Laura Waters
Consultant Physician HIV & Sexual Health, Central & North West London NHS Trust Chair, British HIV Association
Effective HIV treatment means people living with HIV have a normal life expectancy and can enjoy a healthy sex life knowing there is zero risk of passing HIV on to their partners.
About 6,000 people in England are unaware that they are living with HIV. Undiagnosed HIV drives onward transmission and late diagnosis, associated with worse health outcomes and significant health care costs.
Routine HIV testing does more than reach the undiagnosed; a negative HIV test provides an opportunity to discuss and offer prevention strategies: regular testing, condom use, post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP). These options, combined with treating diagnosed HIV, provide the tools to eliminate new HIV transmissions now, but this cannot be achieved without marked improvement in HIV testing.
Therefore, the key message in the final report of the independent HIV Commission, established after the then Health Secretary’s pledge to end new cases of HIV in England by 2030, was ‘test, test, test!’
Routine HIV testing does more than reach the undiagnosed; a negative HIV test provides an opportunity to discuss and offer prevention strategies.
Improving routine testing
The HIV Commission’s recommendations are not new, but a renewed call to follow existing guidance from specialist societies and the National Institute of Health and Care Excellence (NICE.)
Routine emergency department and primary care testing in high prevalence areas is not happening consistently, nor is routine testing in people with conditions indicative of a higher likelihood of HIV.
Yet those of us working in the specialty cannot preach when too many people leave our own sexual health services without being offered an HIV test, adding to an already unacceptable catalogue of missed opportunities.
Reducing the stigma
Stigma is a major barrier to testing so we must educate, using materials written and distributed with input from affected communities. Also normalising HIV testing across healthcare, which could play a major role in reducing stigma, is an urgent priority. The incredibly high uptake yielded by opt-out antenatal HIV testing is testament to what normalised testing can achieve.
We must ensure all health care workers are trained to offer testing non-judgementally, and pathways for managing reactive results and onward referrals are seamless, embedding HIV testing in all health sectors.
The opportunity to eliminate new cases of a long-term condition is a rare one. We have the tools now but the first step to effective HIV treatment or prevention is to test, test, test.
