BHIVA response to Pulse article (12 Dec 2016) 'Four ethical issues to consider before offering HIV tests to your patients'

London, UK - 21 December 2016 Professor Chloe Orkin, Chair of the British HIV Association said: "Every HIV diagnosis that is overlooked or missed by any doctor is a failure of clinical care. People whose HIV is diagnosed late have frequently been seen by a doctor prior to their diagnosis without an HIV test being offered. Nobody dies from being offended, but by overstating the 'ethical issue' of offending patients when offering HIV testing, this article risks HIV infections being missed or diagnosed too late. This oversight means that people fail to receive the treatment and care they need which in turn leading to unnecessary illness and in some cases death. HIV testing is important in preventing onward transmission as people who are diagnosed and treated are no longer infectious to other people. NHS Trusts are reporting missed HIV diagnoses as serious untoward incidents and performing root cause analysis on each one. Surely missing a diagnosis of HIV is a greater medico-legal risk to the medical profession than offending someone by offering a test. This article risks re-inforcing the HIV associated stigma that we have spent 30 years fighting.

"The recent recommendations (1 Dec) by NICE and Public Health England to expand GPs remit in offering HIV testing are based on robust evidence that shows an urgent need to increase the awareness and uptake of HIV testing in England. The advice will also help make HIV testing a routine investigation and – we hope – help reduce the stigma that allows HIV to flourish.

"HIV currently infects 17 more people each day in England, many of whom will remain unaware of their infection precisely due to the stigma which still clings to this undiscriminating and life-threatening condition. We don't have a vaccine or a magic bullet, but we could potentially stop nearly all transmission of HIV, nearly all new infections, purely by diagnosing people earlier and putting them on treatment (and by using PrEP), but we are signally failing to do this. More extensive testing, without wasting too much time on risk assessments (which are too often wrong) is the key part of this. This testing cannot be done just in GUM clinics, where there is very little extra capacity, so MUST be done in other settings – particularly in primary care. Without this increased testing, we will never change the epidemiology of HIV in the UK, and every year there will be another 6000 new diagnoses.

"We believe that GPs are perfectly capable of negotiating complexity in all areas of their practice as well as understanding the critical importance of HIV testing. Let’s not exacerbate this by adding our own preconceptions about who needs testing. It’s time to implement the evidence-based NICE guidance that all doctors are expected to follow to deliver best outcomes within safe, competent practice."


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About BHIVA
Founded in 1995, BHIVA is the leading professional organisation committed to providing excellence in the care of those living with and affected by HIV. It acts as a national advisory body to professions and other organisations on all aspects of HIV care. BHIVA also provides a national platform for HIV care and contributes representatives for international, national and local committees dealing with HIV care. In addition, BHIVA works to promote undergraduate, postgraduate and continuing medical education within HIV care.     www.bhiva.org    @BritishHIVAssoc