HIV testing in the UK

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 2007

A 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.

HIV/AIDS prevention in the UK

HIV prevention in the UK currently includes measures to educate people about HIV/AIDS and how it is passed on so that they can take measures to protect themselves (by using condoms for example); encourage harm reduction measures for drug users (such as needle exchange programmes); and promote HIV testing.

It is widely felt by those working in HIV/AIDS organizations and the healthcare sector that HIV prevention in the UK needs to be stepped up and improved as the number of new infections continues to rise as the level of knowledge of the virus falls.

AIDS & HIV in the UK - the current situation

Although AIDS gets less attention from the media in the UK than it did during the early history of the UK AIDS epidemic, it’s far from a problem of the past. In fact, the epidemic has expanded, with the annual rate of new HIV diagnoses more than doubling between 1999 and 2003, and peaking in 2007.²

HIV prevalence in the UK is relatively low and currently stands at 0.2% of the population³. Statistics show that at the end of 2007 there were an estimated 77,400 people living with HIV in the UK, of whom approximately 20,700 were unaware of their infection. An estimated 7,734 people were newly diagnosed with HIV in the UK in 2007.⁴

Relatively low numbers of people in the UK have died from AIDS in recent years thanks to the availability of HAART (Highly Active Antiretroviral Therapy), which dramatically increases the life expectancy of people living with HIV. In 2007, around 540 HIV-infected persons died, compared to 1,726 in 1995, when antiretroviral treatment for HIV/AIDS was not available. The majority of AIDS related deaths occurred because people were diagnosed late and therefore did not start treatment early enough. In 2007, an estimated 31% of newly diagnosed, HIV-infected adults were diagnosed late.⁵

Although HIV is often perceived to be a ‘gay’ problem, infections acquired through heterosexual sex account for the largest number of HIV diagnoses in the UK. The majority of people who acquired HIV heterosexually were infected overseas but only became aware of their status after being tested in the UK. In terms of HIV infections actually occurring within the UK, gay men (and other men who have sex with men) accounted for two thirds of new cases.⁶

Despite the rising numbers of new HIV infections in the UK, public knowledge of HIV and AIDS appears to have declined. While 91% of people in the UK knew that HIV was transmitted through unprotected heterosexual sex in 2000, by 2007 this figure had fallen to 79%⁷.

Many UK HIV/AIDS organisations are calling for improved sexual health services. The Terrence Higgins Trust, for example, released a 2007 report stating that sexual health services in England remain woefully under prioritised and under funded. It claims that despite the government’s promise of an extra £300 million for sexual health services across the United Kingdom to modernise clinics and reduce waiting times, many GUM (Genitourinary Medicine) clinics remain cramped, out-of-date and understaffed

An overview of AIDS in the Caribbean

Due largely to their close geographic locations, the Caribbean is usually grouped with Latin America in discussions about HIV and AIDS, but the epidemics in these regions are very different. Even within the Caribbean, each country faces a unique situation. The diversity of the region – which is apparent in terms of politics, languages spoken, geographic location and wealth – is reflected in the significantly different ways that countries are affected.

At one extreme, the Bahamas has the highest HIV prevalence in the entire western hemisphere (3%); at the other, Cuba has one of the lowest (0.1%). Haiti (2.2%), Trinidad and Tobago (1.5%) and Jamaica (1.6%) are all heavily affected, while Puerto Rico is the only Caribbean country apart from Cuba where it is thought that less than 1% of the population is living with HIV. ² Other factors, such as AIDS mortality rates and transmission patterns, also vary across countries and areas. ³ See our Caribbean statistics page for more data.

Recent developments have given cause for optimism, with an overall stabilisation in the region. A small number of countries in the Caribbean have even shown signs of a decline in prevalence. In the Dominican Republic prevalence fell from 1% in 2002 to 0.8% in 2007. HIV infection levels have also decreased in Haiti, which has been partly attributed to an increase in condom use and changes in sexual behaviour. ⁴ However, HIV surveillance in the Caribbean is generally considered inadequate, so these reported trends are only vague indicators. Both HIV prevalence and AIDS cases are thought to be widely underestimated in the region. ⁵

Reflecting global patterns, heterosexual sex is now the main route of transmission throughout the region, and it has been established that women and young people are particularly vulnerable. ⁶ Little is known about the role that sex between men plays in the region’s epidemics – it has been estimated that men who have sex with men account for 12% of infections, but it is thought that the actual proportion is higher than this, since the rampant homophobia that exists throughout the region has led to denial and under-reporting.⁷

Despite differences between countries, the spread of HIV in the Caribbean has taken place against a common background of poverty, gender inequalities and a high degree of HIV-related stigma. Migration between islands and countries is common, contributing to the spread of HIV and blurring the boundaries between different national epidemics. ⁸ Additionally, poor availability of HIV and AIDS data makes it difficult to gain a clear picture of each country’s situation.

Children, HIV and AIDS in South Africa

With many women who are HIV-positive still not receiving drugs that could prevent them passing HIV to their babies, HIV infections are alarmingly common amongst children in South Africa. According to UNAIDS, there were around 280,000 children aged below 15 living with HIV in South Africa in 2007.²⁷

Children who are living with HIV are highly vulnerable to illness and death unless they are provided with paediatric antiretroviral treatment. Unfortunately there is still a shortage of such treatment in South Africa. The AIDS Law Project, an NGO based in Johannesburg, estimated that 50,000 children in South Africa were in need of antiretroviral drugs at the beginning of 2006, but that only around 10,000 were receiving them.²⁸ UNAIDS estimates that at the end of 2005, children accounted for 8% of those receiving antiretroviral drugs in South Africa.²⁹

As well as many children being infected with HIV in South Africa, many more are suffering from the loss of their parents and family members from AIDS. UNAIDS estimated that there were 1.4 million South African children orphaned by AIDS in 2007, compared to 780,000 in 2003.³⁰ Once orphaned, these children are more likely to face poverty, poor health and a lack of access to education.

Gender inequality and sexual abuse in South Africa

Although HIV prevention campaigns usually encourage people to use condoms and have fewer sexual partners, women and girls in South Africa are often unable to negotiate safer sex and are frequently involved with men who have several sexual partners. They are also particularly vulnerable to sexual abuse and rape, and are economically and socially subordinate to men. Police reports suggest that in 2004-2005 there were at least 55,114 cases of rape in South Africa ²³, although the actual figure is undoubtedly higher than this since the majority of cases go unreported. In a 2006 study of 1,370 South African men, nearly one fifth revealed that they had raped a woman.²⁴ Rape plays a significant role in the high prevalence of HIV among women in South Africa.

Women often face more severe discrimination than men if they are known to be HIV-positive. This can lead to physical abuse and the loss of economic stability if their partners leave them. Since antenatal testing gives them a greater chance of being identified as HIV-positive, women are sometimes branded as ‘spreaders’ of infection.

The government has acknowledged that many women face ‘triple oppression’ in South African society – oppression on the grounds of race, class and gender – and has been making efforts to address this problem, through education and skills development schemes.²⁵ In September 2007 rape laws were strengthened to stop judges and magistrates taking into account factors such as a rape victim's sexual history, their apparent lack of physical injury, or the relationship between the victim and the perpetrator, when deciding on the length of the perpetrator's sentence.

HIV testing in South Africa

HIV voluntary counselling and testing (VCT) should be an important part of any country’s response to AIDS. The number of VCT sites in South Africa has increased significantly in recent years, with 4,172 operational by November 2006. Despite this progress, there are concerns about the quality of VCT services in some areas. Reports suggest that counsellors are not always adequately trained, may lack medical knowledge about HIV, and are often overworked.¹⁴

Another problem is that women seem to be accessing testing more readily than men in South Africa. Researchers believe that this is due to fears amongst men that their HIV-positive status will be disclosed through testing, and that stigmatisation will follow. Surveys have also suggested that some men see no value in knowing their HIV status, viewing such knowledge as a burden.¹⁵