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Doctors Call for Opt-out Approach to HIV Testing

In this weeks BMJ, two groups of public health doctors argue for routine opt-out HIV testing in healthcare settings such as general practice surgeries, accident and emergency departments and hospital wards.

In the first article, Professor Harold Jaffe and colleagues say that a third of people in the UK with HIV do not know they have the virus, yet UK guidelines recommend opt-out testing only for pregnant women and people attending genitourinary (GUM) clinics.

They argue that routine opt-out testing would not only give a more accurate picture of how many people have HIV, but would cut infection rates, lessen the stigma surrounding testing and reduce the number of people being diagnosed in the later stages of HIV.

They point to America where guidelines from the Centres for Disease Control and Prevention now recommend voluntary opt-out testing as the standard of care for people aged 13-64 years, unless the prevalence of HIV is less than 0.1% of the population.

They say programmes for routine screening have been instituted in emergency departments and urgent care centres at several US hospitals and yielded relatively high rates of previously undiagnosed HIV infection.

About 20,000 UK residents between the ages of 15 and 59 were living with undiagnosed HIV infection in 2005.

Surveys of gay men attending GUM clinics in the same year showed the prevalence of undiagnosed HIV was 3.2%. In women of childbearing age that prevalence was much lower (0.09%), but was highest in women from sub-Saharan Africa (2.4%).

The authors therefore call for surveys to be carried out in areas of known increased HIV prevalence and in facilities that are known to serve people at increased risk of infection. This would provide the necessary data to inform a discussion of expanding opt-out HIV testing.

In view of the clear advantages of early diagnosis of HIV infection
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