Public health doctors have argued for routine opt-out HIV testing in healthcare settings such as general practice surgeries.
In this week's British Medical Journal (BMJ), 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 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.
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.