Non-disclosure of HIV status in UK sexual health clinics—a pilot study to identify non-disclosure within a national unlinked anonymous seroprevalence survey
- Ann Kathleen Sullivan1,
- Emma J Savage2,
- Catherine M Lowndes2,
- George Paul1,
- Gary Murphy2,
- Simon Carne2,
- David J Back3,
- O Noel Gill2
- 1John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- 2Department of HIV and STIs, Health Protection Agency, London, UK
- 3University of Liverpool, Liverpool, UK
- Correspondence to Dr Ann Kathleen Sullivan, John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK;
- Received 17 September 2012
- Revised 17 September 2012
- Accepted 26 November 2012
- Published Online First 13 February 2013
Objectives To identify if HIV-infected individuals attending genitourinary clinics in the UK are not disclosing their HIV status, and to examine the potential utility of drug detection as a method to indicate non-disclosure.
Methods HIV-positive samples from the unlinked anonymous seroprevalence survey from one London centre in 2009 had viral load (VL) assays performed to identify samples with VL below the level of detection (50 copies/ml, VLBLD) or <1000 copies/ml. After data matching, known HIV positives were excluded and the remaining samples analysed for the presence of a panel of antiretroviral drugs.
Results Of 130 HIV-positive samples with sufficient clinical information and not undergoing an HIV test, 18 were classified as remaining undiagnosed after the clinic visit. Thirteen (72%, 95% CI: 47% to 90%) had a VLBLD (n=11) or VL <1000 copies/ml (n=2). Eight had sufficient volume to undergo ARV testing, and all were positive for the presence of drug; all with therapeutic levels of clinically appropriate combinations.
Conclusions Non-disclosure of HIV status occurs among individuals attending sexual health services in the UK. This study demonstrates the feasibility and utility of using both VL and ARV assays in serum samples. Furthermore, the close correlation of detection of ARV with VLBLD suggests drug detection would be a useful tool to monitor non-disclosure prospectively, thus enabling the use of stored serum samples in future studies. The extent to which these findings can be extrapolated to other settings, and the potential impact of non-disclosure on undiagnosed estimates warrants urgent prospective study.