Testing times for HIV

Vaccines are key instruments of public health through which infectious diseases are controlled, but no vaccine is yet on the horizon to prevent HIV infection and control the epidemic, now in its fourth decade. So other, less tried, routes need to be pursued. There is a single example in global public health of the elimination of an infectious disease at a continental level without a vaccine—that of the control of the endemic trepanematoses (yaws, bejel, and pinta) through active case finding and widespread use of benzathine penicillin.1 For antiretroviral therapy to be similarly successful, ever larger proportions of the HIV positive population will need to be identified. This relies on enhanced HIV testing, and in a linked article (doi:10.1136/bmj.f5086), Read and colleagues investigate whether the provision of home HIV testing to men who have sex with men attending a health service would increase their frequency of HIV testing over time.2

Antiretroviral therapy, which has transformed the lives of HIV infected patients, is now the focus of intense investigation as a preventive agent, with strategies for both infected and uninfected populations. But can antiretroviral therapy control the HIV epidemic …