1. Key messages
Antiretroviral therapy (ART) has transformed treatment of HIV infection
The benefits of early diagnosis of HIV are well recognised - not offering HIV testing represents a missed opportunity
Over 25% of HIV-positive individuals remain undiagnosed, accounting for 54-70% of transmission
39% of HIV-positive heterosexuals are not diagnosed until their CD4 cell count falls below 200
In 2005, 24% of deaths in HIV-positive adults were attributable to late HIV diagnosis
In one study, 62% of late diagnoses had been seen in secondary care in the previous 2 years, 26% with an HIV related problem

2. Key messages
UK recommend screening for HIV in adult populations where undiagnosed prevalence is >1/1000 as it has been shown to be cost-effective
UK guidelines recommend routine opt-out HIV testing for patients with <insert relevant condition>
UK guidelines recommend universal HIV testing for patients from groups at higher risk of HIV infection
A perceived lack of risk should not deter you from offering a test when clinically indicated
Some patients may not disclose that they have put themselves at risk of HIV infection in the past
Bullet 2: see ‘Table 1: Clinical indicator conditions for adult HIV infection’ in the UK National Guidelines for HIV Testing 2008 for a full list.

3. Tackling HIV Testing Project Advisory Group
Dr Mary Armitage (Chair), Immediate Past Clinical Vice-President, Royal College of Physicians, Consultant Physician & Endocrinologist, Royal Bournemouth Hospital Dr Nick Beeching, Clinical Lead, Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital Dr Christine Blanshard, Consultant Physician and Gastroenterologist, Homerton Hospital, London Dr Gary Brook, Consultant in Genitourinary Medicine, Central Middlesex Hospital, London Professor Chris Bunker, Consultant Dermatologist, Chelsea & Westminster and Royal Marsden Hospitals, Imperial College London Professor Jackie Cassell, Chair in Clinical Epidemiology, Brighton and Sussex Medical School Dr Martin Fisher, Consultant in HIV/Genitourinary Medicine, Brighton and Sussex University Hospital Dr Susie Forster, Consultant in Genitourinary Medicine and Clinical Lead for Sexual Health, Cambridgeshire Community Services Professor Margaret Johnson, Professor of HIV Medicine, Royal Free Hospital, London Ms Ruth Lowbury, Chief Executive, MedFASH Professor Rob Miller, Consultant Physician and Reader in Clinical Infection, University College Hospital, London Ms Angelina Namiba, Project Manager, Primary Care Access, Positively Women Mr Charles Oduka, Chair, African HIV Policy Network Dr Ed Ong, Consultant in Infectious Diseases, Newcastle General Hospital Ms Kay Orton, Policy Lead for HIV Services, Department of Health Dr Adrian Palfreeman, Consultant in Genitourinary Medicine, Leicester Royal Infirmary Dr Angela Robinson, Consultant in Genitourinary Medicine, University College Hospital, London Dr Murad Ruf, Assistant Director Health Protection, Consultant in Public Health Medicine, NHS Lambeth Ms Heather Wilson, Senior Health Adviser, Barnet Hospital, London

4. Tackling HIV Testing Project Contributors
MedFASH is grateful to the following colleagues who contributed cases and materials to the project:
Dr Rachel Baggaley, Dr Rachel Baggaley, Head of HIV and Health at Christian Aid, Honorary Research Fellow at the London School of Hygiene and Tropical Medicine and working in primary health care in Lambeth PCT
Dr Nick Beeching, Clinical Lead, Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital
Dr Christine Blanshard, Consultant Physician and Gastroenterologist, Homerton Hospital, London
Dr Gary Brook, Consultant in Genitourinary Medicine, Central Middlesex Hospital, London
Professor Chris Bunker, Consultant Dermatologist, Chelsea & Westminster and Royal Marsden Hospitals, Imperial College, London
Dr Kate Cwynarski, Consultant Haematologist, Royal Free Hospital, London
Dr Martin Fisher, Consultant in HIV/Genitourinary Medicine, Brighton and Sussex University Hospital
Dr Susie Forster, Consultant in GUM and Clinical Lead for Sexual Health, Cambridgeshire Community Services
Professor Rob Miller, Consultant Physician and Reader in Clinical Infection, University College Hospital, London
Dr Adrian Palfreeman, Consultant in Genitourinary Medicine, Leicester Royal Infirmary
Dr Conal Perrett, Dermatology Department, Chelsea & Westminster Hospital, London
Dr Alison Rodger, Department of Infection and Population Health, University College London and HIV Department, Royal Free Hospital, London

5. Also contains UK National Guidelines for HIV Testing 2008
from BASHH/BHIVA/BIS
Available from: or

6. Available from enquiries@medfash.bma.org.uk,or

7. Who can test?

8. Who to test?

9. Who to test?

10. Source: Health Protection Agency, www.hpa.org.uk
Table: PCTs in England in 2007 with diagnosed HIV prevalence 2/1000 population (adults aged years)
Source: Health Protection Agency,

11. Source: Health Protection Agency, www.hpa.org.uk
Rates of HIV-infected persons accessing
HIV care by area of residence, 2007
Only 6 PCTs in London do not meet the HPA definition of high local HIV prevalence.
Full information can be found at
Source: Health Protection Agency, 11

12. Who to test?

13. HIV prevalence (%) in adults (15–49) in Africa, 2007
Countries of higher HIV prevalence
HIV prevalence (%) in adults (15–49) in Africa, 2007
2008 Report on the
global AIDS epidemic
Source: UNAIDS Global Report 2008,

14. Countries of higher HIV prevalence
2008 Report on the
global AIDS epidemic
HIV prevalence (%) in adults (15–49)
in Eastern Europe and Central Asia, 2007
Source: UNAIDS Global Report 2008,

15. HIV prevalence (%) in adults (15–49) in Asia, 2007
Countries of higher HIV prevalence
HIV prevalence (%) in adults (15–49) in Asia, 2007
2008 Report on the
global AIDS epidemic
Source: UNAIDS Global Report 2008,

16. Who to test?

17. Which test to use?

18. Q: What should be a reasonable time to receive an HIV test result?