Analysis

Time to move towards opt-out testing for HIV in the UK

BMJ 2007; 334 doi: 10.1136/bmj.39218.404201.94 (Published 28 June 2007)
Cite this as: BMJ 2007;334:1352

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  1. M Hamill, specialist registrar1,
  2. K Burgoine, medical student2,
  3. F Farrell, medical student2,
  4. J Hemelaar, medical student2,
  5. G Patel, medical student2,
  6. D E Welchew, medical student2,
  7. H W Jaffe, professor3
  1. 1Department of Genitourinary Medicine, Mortimer Market Centre, Camden Primary Care Trust, London
  2. 2University of Oxford Clinical School, Oxford
  3. 3Department of Public Health, University of Oxford, Oxford OX3 7LF
  1. Correspondence to: H W Jaffe, Harold.jaffe{at}dphpc.ox.ac.uk
  • Accepted 4 April 2007

M Hamill and colleagues believe the UK could do more to ensure people know their HIV status

The diagnosis of HIV infection is the point of entry to prevention and treatment services. Yet many people are unaware that they are infected. The estimated proportion of people who remain undiagnosed ranges from 90% in sub-Saharan Africa, to one third in the United Kingdom, and a quarter in the United States.1 2 3 The Secretary General of the United Nations declared in 2006 that “Countries should promote, through global and national campaigns, the ideal that each person knows his or her HIV status and has access to AIDS information, counselling and related services, in a social and legal environment that is supportive and safe for confidential testing and voluntary disclosure of HIV status.”4 We consider how the UK should respond to this challenge.

Strategies for testing

HIV tests are usually done as part of diagnosis—in patients with signs or symptoms suggestive of HIV disease— or to screen for infection in people without symptoms. Most screening is done at the patient's request or because a healthcare worker judges a patient to be at increased risk for HIV infection and seeks consent for testing.

One way to increase knowledge of HIV infection status is to use an opt-out approach to testing. This approach, which is also voluntary, considers HIV testing to be a standard part of medical care for particular patient populations. The populations are defined by variables that serve as surrogates for HIV prevalence or risk of HIV infection—for example, age, geographical area, country of origin, and healthcare setting. No judgment is made about an individual patient's risk of infection. Patients are given information about HIV, how the test will be carried out, and are tested unless they specifically decline. Extensive pretest counselling is …

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