Answers in Untested Mystery
posted: 12/04/2011
HIV experts in England are puzzled why some people using STI clinics refuse HIV tests. We know for sure that some of those refusing HIV tests do have HIV (from using blood from samples given for syphilis tests and after the syphilis test is done and the blood sample is made completely anonymous, it can be tested for HIV).
The 2009 results from doing this show that 2.4% of gay and bisexual men and 0.25% of heterosexuals tested for syphilis came to the sexual health clinic with undiagnosed HIV.
But only 63% of these people agreed to a HIV test at the STI clinic - much lower than the average rate of HIV testing for people using STI clinics.
Why are so many people who have ‘undiagnosed’ HIV, refusing HIV tests?
One quarter must already know they have HIV - they are taking HIV treatment !
Some useful answers to the testing mystery have now emerged. Now we know that around a quarter of people with ‘undiagnosed’ must know they have HIV, because blood tests prove they are taking HIV treatment. These and other results, given at the British HIV Association conference in Bournemouth last week, are the first clear evidence of some answers to the ‘undiagnosed’ mystery.
Slightly more heterosexual women and men (32% for both men and women) than gay men (24%) are using a different clinic for STI checks than for their HIV treatment. Experts thought gay men with HIV were more likely to go elsewhere for HIV checks than heterosexuals. Experts don’t always guess right. Some people with HIV have told community organisations and patient advocates that one reason they go elsewhere for testing is to avoid unwanted, intrusive or judgemental discussion of their sexual behaviour by their own HIV clinic.
The results means
- 9 in 100 of the gay and bisexual men who said yes to a syphilis test but no to a HIV test have HIV. At least 2 of those 9 are on treatment but didn’t tell the STI clinic they have HIV
- 8 in 1000 of the heterosexual women and men similarly are HIV positive. At least 2 of those 8 are on treatment but did not tell the STI clinic they have HIV.
These findings will make little difference to national estimates of how much undiagnosed HIV there is in the country.
Why do gay men who don’t yet know they have HIV refuse HIV tests?
Another small study given to last weeks conference looked at why some gay men refuse HIV tests. Researchers gave an anonymous questionnaire to 19 men who didn’t want to be tested, even though they had had anal sex without condoms and have, either never been tested, or had taken anal sex risks since their last HIV test.
The men could tick more than one reason.
15 of the 19 men said they believed they were at low risk of HIV infection [2 of the 19 men knew their partner has HIV]
- 14 said they were emotionally unprepared for a positive result
- 4 said they don’t like giving a blood [but nonetheless gave this to have the syphilis test]
- 4 also mentioned prosecutions for HIV transmission
- 4 said they were planning to test 'next month'
- 3 mentioned worries about the confidentiality of the HIV test result.
Testing Advantages well known
Most of the men know the advantages of HIV testing
- 16 said testing could give peace of mind
- 16 said testing allows treatment to start at the best time.
Testing worries rule
But all the gay men listed the disadvantages to them of HIV testing.
- 17 said testing was stressful
- 8 were worried about having to tell a boyfriend if they were positive
- 7 were concerned about the insurance and mortgage implications.
Unready for positive result, testing stress, in denial about risks
So most of these gay men didn’t feel emotionally ready to deal with a positive result, and find HIV testing stressful.
- Most thought their HIV risk was low, despite having taken enough risks to have got HIV and needing to visit an STI clinic.
The study authors suggest investigating ways of overcoming gay men’s resistance to testing at STI clinics.
Source
Reference – the free conference abstracts - read O13 & P152
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