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We wholeheartedly agree with the letter from Barber et al1 regarding the need for a lower threshold of HIV testing outside of traditional GU medicine settings.
Clinicians in general practice should not be afraid of offering HIV tests where clinically indicated or if requested by the patient. Let's reiterate the advice that ‘counselling’ is not required (although you must gain consent from the patient before testing) and that life insurance issues should not be a deterrent to offering an HIV test. If the HIV result returns as negative, insurance companies do not need to be informed; in fact, with improved treatments resulting in a better prognosis, some insurance companies are now happy to offer cover to some HIV-positive patients.
What are the clinical indications for HIV testing? Not only the signs and symptoms that would raise suspicion of HIV infection, but also the opportunistic offer of an HIV test to those patients from certain high-risk groups, such as:
What signs and symptoms might prompt suspicions of HIV infection?
This list is not exhaustive and further, more comprehensive advice on HIV in primary care is available in an easy-to-read booklet produced by the Medical Foundation for AIDS and Sexual Health (MedFASH) and available to download for free from their website.3
Guidance on managing other sexually transmitted infections in primary care has been produced by the Royal College of General Practitioners (RCGP) with the involvement of the British Association for Sexual Health and HIV (BASHH)4, and is also available to download for free from the RCGP and BASHH websites.
The RCGP, supported by the Department of Health in partnership with BASHH, the Faculty of Sexual Health and Reproductive Healthcare, the Royal College of Nursing, and other relevant stakeholders, is also producing an Introductory Certificate in Sexual Health aimed at increasing awareness of HIV and sexual health matters in general practice. Using a similar format to the highly successful RCGP Certificate in the Management of Drug Misuse Part 1, it will consist of an e-module and a face-to-face training day. This course is specifically aimed at generalists in general practice and addresses sexual health care including taking sexual histories, contraceptive issues, and management of STIs including HIV. (Further details can be obtained by emailing Russell Fleet at MedFASH. Contact details can be found at www.medfash.org.uk/)
Rates of HIV continue to rise in the UK. General practice clinicians are ideally placed to be vigilant with regard to HIV testing and this was highlighted last year by a letter from the Chief Medical and Nursing Officers encouraging HIV testing in all healthcare settings outside of those traditionally offering the service.5 Ample guidance is being made available to assist clinicians with the confidence to do so.