This briefing summarises NICE's recommendations for local authorities and partner organisations on promoting HIV testing. It is particularly relevant to health and wellbeing boards, commissioners of HIV testing services and other organisations involved with delivering sexual health services.
HIV is a blood-borne virus. It is usually transmitted through unprotected sexual intercourse when one participant has the virus. If diagnosed early, people with HIV who are on treatment live full and normal lives and have a very low risk of onward transmission of the virus. HIV has become a manageable long-term condition. Further information about the virus can be found on the HIV and AIDS pages on the NHS Choices website.
Local authorities must commission comprehensive sexual health services, including HIV testing in community and sexual health services. They are also responsible for commissioning HIV prevention. Clinical commissioning groups are responsible for funding HIV testing in primary and secondary care. NHS England is responsible for commissioning HIV treatment and care (including drug costs for post-exposure prophylaxis following sexual exposure).
In the UK, HIV is most prevalent among men who have sex with men (47 per 1000) and women and men from black-African communities (38 per 1000) although these are not the only groups affected. Within local authority areas there may be other groups who also have a high prevalence. In 2012, an estimated 98,400 people were living with HIV in the UK, accounting for 1.5 per 1000 people.
In the same year, an estimated 21,900 people with HIV were unaware they were infected. (This figure is estimated by a statistical model using a range of data, including a longstanding anonymous testing surveillance programme run by Public Health England.) This includes 7300 men who have sex with men (17% of the estimated 41,000 men who have sex with men who have HIV) and 7300 black Africans (23% of the estimated 31,800 black Africans with HIV in the UK).
HIV testing is key to preventing its transmission, because more than 50% of new cases are estimated to have been the result of people who are undiagnosed having unprotected sex. People who do not know their HIV status are believed to be 3 times more likely to pass on the infection than those who know their status. They are also more than twice as likely to have unprotected sex.
Timely diagnosis of HIV carries huge health benefits and, in addition, once people are being treated they are much less infectious. Once someone is diagnosed with HIV they are also likely to make more effort to reduce the risk of transmission. Earlier diagnosis of HIV, leading to better management of the condition, can help reduce demand on long-term care and other services.
The National Institute for Health and Care Excellence (NICE) is an independent organisation providing guidance and advice to improve health and social care.
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