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Normalise HIV testing to stop spread of infection

Universal HIV testing would destigmatise the process and save lives

OnMedica Staff

Wednesday, 30 September 2009

Doctors have called for HIV testing to become more socially acceptable and widespread because, they write in the Royal College of Physicians’ journal Clinical Medicine, such normalisation of testing would avoid a third of HIV-related deaths.

The authors of the new concise guidance, summarised from the British HIV Association’s 2008 guidelines, point out that about a third of HIV-positive adults in the UK don’t know their HIV status, even though many of them have recently seen a health professional. Not knowing that they are infected with the virus puts their own health at risk and risks them passing the virus onto others.

Most people diagnosed and treated early remain fit and well, but those who present late have greatly increased morbidity and mortality. In the UK a quarter of newly diagnosed individuals already have a CD4 count below 200, a marker of late diagnosis, and in 2006, almost a quarter of total deaths in the UK from HIV were directly attributable to diagnosis being made too late for treatment to be effective.

Knowing one’s HIV-positive status is associated with less risky behaviour. More than half of new HIV infections, in the US at least, are transmitted from individuals who did not know they were HIV-positive.

Uptake of HIV testing is increased when it is an opt-out rather than an opt-in decision, so the physicians want to introduce routine testing to destigmatise the process. The guidance says that testing should remain voluntary and confidential, but it should be offered to everyone accessing sexual health services, antenatal and abortion services, drug dependency programmes, and healthcare services for people diagnosed with tuberculosis, hepatitis B and C and lymphoma.

The authors say that any doctor, midwife, nurse or trained healthcare worker should understand when testing is recommended – which is clarified in the guidance – and be able to obtain consent for and to conduct an HIV test themselves.

Meanwhile, the World Health Organization reported yesterday that the number of people in low- and middle-income countries who are receiving antiretroviral treatment rose by 36 per cent over 2008, to 4 million. The number of health facilities providing HIV testing and counselling rose 35 per cent in the same period, news that is welcomed by the United Nations Programme on HIV/AIDS.

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