One of our strategic goals is to achieve early diagnosis of HIV through ethical, accessible and appropriate testing.
Priorities for HIV testing
HIV testing rates amongst the groups most affected, including gay and bisexual men and black African men and women, are still far too low, with only just over half ever having had an HIV test. We therefore want to see a change in testing culture - with at least annual testing becoming the norm for gay and bisexual men and over 80 per cent of African men and women having had an HIV test. This will require sustained funding for initiatives to reduce undiagnosed HIV.
One in three people are currently being diagnosed late - after the point at which they should have begun treatment - which seriously increases the likelihood of a poor response to treatment and early death. To address this we want to see the provision of training for health professionals so that they recognise the early symptoms of HIV infection. A review is needed of existing testing messages to ensure that they reflect current practice and there is an appropriate emphasis on early and regular testing.
HIV Testing Action Plan
In 2009 NAT developed an action plan to increase uptake of HIV testing and reduce late diagnosis in the UK. The plan provides an overview of NAT’s thinking on current HIV testing strategies in the UK. It also identifies priority activities to increase political will, commitment and resources from a wide range of stakeholders to support the roll-out of HIV testing beyond GUM and antenatal settings, in light of the new national HIV testing guidelines.
This includes a recommendation that the National Screening Committee consider what aspects of the new national HIV testing guidelines could be adopted as a National Screening Programme for HIV.
NAT is advocating for this recommendation and the other activities identified in the plan to be taken forward. Read the HIV Testing Action Plan.
National Guidelines for HIV Testing
In 2008 BHIVA, BASHH and BIS jointly produced national guidelines for HIV testing. The guidelines are intended to increase HIV testing in all healthcare settings in order to reduce the level of undiagnosed HIV in the UK.
The Guidelines recommend that universal HIV testing is offered in the following settings:
- GUM or sexual health clinics
- antenatal services
- termination of pregnancy services
- drug dependency programmes
- healthcare services for those diagnosed with tuberculosis, hepatitis B, hepatitis C and lymphoma
They also recommend that HIV testing should be considered for everyone registering with a GP and all general medical admissions to hospital in areas with a high prevalence of HIV. For a list of high prevalence areas see the HPA website:
In addition, HIV testing is recommended for anyone who presents with any in a list of specified clinical indicator conditions. For example:
- Peripheral neuropathy
- Severe psoriasis
- Chronic diarrhoea of unknown cause
- Anal Cancer
- Lung Cancer
- Hodgkin's Lymphoma
The Guidelines also provide recommendations on the frequency of testing, the type of test used, pre and post-test discussions and suspected primary infection.
You can download a full copy of the guidelines here: http://www.bhiva.org/HIVTesting2008.aspx
NAT was represented on the writing group from the Guidelines.
NICE Guidance on HIV testing for MSM and black African communities
In March 2011 NICE published two sets of public health guidance on increasing the uptake of HIV testing to reduce undiagnosed infection and prevent transmission among MSM and black African communities in the UK.
The Guidance recognises and endorses the recommendations of the UK National Testing Guidelines, including that HIV testing should be offered to everyone in certain settings and that in areas of high HIV prevalence a HIV test should be considered for everyone when registering with a GP or being admitted to hospital.
The Guidance makes detailed recommendations for healthcare professionals, commissioners and managers as to assessing local need, planning services, promoting testing and offering testing in specialist services, primary and secondary care. They also make recommendations on outreach, testing in community settings, community engagement and reducing barriers to testing.
Download the guidance here:
Time to test pilots
The Department of Health have been running pilot projects looking at the feasibility and acceptability of offering HIV tests as routine when registering with a GP or being admitted to hospital in a areas with a high prevalence of HIV.
The Health Protection Agency conducted an evaluation of these pilots, and has found that testing in these setting was generally feasible and acceptable to both staff and patients. The pilots also diagnosed a number of previously undiagnosed HIV infections.
An interim report on the pilots is available on the HPA website: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1287145269283 and a final report is expected in 2011.
Testing Information for Gay Men
It is now recommended that sexually active gay men (or men who sometimes have sex with other men) have an HIV test at least once a year. NAT, in partnership with GMFA and BASHH and with support from the Health Protection Agency, produced a leaflet to explain to gay men why having regular HIV tests is important and to explain how they can have a test.
The leaflet was funded by the Department of Health and made available to Sexual Health Clinics. The artwork of the leaflet is now freely available for anyone that would like to print the leaflets for distribution. For further information contact policyandcampaigns@nat.org.uk.
Primary HIV infection
NAT has launched a new report, Primary HIV Infection: knowledge amongst gay men, following a survey of over 8,000 men carried out with Gaydar.
The results show that over 60% of gay men incorrectly believe there are no symptoms of primary HIV infection and when presented with a list of symptoms only just over a third correctly identified the most commonly experienced combination of symptoms: sore throat, fever and rash.
Awareness of primary HIV infection must be increased amongst those at risk of HIV. It is important people know what the common symptoms are and know to ask for an HIV test. Knowledge amongst GPs must also be improved so they are able to identify potential HIV infections early.
Early diagnosis of HIV is very important, both in terms of preventing onward transmission and in terms of maximising the long-term health of people once infected. New research reported in July 2011 at the International AIDS Society Conference in Rome suggests there could be life-long health benefits for people with HIV if they undertake a short period of anti-HIV treatment during the very early stage of HIV infection.
Read our report to find out more.
In 2008 NAT held an expert seminar on primary HIV infection. We found conclusive evidence that symptoms of early-stage HIV infection (clinically known as 'primary HIV infection') are being commonly missed by people who are infected, by doctors and by other healthcare professionals. The seminar report contains a series of recommendations that include:
- encouraging anyone who suspects they have symptoms of primary HIV infection to seek clinical advice
- making the latest testing technologies including fourth generation assays consistently available in all laboratories testing for HIV
- providing healthcare workers training to recognise risks and symptoms related to primary HIV infection.
Read the report Primary HIV Infection.
Improving HIV testing
In 2007 NAT held an expert seminar to look at ways of improving HIV testing and prevention in England. The seminar report contains our recommendations on encouraging increased rates of early HIV diagnosis through ethical, accessible and appropriate HIV testing. Improving access to testing within GUM clinics, offering testing in other settings, offering a variety of methods of HIV testing and reducing the stigma around taking a test are all ways that could improve testing uptake and reduce late diagnosis.
Read the seminar report Updating our Strategies which outlines the key discussions that took place and presents NAT's recommendations for improving HIV prevention and testing in England.
See the seminar presentations.
Home sampling and self-testing
Relatively new forms of HIV testing are home sampling, in which people can take a sample at home and send it away to be tested in a laboratory, and self-testing, still illegal in the UK, which allows people to test and find out the results at home within minutes. NAT developed a briefing with information about home sampling and self-testing, as well as our views and recommendations. Read the briefing Home Testing for HIV.
To find out more about getting an HIV test please visit our HIV Facts section.
To share your thoughts and experiences on HIV testing please contact policyandcampaigns@nat.org.uk