HIV testing of men and women increased 11- and 19-fold respectively in general practice between 1995 and 2005. However, testing rates still remained relatively low.

This retrospective cohort study looked at trends in HIV testing in primary care and estimated the proportion of HIV-positive individuals who are known to their GPs. It used data from practices contributing to the General Practice Research Database (GPRD). The GPRD is broadly representative of the UK population in terms of demographics, with slight under-representation of inner London and Scotland.

Cases from practices were compared with age- and age-sex specific reports from the SOPHID surveillance system. SOPHID (Survey Of Prevalent HIV Infections Diagnosed) is an annual survey of all persons attending for HIV care in specialist services across the UK. It is the best available estimate of prevalence of HIV.

There was an 11-fold increase in male testing and 19-fold increase in non-pregnant female testing between 1995 and 2005. Antenatal clinics adopt an opt-out policy of HIV testing so there is usually a high uptake. Inclusion of antenatal tests yielded a 129-fold increase in uptake of testing in women over this 10-year period.

In 2005, there were 71.3 and 61.2 tests per 100,000 person-years for males and females respectively; this peaked at 162.5 and 173.8 per 100,000 person-years for the 25-34 age group. Non-antenatal testing rates in London seemed to be more than double the rates seen elsewhere in the UK in both sexes.

The proportion of HIV individuals who had their status recorded in GP records was estimated to be 50.7% in 2005; this changed little in the 10-year period. Recording appeared lower in London (41.8%) compared with elsewhere in the UK (60.1%).

This paper seems to confirm that GPs are doing the right thing by testing more in high prevalence areas such as London.
It is surprising that despite more testing and high rates of GP registration and consultation, that a lower proportion of people with HIV have their diagnoses recorded in London practices.

This may be explained by the fact that patients in London can access primary care easily from their specialist clinic or other facilities such as walk-in centres and casualty; whereas in non-urban areas it is more difficult to access primary care services other than from a GP.

There may be similar explanations for low HIV testing rates and lack of recording of HIV status in primary care.

Patients' concerns about confidentiality, insurance, discrimination and lack of knowledge and skills of primary care staff can be real deterrents to testing and divulging diagnosis to a GP.

The CMO is strongly encouraging improved detection of HIV in non-specialist settings.

This is a signal for primary care to act to dispel these myths and misconceptions so that earlier diagnosis can take place; this will help reduce morbidity and mortality among those most at risk of HIV.

Dr Richard Ma