Expanding HIV testing in the UK

There is room for an improvement in testing and diagnosis rates in the UK. In 2009, the UK’s Health Protection Agency¹ (HPA) estimated that one-third of people newly diagnosed with HIV in the UK had a CD4 count below 200 cells/mm³ and were therefore at high risk of AIDS. In addition, studies have estimated that people with CD4 counts below 200 cells/mm³ are five to six times more likely to transmit HIV per sexual act than people in chronic infection with higher viral loads.²

In their report for 2008, the HPA expressed concern about the high proportion of patients who only had their HIV infection detected when their CD4 cell count was below 200 cells/mm³: 32% had a CD4 cell count below this level at the time of their diagnosis in 2008 and 55% had a CD4 cell count below 350 cells/mm³, the levels at which guidelines recommend the start of treatment. The HPA estimates that 27% of people with HIV in the UK are undiagnosed.

Although by definition people with acute HIV infection are not always easy to identify, a study presented at the 2008 BHIVA Conference found that 2.5% of male patients aged 18 to 50 reporting to hospital A&E departments with flu-like symptoms in the high-prevalence town of Brighton in fact had HIV.³

Although testing rates in gay men in the UK have considerably increased in the last few years (see below), a study published in 2008 found that, among gay men tested anonymously in commercial gay venues, 40% of men with HIV were unaware that they were infected. Sixty per cent of these men were ‘sure’ they were HIV negative.⁴ Researchers estimated that 40% of the undiagnosed men had had sex with someone who was definitely or probably HIV-negative.

Because sexually active gay men have high HIV-incidence rates (in the region of 2 to 4% a year), the Health Protection Agency recommends that they have an HIV test at least once a year, reiterating advice given by the Chief Medical Officer as long ago as 2004.⁵

Rates of HIV testing in the UK are increasing. In 2008, 100,000 HIV tests were performed in sexual health clinics and, overall, 93% of patients attending such clinics are now tested for HIV.

Data from the last UK Gay Men’s Sex Survey (GMSS), collected in 2007,⁶ show that, by that year, two-thirds of gay men in the UK had taken an HIV test at least once, a rise from below 50% in 2002.

In 2001, 46% of men had ever taken an HIV test. This rose to 49% in 2002, before rising steadily to 62% in 2006 and 66% in 2007.

The men least likely to have ever had an HIV test were of white British or Asian ethnicity, younger, not in a relationship, and tended to live away from the larger gay cities.

As the number of men ever tested has increased, the proportion of men diagnosed with HIV has too. It has risen from 4% in 2001 to just under 10% in 2007.

HIV testing rates in Scotland have tended to lag behind England and Wales but show promising signs of now having caught up or even overtaken them. A gay men’s survey conducted in 2008⁷ showed that three-quarters of respondents reported ever having had an HIV test. Between 2005 and 2008, recent HIV testing increased from 33 to 48%. Among HIV-positive men, there was a reduction in undiagnosed infection between 2005 and 2008 from 42 to 26%.