Although rates are improving, gay men in the UK still take HIV tests less often than their counterparts in comparable countries, and nearly half of African men with HIV in the UK still don’t test until they’ve developed AIDS.
In our feature Don’t live in ignorance, we’ll look at what can be done to improve the situation. But what do the figures actually show?
More than 90% of gay men in the US have taken a test for HIV at some point, according to community surveys, and more than 95% in Australia.1 In comparison the annual United Kingdom Gay Men’s Sex Survey showed that the proportion of UK gay men who have ever taken a test rose to 66% in 2007 (the last year we have full figures for).2
People don’t test often enough, either. The most recent Gay Men’s Sex Survey –admittedly with data collected in 2005 –found that the proportion of gay men who’d taken a test in the last twelve months was, at 32%, far lower in the UK than it was in Australia or the US.3 In the US three-quarters of gay men have tested in the last year, while in Australia half have taken a test in the last six months.
In the UK African community, testing rates are lower than in gay men. In the 2007 BASSLine Survey of over 4000 Africans in the UK, only 47% of respondents had ever had an HIV test.4
There are two reasons why it’s important that as many people with HIV are tested as possible. One is that once people are diagnosed, the majority immediately start taking fewer HIV transmission risks. A bit late from their point of view – but highly protective of others. The US Centers for Disease Control have estimated that in the immediate post-diagnosis period people reduce their risk behaviour by 70%,5 and a study that followed a group of women living with HIV in the slums of Nairobi found that they maintained a long-term reduction in their risk behaviour of 30 to 40%.6
The earlier you are diagnosed, the more likely you are still to be in the acute stage when you’re very infectious: between a quarter and a half of all HIV is acquired from people who have recently caught it themselves.7, 8, 9
But the most important reason to increase testing rates is to diagnose people before they become ill. The HPA’s statistics10 show that a quarter of gay men, a third of newly diagnosed people overall, and nearly a half (47%) of heterosexual men are diagnosed with CD4 counts below 200, and the British HIV Association11 found that quarter of all HIV-related deaths were directly due to patients being diagnosed too late to respond to treatment.
People who died due to late diagnosis were twice as likely to be young (under 30) than people who died for other reasons, and more than twice as likely to be ‘non-white’.
It is important to say that the testing situation is improving and that there is already some evidence of culture shift. In Scotland, in 2002 only half of the gay men interviewed in community surveys had ever taken an HIV test. In contrast, yet-to-be-published figures from 2008 now show that three-quarters have ever tested and nearly half have tested in the last year.12,13 ,14 In the Gay Men’s Sex Survey, which may sample a broader range of gay men, the 2007 figure of two-thirds of respondents having ever tested is an increase from under half in 2001. In gay men the average CD4 count at diagnosis has risen from 350 in 2000 to 410 in 2007, and in heterosexual men from 150 to 230.15
We have high testing rates in some groups. One of these is pregnant women, where the UK has one of the best rates in the world: about 95% of women are tested during pregnancy. As a result the proportion of babies infected by HIV-positive mothers has fallen from 16% in 1998 to about 4% now (though this figure could still be improved).
Similarly, testing by people who go for sexual health check-ups has risen. In 1998 only half of gay men and a quarter of heterosexuals attending genitourinary medicine (GUM) clinics included an HIV test in their check-up. This proportion has now risen to 86% in gay men and 95% in heterosexuals.
But not everyone goes to sexual health clinics, or needs to. What can we do about offering HIV tests in other places? In Don’t live in ignorance, we’ll find out.
1. Prestage G et al. Trends in HIV testing among homosexual and bisexual men in eastern Australian states. Sex Health 5:119-23, 2008.
2. Hickson F et al. Testing targets: findings from the United Kingdom Gay Men’s Sex Survey 2007. Sigma Research, 2009.
3. Sullivan PS et al. Reemergence of the HIV Epidemic Among Men Who Have Sex With Men in North America, Western Europe, and Australia, 1996–2005. Annals of Epidemiology 19:423–431, 2009.
4. Dodds C et al. BASS Line 2007 survey: assessing the sexual HIV prevention needs of African people in England. Sigma Research, 2008.
5. CDC Advancing HIV Prevention: New Strategies for a Changing Epidemic --- United States, 2003. Mortality and Morbidity Weekly Report (MMWR) 52(15);329-332, April 2003.
6. McClelland RS et al. HIV-1 acquisition and disease progression are associated with decreased high-risk sexual behaviour among Kenyan female sex workers. AIDS 20(15): 1969-1973, 2006.
7. Hughes G et al. Recent phylodynamics of the HIV epidemic among MSM in the UK Fifteenth Conference on Retroviruses and Opportunistic Infections, Boston, abstract 13, 2008.
8. Yerly S et al. The contribution of individuals with recent infection to the spread of HIV-1 in Switzerland: a 10-year survey. Fifteenth Conference on Retroviruses and Opportunistic Infections, Boston, abstract 512, 2008.
9. Brenner BG et al. High rates of forward transmission events after acute/early HIV-1 infection. J Infect Dis 195: 951-59, 2007.
10. Health Protection Agency Testing Times: HIV and other Sexually Transmitted Infections in the United Kingdom. 2007.
11. British HIV Association. Clinical Audit Report 2005–6. See www.bhiva.org/files/file1030338.pdf
12. Hart G et al. Gay men's HIV testing behaviour in Scotland. AIDS Care, 14 (5). pp. 665-674, 2002.
13. Personal Communication, MRC Social and Public Health Sciences Unit, Glasgow.
14. Williamson L et al. HIV testing trends among gay men in Scotland, UK (1996-2005): Implications for HIV testing policies and prevention. Sex Transm Inf., published online 9 Mar 2009.
15. Health Protection Agency CD4 surveillance scheme: monitoring immunosuppression in HIV-infected adults. Annual report 2008.
