At the same time as the release of depressing figures by the UK Health Protection Agency (HPA) showing a doubling of the annual rate of fresh HIV diagnoses in the UK, the National Institute for Health and Clinical Excellence (NICE) has just issued two sets of recommendations on HIV prevention.
Annual figures for new diagnoses of UK-acquired HIV have risen steadily from 1,950 in 2001 to 3,780 in 2010. Three fifths of these diagnoses are “late” diagnoses (i.e. after the point treatment should have begun). The HPA places a figure of £32 million annually on the failure to prevent the 3,780 cases diagnosed this year.
Two documents have been issued by NICE containing detailed recommendations regarding the most at risk groups – respectively, men who have sex with men (MSM), and UK black Africans. The aim of both documents is to recommend a more proactive approach to HIV testing. The strategy builds on current UK guidelines (British HIV Association et al. 2008) advocating the “normalization” of HIV tests, and specifically recommending that in certain areas – e.g. where more than 2 in 1000 people have been diagnosed with HIV – tests be offered to everyone.
Specific guidance in the MSM document is directed to those capable of playing a role in different capacities. Specialist sexual health services should offer testing to all who attend. Primary and secondary care providers should recommend testing at registration or admission, not only to individuals at high risk, but to everyone in areas where there is high prevalence (more than 2 in 1000), or a large community of men having sex with men. Health care promoters are specifically urged to promote testing in their promotional literature. Finally, planning services should work in partnership with relevant local organizations to gather data, assess local need and develop a strategy in respect to both of these at risk groups.
The recommendations for black Africans, though complementary and covering some of the same ground, are differently structured and more complex. The failure of the two documents to dovetail is no doubt an unfortunate result of the differing needs of the respective groups. The latter document builds on current UK guidelines (British HIV Association 2008) recommending that HIV testing be offered to men and women from countries of high prevalence as well as the guidelines mentioned above. The different emphasis in the latter document, and the preponderance of recommendations addressed to directors and commissioners of public health, may reflect the smaller role of specialist sexual health services, on the one hand, and the real possibility (and challenge) of community engagement, on the other, with responsibility falling on public health commissioners to ensure that that the needs of high risk communities are met through the provision of primary and secondary health care services within their sphere of operation.
Recommendations to “collect information about current HIV diagnoses” may pose a challenge to public health services lacking the necessary epidemiological expertise.
National Institute for Health and Clinical Excellence, “Increasing the uptake of HIV testing to reduce undiagnosed infection and prevent transmission among men who have sex with men”, PH34, March 2011
National Institute for Health and Clinical Excellence, “Increasing the uptake of HIV testing to reduce undiagnosed infection and prevent transmission among black Africans in England”, PH33, March 2011