Individuals attending sexual health clinics for the first time should be offered an HIV test, and gay men should have annual HIV tests, the government’s Chief Medical Officer, Prof. Sir Liam Donaldson is recommending in his annual report, which highlighted undiagnosed HIV as a key UK health priority.
It’s estimated that there have been a total of 50,000 HIV diagnoses in the UK. According to Sir Liam's report as many as 59% of HIV-positive gay men and a third of HIV-positive Africans leave sexual health clinics without their infection being diagnosed.
The Chief Medical Officer said more needed to be done to ensure early diagnosis of HIV in infected individuals so their chances of infecting others are minimised.
HIV tests should be offered and recommended to all individuals attending a sexual health clinic for the first time, Sir Liam recommends. Furthermore, all patients who attend a clinic with syphilis or gonorrhoea should have an HIV test offered and recommended, as should heterosexuals who have had unprotected sexual intercourse in a country with a high HIV prevalence.
Gay men, who remain the group most affected by HIV in the UK, should be encouraged to have an annual HIV test, said Sir Liam. This recommendation represents a radical shift, particulalry as gay men are being encouraged to have an HIV test even if they have not had a sexually transmitted infection or have attended a sexual health clinic. This could mean that many gay men are tested for HIV in primary care settings.
It's estimated that around 55% of gay men in the UK have been tested for HIV and the Chief Medical Officer's recommendation could see testing levels increase to those seen in Australia, where approximately 90-95% of gay men have had an HIV test.
The feasibility of offering HIV testing in settings other than sexual health clinics should be explored, and Sir Liam backed campaigns to encourage HIV testing amongst Africans in the UK.
Speaking at the launch of his report in central London Sir Liam said, “early detection and diagnosis is important in preventing the spread of HIV, but estimates show that a third of those infected with HIV are unaware of their infection. Opportunities are not being taken to test people who attend genitourinary medicine clinics…More needs to be done to ensure that people who are infected with HIV are detected at an earlier stage so that they do not then infect other people, and so that their own health care treatment can commence earlier to reduce progression of the disease. Testing in genitourinary medicine clinics is the key."
The Chief Medical Officer also condemned the long waiting times for appointments at sexual health clinics. Figures released yesterday, and reported on aidsmap.com showed that the total number of sexually transmitted infections diagnosed in the UK in 2003 increased 4% over the year before. According to figures in the Chief Medical Officer’s report 28% of people with an acute sexually transmitted infection had to wait more than 48 hours to receive treatment. It will not be possible to reverse the continuing increases in sexually transmitted infections, said Sir Liam, unless prompt access to treatment was available.
Details of the rising cost of HIV to the NHS are also included in the Chief Medical Officer's report. Between 2000/01 and 2001/02 total expenditure on HIV prevention, treatment and care increased by over 10% from £289.3 million in 2000/01 to £331 million in 2001/02. Most of the additional money went towards paying for antiretroviral drugs.