Introduction

Voluntary counselling and testing (VCT) for HIV is an important tool in the control of the HIV epidemic in developed countries, where the majority of individuals diagnosed with HIV present in this way. In the United Kingdom, such tests are readily available at genitourinary medicine (GUM) clinics, where the promotion of routine VCT for HIV is a strategic priority.¹ In spite of this, around 40–50% of HIV seropositive individuals who attend UK GUM clinics remain undiagnosed, and despite well publicised advances in the management of HIV this proportion did not change between 1996 and 1998.¹ People attend GUM clinics with a variety of sexual health problems and many may not have considered taking an HIV test before the subject is raised during the consultation. Whittall Street Clinic, a large urban GUM clinic in the West Midlands, United Kingdom, has a “universal offer” policy for HIV tests: clinic protocol requires doctors or health advisers seeing new patients to ask about and record risk factors for HIV infection, and offer information about HIV testing to all regardless of risk. This policy is audited with regular case note review, which gave rise to initial concerns about differences in HIV …