Experience in the UK

The number of new diagnoses of HIV in the UK is increasing, with most new diagnoses reported in men who have sex with men (MSM) and black African heterosexuals the later of whom usually acquire their infection abroad. Around 31% of people infected with HIV in the UK are unaware of their diagnosis, and one in three are diagnosed for the first time with a CD4 count <200 cells/mm³ or with AIDS. Late diagnosis is the most important factor that explains most HIV-related causes of death in the UK. Strategies to increase HIV-testing include universal approaches in antenatal and STD clinics (known as genitourinary [GU] medicine clinics), but other opportunities for prompt diagnosis are often missed during secondary and primary consultations - even when patients present with HIV-related illnesses. Furthermore, a significant proportion of people with undiagnosed HIV who attend GU medicine clinics leave without being offered an HIV test or a diagnosis of HIV. Universal offer (opt-out testing) policies seem to work well - such as in the successful antenatal testing programme - but local strategies to increase HIV-testing and prompt diagnosis, such as training courses and rapid HIV-testing initiatives have met with varied success. New national guidelines for the UK have been published and, if successfully implemented, should help to address some of these issues.