According to British guidelines, HIV testing should be offered at GUM clinics as part of routine STD screening, regardless of symptoms of disease or risk factors of infection. The guidelines state that everybody taking an HIV test should have a pre-test discussion, and be offered counselling if requested, or if there is a high risk of a positive result.28
The number of people being tested for HIV and other STDs at GUM clinics (where the majority of people are tested for HIV) has risen in recent years. Almost half of sexual health screens in 2003 included an HIV test; this proportion increased to two-thirds for England, Wales and Northern Ireland in 2006. Overall, around 800,000 had an HIV test in a GUM clinic in England, Wales and Northern Ireland in 2007A major worry is that many people infected with HIV aren’t accessing testing services soon enough. It’s estimated that nearly one third of HIV-positive adults in the UK are diagnosed late, and for heterosexual men this figure rises to 42%.30 It can be difficult to treat someone with HIV if they are diagnosed late, and in some cases late diagnosis leads to death. According to the British HIV Association (BHIVA), at least a quarter of deaths reported in HIV-positive people in the UK between 2004 and 2005 may have been avoided if HIV had been diagnosed at an earlier stage31. BHIVA, along with other experts, say that non-HIV clinicians such as General Practitioners (GPs) need to be made more aware of the importance of early diagnosis. They have also called for HIV testing to be made a routine part of more generic healthcare services that aren’t specialised towards HIV or sexual health32. Introducing an opt-out testing policy (whereby everybody attending a GUM clinic is given an HIV test unless they specifically ask not to be tested) may be another way to reduce the number of people diagnosed late. Of previously undiagnosed HIV-infected heterosexual men and women attending GUM clinics in 2006, one quarter left the clinic unaware of their HIV infection in 200633.
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