For further background information please see the HPA HIV webpages.
Sample required for diagnosis: Clotted blood (2-6ml)
In 2008 the British HIV Association published new UK National Guidelines for HIV Testing [external link]. The following text is based on the report and updated with the 2011 NICE guidelines for expanded testing among the black African community [external link] and among men who have sex with men [external link].
Who should be offered a test?
Where the diagnosed HIV prevalence in the local population exceeds 2 in 1000 population an HIV test should be offered and recommended to:
HIV testing should be also routinely offered and recommended to the following patients (irrespective of the prevalence of HIV in the local population):
*see country pages
Who can test?
It should be within the competence of any doctor, midwife, nurse or trained healthcare worker to obtain consent for and conduct an HIV test.
The primary purpose of pre-test discussion is to establish informed consent for HIV testing. Lengthy pre-test HIV counselling is not a requirement, unless a patient requests or needs this. The essential elements that the pre-test discussion should cover are:
Some patients may need additional help to make a decision, for example, because English is not their first language. It is essential to ensure that these patients have understood what is proposed, and why. It is also important to establish that the patient understands what a positive and a negative result mean in terms of infection with HIV as some patients could interpret 'positive' as good news.
Post-test discussion for individuals who test HIV positive
As is good clinical practice for any situation where bad news is being conveyed, the result should be given face to face in a confidential environment and in a clear and direct manner. If a patient's first language is not English, consideration should be given to utilisation of an appropriate confidential interpretation service. If a positive result is being given by a non-genito-urinary medicine/HIV specialist, it is essential, prior to giving the result, to have clarified knowledge of local specialist services and have established a clear pathway for onward referral.
It is recommended that any individual testing HIV positive for the first time is seen by a specialist (HIV clinician, specialist nurse, sexual health advisor or voluntary sector counsellor) at the earliest possible opportunity, preferably within 48 hours and certainly within two weeks of receiving the result.
For full guidance see UK national guidelines for HIV testing [external link] and the 2011 NICE guidance on expansion of HIV testing:
HIV for non-HIV specialists: diagnosing the undiagnosed [external link]
In the UK, HIV is generally managed by secondary care HIV physicians (usually genito-urinary medicine or infectious disease specialists depending on local arrangements).
Care pathways encourage the early commencement of combination anti-retroviral therapy.
The role of the primary care practitioner is to encourage people at risk to be tested and to promptly refer those found to be positive. People living with HIV may also require primary care support through their long term treatment and the GP may need to liaise closely with the secondary care team in prescribing for non-HIV related conditions. Guidelines are available for the immunisation of HIV infected adults [external link].
Other useful clinical guidelines:
Prevention of the spread of HIV infection relies on sexual health promotion, testing and treatment of at risk groups for HIV, and testing and treatment for other STIs. Screening for HIV should be offered to all pregnant women to reduce the rate of mother to child transmission and HIV positive mothers should be counselled about breast feeding. The primary care practitioner has an important role to play in all these aspects.
Patient UK leaflet HIV and AIDS information [external link]
Terrence Higgins Trust (THT) publications [external link]
The African Eye Trust [external link] HIV treatment questions and answers sheets
Do it Right [external link] information on sexual health for Africans living in England
Your story, your script: helping people make decisions about HIV treatment [external link] printable resources
Positively Women magazine [external link] written and edited by women living with HIV
NAM patient information booklets [external link] are available online to download. For access to hardcopies of these resources, primary care practioners can register with NAM's free booklet scheme by calling +44 (0)20 7840 005 or emailing firstname.lastname@example.org. The NAM website provides resources in Arabic, Czech, Dutch, French, German, Hebrew, Italian, Norwegian, Polish, Portuguese, Romanian, Russian, Somali, Spanish, Swedish, Thai and Turkish.
Antenatal screening for HIV [external link] (Department of Health information leaflet). Available in English, Arabic, Gujarati, Punjabi, Somali, Swahili, Turkish.
NAZ Project London [external link] free resources
HIV & AIDS information for female sex workers [external link] and STI, AIDS and Hepatitis B information for transgender sex workers [external link] in a range of languages is available from TAMPEP (European Network for HIV/STI Prevention and Health Promotion among Migrant Sex Workers)
HIV: diagnosis and care in general practice [external link] training video from HPA migrant health event 12 November 2012
Avert [external link] local HIV/AIDS services available in the UK
African Health Policy Network [external link] an umbrella organisation of mostly African-led community based organisations that enables Africans to speak with a collective and representative voice on sexual and public health matters, with a mission to advance the health and well being of Africans living in the UK.
British Association for Sexual Health and HIV [external link] (BASHH) - a professional representative body for those practising sexual health including the management of STIs and HIV in the UK
British HIV Association [external link] (BHIVA) - a UK based professional association representing professionals in HIV care
NAT (National AIDS Trust) [external link] - the UK's leading HIV policy charity dedicated to transforming the UK's response to HIV
National African HIV Prevention Programme (NAHIP) [external link] - funded by the Department of Health, NAHIP works with predominantly African-led organisations to deliver HIV prevention interventions
Terrence Higgins Trust [external link] (THT) - the largest HIV and sexual health charity in the UK
The Medical Foundation for AIDS & Sexual Health [external link] a UK based charity which works with policy-makers and health professionals, supported by the British Medical Association
Black Health Agency services [external link] including an African AIDS Helpline and HIV support project
HIV for non-HIV specialists, Diagnosing the undiagnosed [external link]. A practical guide for healthcare professionals in secondary care to support improved detection and diagnosis of HIV in the UK, by Dr Rachel Baggaley. Published by the Medical Foundation for AIDS & Sexual Health (MedFASH)
HIVinsight [external link] E-tutorials for nurses, an online educational initiative which has been developed by the National HIV Nursing Association (NHIVNA)
Sexual health, asylum seekers and refugees: a handbook for people working with refugees and asylum seekers in England [external link], by Ruth Wilson, Marsha Sanders and Hidegard Dumper. Published by the Family Planning Association.
The African Eye Trust [external link] provides HIV treatment information to African communities, including an HIV treatments magazine 'The African Eye Voice' for African communities in the UK.
TAMPEP [external link] European Network for HIV/STI Prevention and Health Promotion among Migrant Sex Workers
AIDS & Mobility Master Toolkit [external link] - a collection of core training materials and relevant additional information from the fields of HIV prevention and migrant health for anyone interested in learning about or implementing a transcultural HIV and AIDS mediator project.