'HIV tests for all' proposed

Published: December 30, 2011

J“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 focussed 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 focussed 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.

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