'Significant' proportion of HIV positive patients may not be telling NHS staff about their infection

February 13, 2013, British Medical Journal

A significant proportion of HIV positive patients may not be disclosing their infection to NHS staff, when turning up for treatment at sexual health clinics, suggests preliminary research published online in the journal Sexually Transmitted Infections.

If the findings reflect a national trend, this could have implications for the true prevalence of undiagnosed HIV infection in the population, which is based on the numbers of "undiagnosed" patients at sexual health clinics, say the authors.

Currently, it is estimated that around one in four people in the UK who is HIV positive doesn't know s/he is infected with the .

The estimate is based on several sources of data, including the GUMAnon Survey, which routinely looks for in taken from patients to test for at one of 16 participating sexual health clinics across the UK.

The results are then matched with the individual's diagnostic status—whether they had been diagnosed before their arrival at the clinic, or were diagnosed at their clinic visit, or left the clinic "unaware" of their .

It is thought that a proportion of patients who do know their HIV status nevertheless choose not to reveal it to NHS staff when attending for services elsewhere, so the researchers set about trying to find out whether there is any basis for this belief.

They therefore analysed all HIV positive samples from one participating GUMAnon clinic in London in 2009 for the presence of very low viral loads—very low amounts of circulating virus, and a hallmark of successful drug treatment—and various antiretroviral drugs.

Of the 130 samples which matched clinic records, 28 were from patients who were not known to be HIV positive before their arrival at clinic. Ten had been tested for HIV at their clinic visit.

The remaining 18 did not have a test at the clinic, and were therefore classified as undiagnosed. Yet almost three out of four (72%; 13) of these samples had very low , indicative of successful drug treatment.

Only 8 samples were of sufficient volume to be able to officially test for , but evidence of HIV treatment was found in all of them.

"This is the first published objective evidence that non-disclosure of HIV status as a phenomenon exists in patients attending [sexual health] clinics in the UK," write the authors.

"Given the high proportion of individuals classified within this study as [non-disclosing], the extent to which these findings can be extrapolated to other clinics, and the degree to which they may influence estimates of the proportion of undiagnosed HIV in the community, warrants further study," they conclude.

In an accompanying podcast, lead author Dr Ann Sullivan of London's Chelsea and Westminster Hospital NHS Foundation Trust, explains that there are many different sexual health clinics in London which people who are HIV positive can attend, so it may be easier for them to keep schtum about their infection than in other parts of the country.

The reasons why they don't come clean about their HIV status may be that they don't want to be "judged," given that they have come to the clinic with another infection, which implies they are indulging in risky sexual behaviour, she suggests.

But by not revealing their HIV status, they could be missing out on the chance to be treated more holistically and discuss other aspects of their health which might be affected by , she says.

Explore further: Canada high court lowers bar for HIV disclosure

More information: doi 10.1136/sextrans-2012-050801

Related Stories

Canada high court lowers bar for HIV disclosure

October 5, 2012
Canada's Supreme Court on Friday decriminalized the non-disclosure of HIV status prior to sex where no realistic possibility of transmitting the potentially deadly virus exists.

Fifth of US youth with HIV unaware during first-time sex

November 10, 2012
Twenty percent of young people born with HIV in the United States don't know they're infected when they have sex for the first time, according to a new study released Friday.

Interventions needed to promote healthy behaviors among perinatally HIV-infected youth

November 8, 2012
As youth infected at birth with HIV reach adolescence and young adulthood, a new study published in Clinical Infectious Diseases underscores the need to promote healthy behaviors as some of these young people become sexually ...

Mayo Clinic makes kidney and pancreas transplant available to HIV-infected patients

December 6, 2011
Mayo Clinic in Florida is now offering kidney and pancreas transplants to HIV positive patients with advanced kidney disease and diabetes. Evidence is now solid that HIV-positive patients have the same favorable outcome in ...

HIV status doesn't influence Hodgkin's lymphoma outcome

October 11, 2012
(HealthDay)—Despite more extensive disease and more adverse prognostic factors, HIV-positive patients with Hodgkin's lymphoma (HL) do not have worse outcomes when treated with doxorubicin, bleomycin, vinblastine, and dacarbazine ...

Recommended for you

War in Ukraine has escalated HIV spread in the country: study

January 15, 2018
Conflict in Ukraine has increased the risk of HIV outbreaks throughout the country as displaced HIV-infected people move from war-affected regions to areas with higher risk of transmission, according to analysis by scientists.

Researchers offer new model for uncovering true HIV mortality rates in Zambia

January 12, 2018
A new study that seeks to better ascertain HIV mortality rates in Zambia could provide a model for improved national and regional surveillance approaches, and ultimately, more effective HIV treatment strategies.

New drug capsule may allow weekly HIV treatment

January 9, 2018
Researchers at MIT and Brigham and Women's Hospital have developed a capsule that can deliver a week's worth of HIV drugs in a single dose. This advance could make it much easier for patients to adhere to the strict schedule ...

New long-acting, less-toxic HIV drug suppresses virus in humanized mice

January 8, 2018
A team of Yale researchers tested a new chemical compound that suppresses HIV, protects immune cells, and remains effective for weeks with a single dose. In animal experiments, the compound proved to be a promising new candidate ...

Usage remains low for pill that can prevent HIV infection

January 8, 2018
From gritty neighborhoods in New York and Los Angeles to clinics in Kenya and Brazil, health workers are trying to popularize a pill that has proven highly effective in preventing HIV but which—in their view—remains woefully ...

Researchers find clues to AIDS resistance in sooty mangabey genome

January 3, 2018
Peaceful co-existence, rather than war: that's how sooty mangabeys, a monkey species found in West Africa, handle infection by SIV, a relative of HIV, and avoid developing AIDS-like disease.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.