HIV

All patients attending a genitourinary medicine (GUM) clinic should be offered an HIV test, according to the National Strategy for Sexual Health and HIV, as part of the initial screening for sexually transmitted infections.1 This does not mean that testing is restricted to new patients only and all re-presenting HIV negative patients should be offered and encouraged to have serological testing for HIV and syphilis following possible re-exposure.

Screening of symptomatic and asymptomatic patients attending GUM clinics for HIV is indicated for the following reasons:

• The benefits of early self knowledge of HIV infection in controlling the spread of HIV infection are now recognised.2

• There is also enough evidence through cohort studies which show that many people will reduce sexual and needle sharing risk behaviour after a diagnosis of HIV infection3,4,5,6,7,8,9,10 and, similarly, those who are unaware of their HIV status do not change their high risk behaviours.6,11–13

• Highly active antiretroviral treatment (HAART) is an important contributor in reducing transmission as a result of the reduction in HIV burden and therefore infectivity in those individuals who are diagnosed early and treated.14

• There is also consensus that it is best to start HAART before the onset of severe immunosuppression.15

Screening of asymptomatic at-risk groups is most effective if it is coupled with a personalised prevention counselling service. The screening service should provide information regarding the transmission, prevention, and the meaning of HIV test results.16 This information should form part of a leaflet that everybody should receive. Additional information should be offered to those refusing a test as lack of perceived risk has been found to be the main reason for test refusal.17 Confidentiality of patients must be ensured and informed consent must be obtained …