Older people less likely to be offered an HIV test in English sexual health clinics

Despite their mandate to offer HIV testing to all attendees, sexual health clinics in England are less likely to offer a test to older patients, according to an analysis of Public Health England data recently published in the International Journal of STD & AIDS.

Attendees in their late twenties had the highest likelihood of being offered HIV testing, with the proportion of attendees who were offered testing declining with increasing age.

In the 15-49 years age group, HIV testing was offered to 92% of men who have sex with men (MSM), 92% of heterosexual men and 85% of heterosexual women. For people aged over 50 years, offer rates fell to 88%, 85% and 78% respectively.

The decline in the offer of HIV testing was steepest for older heterosexual women. In those aged over 70 years, HIV testing was offered to 87% of MSM, 76% of heterosexual men and 52% of women.

While clinicians might be reluctant to offer a test because they think older patients are more likely to refuse, this concern is not backed up by the data. The strongest determinant of acceptance of the offer was sexual orientation.

• Men who have sex with men: 96% of those under the age of 50 and 94% over 50 accepted the offer.
• Heterosexual men: 85% of those under 50 and 83% of those over 50 accepted the offer.
• Heterosexual women: 75% of those under 50 and 77% of those over 50 accepted the offer.

Low rates of HIV testing among older patients in primary care and other general health settings might be explained by clinicians not seeing sexual health as relevant in this age group, or expecting their older patients to be uncomfortable talking about sexually transmitted infections. However, this should not be a factor when older people attend sexual health clinics.

National and international HIV testing guidelines recommend that all people attending sexual health clinics are offered an HIV test. Moreover, people over the age of 50 are more likely to be diagnosed with HIV at a late stage, with a CD4 cell count below 350 cells/mm³, than younger people.

The figures come from 1.4 million attendance records from sexual health clinics in 2014. A comparison of the years between 2009 and 2014 did show some improvement over time, but the lower rate of HIV testing in older people is likely to contribute to late diagnosis in this age group.