV were men who have sex with men.
47,000 people living with HIV in the UK were heterosexual, of whom 19,300 were African-born women and 9,900 were African-born men.
One in three heterosexuals living with HIV in the UK was thought to have been born in the UK or countries outside Africa.
More than 2,000 people living with HIV were estimated to be people who inject drugs.

These estimates included people who were living with HIV but had not been diagnosed. The estimates for people with undiagnosed HIV were:

men who have sex with men: 26%
heterosexual men: 28%
heterosexual women: 21% (all pregnant women receive antenatal HIV screening)
people who inject drugs: 21%

Are infections increasing?

The national UK prevalence of HIV in 2010 was around 1.5 cases per 1,000 people (2 cases per 1,000 men and 0.9 cases per 1,000 women). This is similar to European countries such as Ireland, the Netherlands and Germany, and is lower than some eastern and southern European countries, where higher prevalence is thought to be driven particularly by injecting drugs.

In 2010, 4,510 men and 2,150 women were newly diagnosed with HIV in the UK, a new diagnosis rate of 0.15 per 1,000 men and 0.07 per 1,000 women. Of these new cases of HIV, 45% were thought to have been acquired abroad, whereas 55% were acquired in the UK. The number of new infections acquired in the UK doubled from 1,950 in 2001 to 3,640 in 2010.

There had been a year-on-year decline in the number of new diagnoses since 2005, driven largely by fewer people acquiring the infections abroad through heterosexual sex. However, this trend appears to have stopped.

The HPA report highlights that the number of new HIV diagnoses among men who have sex with men has reached an all-time high. Of new diagnoses of HIV among these men, 81% were likely to have been acquired in the UK, 83% of the men were white and 67% were born in the UK. An estimate of the incidence of new diagnosis in men who have sex with men aged 15-44 living in UK has risen from 0.5% per year in 2002 to 0.9% in 2007.

What does the HPA recommend to tackle HIV?

The HPA has called for more extensive testing to detect people who are living with HIV. Strategies may include routinely offering HIV tests to new patients at GP practices and people who are admitted to hospital in areas of the country where rates of HIV infection are high.

It also suggests that sexual health clinics should ensure that HIV testing is offered as part of a universal sexual health screen for every person who attends.

The HPA recommends that people most at risk of HIV infection (such as men who have sex with men; black Africans; and people who inject drugs) should have an annual HIV test, and men who have sex with men should consider more frequent testing.

It was reported that access to HIV care in the UK is excellent, as is the standard of care. However, for people living with HIV with a CD4 count (a type of immune cell) of less than 350 cells per mm3 of blood who are currently not receiving antiretroviral therapy (around one in 10 people), doctors should prioritise reviewing these patients’ care. The HPA also recommends that all people with HIV should receive a newly available vaccination against the bacterium that can cause invasive pneumococcal disease (IPD), called PCV13, as the incidence of IPD in adults living with HIV is almost 50 times higher than in the general population (aged 15-44).

Where can I get tested?

You can go for an HIV test and sexual health screening at:

your GP or private clinic
a sexual health clinic, also known as a genitourinary medicine (GUM) clinic
a fastest clinic run by the Terrence Higgins Trust, which also tests for other sexually transmitted infections
some contraception and young people’s clinics
an antenatal clinic, if you are pregnant
local drugs agencies, if you are an injecting drug user

If you go to your GP, the test results will be confidential but will go on your medical record. GUM clinics are free and open to everyone. All information is confidential and will not be passed on to your GP without your permission.

Find sexual health services near you

The most effective way to prevent transmission of HIV through sex is to use condoms with every new partner. Taking antiretroviral HIV medications lowers the amount of HIV virus in the blood which, when also using condoms, can further lower the risk of infecting a partner.

What options are there for treating HIV?

Antiretroviral therapy is widely available and has transformed HIV infection from a fatal illness to a chronic but manageable condition. The HPA report said that people with HIV infection can expect a near-normal lifespan, and that there are far fewer side effects with newer HIV therapies than with earlier drugs for HIV.

The HPA report highlights that the drugs are more effective if started promptly, again emphasising the need for testing. The 2008 British HIV Association guidelines (PDF, 384Kb) suggest that treatment discussions should start when a patient’s CD4 count falls below 350 cells per mm3 of blood. The HPA report found that in 2010, 82% of HIV-diagnosed people in care received antiretroviral therapy regardless of CD4 count, compared with 69% in 2000.