HIV testing no longer needs special status

Before highly active antiretroviral therapy (HAART) was introduced, the advantages to infected individuals of knowing their HIV status were minimal, and counselling before HIV testing was the recommended practice.1 This usually limited testing by relying on people who were obviously at risk presenting themselves for testing. Such groups included injecting drug users and men who have sex with men and their sexual contacts. Targeting of these groups will become an increasingly less useful concept as HIV continues to spread into the population that is conventionally not at risk.

Do we need to reconsider if routine voluntary counselling and testing is appropriate today? Since 1991 heterosexual transmission of HIV has been the most common mode of transmission in the United Kingdom.2 Currently, nearly half of those infected heterosexually and a quarter of infected men who have sex with men in the United Kingdom are undiagnosed.3 A quarter of newly diagnosed patients in the United Kingdom in 2002 were diagnosed late with serious immunosuppression.3 Unless further initiatives are undertaken the epidemic will worsen. Possible initiatives would be to lower thresholds for HIV testing by reducing the emphasis on pre-test counselling.

Reasons for low HIV testing rates and thus low detection …