Skip to main content

Main menu

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • RESOURCES
    • About BJGP
    • Conference
    • Advertising
    • BJGP Life
    • eLetters
    • Librarian information
    • Alerts
    • Resilience
    • Video
    • Audio
    • COVID-19 Clinical Solutions
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio

User menu

  • Subscriptions
  • Alerts
  • Log in

Search

  • Advanced search
British Journal of General Practice
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
  • Listen to BJGP podcast
Advertisement
British Journal of General Practice

Advanced Search

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • RESOURCES
    • About BJGP
    • Conference
    • Advertising
    • BJGP Life
    • eLetters
    • Librarian information
    • Alerts
    • Resilience
    • Video
    • Audio
    • COVID-19 Clinical Solutions
Letters

How can we remove barriers to HIV testing outside of a GUM setting?

Tristan J Barber, Anatole Menon-Johansson and Simon Barton
British Journal of General Practice 2008; 58 (550): 365. DOI: https://doi.org/10.3399/bjgp08X280308
Tristan J Barber
St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust, London. E-mail:
Roles: Specialist Registrar GUM/HIV
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: simon.barton@chelwest.nhs.uk
Anatole Menon-Johansson
St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust, London. E-mail:
Roles: Specialist Registrar GUM/HIV
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: simon.barton@chelwest.nhs.uk
Simon Barton
St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust, London. E-mail:
Roles: Clinical Director HIV/GUM Directorate
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: simon.barton@chelwest.nhs.uk
  • Article
  • Info
  • eLetters
  • PDF
Loading

Approximately 32% of patients infected by HIV in the UK remain undiagnosed.1 Delayed HIV diagnosis is responsible for HIV presentation at lower CD4 T-cell count and such patients respond less well to antiretroviral therapy.2 At least 35% of HIV-related deaths in 2005/6 in the UK were attributed to late diagnosis of infection.3 Furthermore, delays in HIV diagnosis and initiation of antiretroviral therapy contribute to horizontal and vertical transmission of HIV infection.4,5

A recent study examined the factors which were significantly associated with GUM clinic patients (not exclusively attending for HIV testing) agreeing to GP contact. These factors included heterosexual orientation, initial GP referral, and not considering HIV testing to have negative implications for future mortgage and life insurance applications.6

Two factors have been reported to us that impair the ability of non-genitourinary practitioners, both in primary care and other specialist care settings, to perform HIV testing. The first is pre-test counselling. We would argue that, as in other disease areas, the pre-test counselling is no longer necessary as there are clear health benefits in knowing about an HIV diagnosis which outweigh perceived disadvantages. This is consistent with a general move towards ‘opt out’ HIV testing in GUM clinics and antenatal services.7 In rare, high risk, or acutely unwell cases, pre-test counselling may be the preferred option, but for the majority of patients it is not required. The second barrier cited is that of transparency about HIV testing for insurance company medical reports. However, the GP and insurance applicants are not required to notify insurers when negative tests are performed.8

The life expectancy of a 25-year-old HIV-positive person, who is hepatitis C negative, has been estimated to be greater than 35 years9 and this will increase as newer anti-retroviral drugs become available. Like other chronic and manageable conditions, an early diagnosis is essential to maximise individual and community health but this can only be achieved by the removal of barriers to widespread HIV testing across all hospital departments and primary care. We urge that the earlier diagnosis of HIV infection is made a clear priority and that the role of specialist genitourinary clinicians to enable better training, clear referral pathways, and the destigmatisation of testing in all care settings are key parts of the development of local sexual health networks.

  • © British Journal of General Practice, 2008.

REFERENCES

  1. ↵
    1. UK Collaborative Group for HIV and STI Surveillance
    (2006) A complex picture. HIV and other sexually transmitted infections in the United Kingdom: 2006 (Health Protection Agency, Centre for Infections, London).
  2. ↵
    1. Palella FJ Jr.,
    2. Deloria-Knoll M,
    3. Chmiel JS,
    4. et al.
    (2003) Survival benefit of initiating antiretroviral therapy in HIV-infected persons in different CD4+ cell strata. Ann Intern Med 138:620–626.
    OpenUrlCrossRefPubMed
  3. ↵
    1. Johnson M,
    2. Skinner C,
    3. O' Mahony C
    Mortality Audit. BHIVA Audit and Standards Sub-Committee. http://www.bhiva.org/files/file1001379.ppt (accessed 14 Apr 2008).
  4. ↵
    1. Wawer MJ,
    2. Gray RH,
    3. Sewankambo NK,
    4. et al.
    (2005) Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda. JID 191:1403–1409.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Pilcher CD,
    2. Tien HC,
    3. Eron JJ,
    4. et al.
    (2004) Brief but efficient: acute HIV infection and the sexual transmission of HIV. JID 189:1785–1792.
    OpenUrlCrossRefPubMed
  6. ↵
    1. Fernando I,
    2. Clutterbuck D
    (2008) Genitourinary medicine clinic and general practitioner contact: what do patients want? Sex Transm Infect 84:67–69.
    OpenUrlAbstract/FREE Full Text
  7. ↵
    1. Collini P
    (2006) Opt-out HIV testing strategies. BMJ, http://clinicalevidence.bmj.com/downloads/2.Opt-out HIV testing strategies.pdf (accessed 14 Apr 2008).
  8. ↵
    1. Association of British Insurers
    (2005) Gay men and insurance (ABI, London) http://www.abi.org.uk./Display/default.asp?Menu_ID=1140&Menu_All=1,946,1140&Child_ID=656 (accessed 14 Apr 2008).
  9. ↵
    1. Lohse N,
    2. Hansen AB,
    3. Pedersen G,
    4. et al.
    (2007) Survival of persons with and without HIV infection in Denmark, 1995–2005. Ann Intern Med 146:87–95.
    OpenUrlCrossRefPubMed
View Abstract
Back to top
Previous ArticleNext Article

In this issue

British Journal of General Practice: 58 (550)
British Journal of General Practice
Vol. 58, Issue 550
May 2008
  • Table of Contents
  • Index by author
Download PDF
Article Alerts
Or,
sign in or create an account with your email address
Email Article

Thank you for recommending British Journal of General Practice.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
How can we remove barriers to HIV testing outside of a GUM setting?
(Your Name) has forwarded a page to you from British Journal of General Practice
(Your Name) thought you would like to see this page from British Journal of General Practice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
How can we remove barriers to HIV testing outside of a GUM setting?
Tristan J Barber, Anatole Menon-Johansson, Simon Barton
British Journal of General Practice 2008; 58 (550): 365. DOI: 10.3399/bjgp08X280308

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
How can we remove barriers to HIV testing outside of a GUM setting?
Tristan J Barber, Anatole Menon-Johansson, Simon Barton
British Journal of General Practice 2008; 58 (550): 365. DOI: 10.3399/bjgp08X280308
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
    • REFERENCES
  • Info
  • eLetters
  • PDF

More in this TOC Section

  • Inequalities in CKD management can be overcome
  • Changes in patient experience associated with growth and collaboration in general practice
  • It’s time to look again at GP funding
Show more Letters

Related Articles

Cited By...

Advertisement

BJGP Life

BJGP Open

 

@BJGPjournal's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Current Issue
  • All Issues
  • Online First
  • Authors & reviewers

RCGP

  • BJGP for RCGP members
  • BJGP Open
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers
  • RCGP e-Portfolio

MY ACCOUNT

  • RCGP members' login
  • Subscriber login
  • Activate subscription
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP: research
  • Writing for BJGP: other sections
  • BJGP editorial process & policies
  • BJGP ethical guidelines
  • Peer review for BJGP

CUSTOMER SERVICES

  • Advertising
  • Contact subscription agent
  • Copyright
  • Librarian information

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7679
Email: journal@rcgp.org.uk

British Journal of General Practice is an editorially-independent publication of the Royal College of General Practitioners
© 2021 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242