Non-disclosure of HIV status in UK sexual health clinics—a pilot study to identify non-disclosure within a national unlinked anonymous seroprevalence survey

Abstract

Objectives To identify if HIV-infected individuals attending genitourinary clinics in the UK are not disclosing their HIV status, and to examine the potential utility of drug detection as a method to indicate nondisclosure. Methods HIV-positive samples from the unlinked anonymous seroprevalence survey from one London centre in 2009 had viral load (VL) assays performed to identify samples with VL below the level of detection (50 copies/ml, VLBLD) or <1000 copies/ml. After data matching, known HIV positives were excluded and the remaining samples analysed for the presence of a panel of antiretroviral drugs. Results Of 130 HIV-positive samples with sufficient clinical information and not undergoing an HIV test, 18 were classified as remaining undiagnosed after the clinic visit. Thirteen (72%, 95% CI: 47% to 90%) had a VLBLD (n=11) or VL <1000 copies/ml (n=2). Eight had sufficient volume to undergo ARV testing, and all were positive for the presence of drug; all with therapeutic levels of clinically appropriate combinations. Conclusions Non-disclosure of HIV status occurs among individuals attending sexual health services in the UK. This study demonstrates the feasibility and utility of using both VL and ARV assays in serum samples. Furthermore, the close correlation of detection of ARV with VLBLD suggests drug detection would be a useful tool to monitor non-disclosure prospectively, thus enabling the use of stored serum samples in future studies. The extent to which these findings can be extrapolated to other settings, and the potential impact of non-disclosure on undiagnosed estimates warrants urgent prospective study.

Failure to Identify HIV-Infected Individuals in a Clinical Trial Using a Single HIV Rapid Test for Screening

“…6 Although HIV testing is not usually performed for individuals with a prior HIV diagnosis, it may occur in clinical settings or clinical trials to confirm self-reported HIV status or to determine HIV status in individuals who are aware of their HIV infection but choose not to disclose this information. 7–9 …”

STI testing without HIV disclosure by MSM with diagnosed HIV infection in England: cross-sectional results from an online panel survey

“…Population prevalence of HIV in the UK is estimated by data synthesis and statistical modelling 1. Multiple data sources include the GUM Anon survey that tests unlinked, anonymised residual samples of blood taken for routine syphilis testing from users of 16 genitourinary medicine (GUM) clinics.…”

“…Concern has been expressed that the proportion of the undiagnosed HIV-infected population is inflated because some people with diagnosed HIV seek screening for sexually transmitted infections (STIs) at services away from their usual care provider without disclosing their HIV status 1 3. Research indicates that this may be the case but does not explain why.…”

Highlights from this issue

“…We are reminded in this month's Editor's Choice by Lowndes et al 5 of continuing felt need for confidentiality in a report which for the first time estimates HIV non-disclosure by HIV diagnosed men in London STI clinics. Using an anonymous seroprevalence survey, the authors scrutinised HIV positive samples reported as undiagnosed, and found a substantial proportion of individuals to have a very low viral load, with antiretrovirals present.…”