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The UK's appalling failure to tackle HIV Editorial
  The Lancet, 30 May 2009
How many people are living with HIV in the UK? The answer is estimated to be around 77 000. How many of these individuals do not know they have HIV? About 21 000. The numbers come from the Health Protection Agency (HPA) and were released in November, 2008. The number of heterosexual infections increased in 2007 to 960, up from 540 in 2003. Diagnoses among gay men also increased. Most worryingly of all, a third of those living with HIV were diagnosed late, after that point at which treatment should have begun.
It should be a matter of deep concern to the UK's Department of Health that so many individuals are entirely unaware of their positive HIV status. To its credit, the HPA has suggested that doctors take HIV testing more seriously. But because the HPA is divorced-strategically and operationally-from front-line delivery of clinical care in the NHS, its recommendations have been largely ignored. As one former senior government health official told The Lancet, the number of undiagnosed people with HIV is an "appalling statistic", and a "serious epidemiological issue". He and others have urged a stronger public health response. But no one is listening.
What is needed is a purposeful, but not coercive, policy of HIV testing for all men and women aged 15 to 59 years. The means of targeting this population is straightforward-via patients registered to general practitioners and those admitted to hospital. Uptake of HIV testing can work. In antenatal and genitourinary clinic settings, for example, uptake is 94% and 75%, respectively. There are several traditionally high-risk areas-London and the south coast of England together with other major conurbations. Wider access to testing, however, has not been made easier since the HPA's call to action. General practitioners have not risen to the HPA's challenge. Hospitals pay little attention to their public health responsibilities, of which HIV diagnosis is an important part. Primary care trusts display little interest in tackling this serious public health challenge.
There is no credible strategy to diagnose and care for those living with, but unaware of, HIV in Britain today. This is an extraordinary failure in public health. The UK's policy is "out of sight, out of mind". This failure needs an urgent response.
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