Time to Test for Under 25s

posted: 04/01/2011

All young people under-25 should be offered HIV tests as part of everyday healthcare when visiting hospital or seeing their GP, say sexual health charities.

New figures show 13,000 people under 25 in the UK have HIV. Leading sexual health charities, like BASSH and NAM, told the BBC they want routine HIV tests to be provided, no matter what the young person’s race, gender, sexuality or postcode.

Making HIV testing part of ordinary healthcare routines would mean more young people are diagnosed in good time. HIV treatments do not work well when people are diagnosed late, and late diagnosis is a big problem in North West England.
 

Aaron's story 

Currently only the people considered most at risk, like gay men, black Africans living in the UK or drug users who share injecting kit, are normally offered HIV tests. This ignores some people, like Aaron.
 

Aaron, 25, lives in Birmingham, is happily married with two kids and is HIV positive. He only found out after he started to feel run down in September 2009.
"I can always remember the day I got diagnosed - the ninth of the ninth '09. It started off thinking that I had swine flu and they gave me the Tamiflu tablets."
Aaron had a sore throat and a fever and was showing all the symptoms of HIV, but didn't know it. "It didn't actually come across the doctor's mind to put me in for an HIV test or anything else like that. It was only when I started getting a rash below that I was quite concerned and I didn't want my Mrs to find out."
 

Routine HIV testing of people under 25
If proposals for routine testing of under 25s go ahead, under-25s would be asked to take a HIV test during any GP visit or hospital treatment. Dr Steve Taylor is leading consultant at Birmingham's Heartlands HIV Service and he told the BBC: "One of the reasons that GPs and doctors don't often offer HIV tests is that we have a perception of what someone with HIV looks like. The average person on the street, like Aaron, just doesn't feature on the radar."
 

Aaron says he's thankful he was eventually offered a blood test. "The doctors put it off by giving me antibiotics, but I thought this isn't right. So I called NHS Direct and they actually referred me to get a routine blood test, which I'm happy I did otherwise I don't know where I'd be today." Being a heterosexual male with a wife and kids, doctors had previously missed the opportunity to test Aaron. "Back in the day I used to be a bit of a player and sleep with people without protection", he admits. Aaron is living a normal life and takes HIV treatments daily - he's just relieved he didn't infect his wife. "It was disturbing having to tell my wife that I have HIV. I was worried she'd think I was sleeping around. It's a miracle that she hasn't got it and I feel pleased that I haven't passed it on."
 

Pilot testing trials
In November 2009, several pilot HIV screening programmes were run as trials in Brighton (with its many gay men), Leicester, and in Lewisham (south-east London and with a large black African population). The Department of Health will now consider the Time to Test report from the Health Protection Agency on the results of these trials, and decide what to do. 

Time to Test recommendations to the government

• HIV testing in primary care and general medical admissions must be prioritised in areas with a high diagnosed HIV prevalence (i.e. more than 2 people in 1,000 15-59 year olds) and among most at-risk populations, in order to reduce late diagnoses and the proportion who are undiagnosed.
• Efforts are required to increase the uptake of HIV testing among people attending sexually transmitted infection (STI) clinics and to maintain high uptake of HIV testing among women attending for antenatal care.
• Community HIV testing services need to be appropriately targeted and established with strong community representation. To be successful these initiatives require long term commitment.
• Strong links between HIV specialist services and primary care, hospital and community projects are essential for immediate continuity of care for newly diagnosed patients. Particular attention should be paid to prompt referral of patients newly diagnosed in primary care and community services to minimise loss to follow-up.
• Economic evaluations, including cost-effectiveness studies, are needed to determine the best strategies to expand HIV testing in each of these settings.
• Concerted effort and ongoing resources (both human and financial) are needed to sustain successful projects beyond the research and pilot stages.
   

Time to Test report and recommendations (December 2010)

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HIV and people under 25 in NW England

 

• By the end of 2009, there were 333 people under 25 diagnosed with HIV living in NW England
• Three quarters (248 out of 333) of the young people living in NW England got HIV sexually, as teenagers and young adults. Sex education around HIV is clearly not working for hundreds of young people. Almost all the other young people became HIV positive as a baby, from their mother 
• One in three of the 15 - 19 year olds got HIV through sex (most of those diagnosed between 15 and 19 were infected as babies - very few 15 - 19 year olds take HIV tests)
• Almost all the 213 young people between 20 and 24 years old got HIV sexually (only 9 got HIV in any other way)
• Around half the teens and young adults who got HIV sexually are bi and gay men, and the other half are heterosexual women and men (three quarters of the heterosexually infected people are young women)
• Most of the young gay and bi men with HIV are white, with around 5% having an ethnic minority background; most of the heterosexually infected young people have an ethnic minority background, with a minority who are white.
   

This analysis comes from figures in Tables 3.1 and 3.5 of the 2009 report on HIV in NW England. 

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Halve It campaign
One in four people living with HIV in the UK is unaware they have the infection and therefore unable to access potentially life-saving treatment. Halve It is a new joint campaign aiming to halve, within five years, the proportion of people living with undiagnosed HIV infection and the proportion of people diagnosed late with HIV. The campaign is led by a coalition of HIV and healthcare experts, including MedFASH.
 

The Halve It position paper Early Testing Saves Lives calls on government nationally and locally to make HIV a public health priority. It was launched on World AIDS Day at the Time to Test for HIV multidisciplinary conference, by British HIV Association Chairman, Dr Ian Williams and MedFASH Chief Executive, Ruth Lowbury.

Early Testing Saves Lives    MedFash report for the national Halve It campaign

Time to test for HIV - videos and pdf files of all the presentations. Includes reports of the Brighton, Leicester and Lewisham HIV testing trials 
 

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