UK News

‘Silence on HIV still equals death’

Diagnosing people with HIV across the world is now the key to fighting the epidemic, Dr Kevin de Cock, of the World Health Organisation (WHO), told the autumn BHIVA conference.

The 2005 G8 summit at Gleneagles in Scotland had promised universal access to antiretroviral (ART) drugs for all people worldwide that needed them by 2010, but can we have universal access without universal testing?

There are several serious restrictions on widespread HIV testing, not least concerns about civil liberties, the uncertain natural history of HIV and lack of effective treatment. But testing all pregnant mothers, as in the UK, can reduce mother to child transmission (MTCT) to virtually zero. This proves how effective universal testing can be, Dr de Cock argued.

Research has shown just how life saving antiretroviral therapy (ART) can be. In the US it is estimated that at least 3 million years of life have been extended in just 10 years of ARVs. But the main problem has been diagnosing and treating people early enough for therapies to work. In the UK a third of people infected with HIV do not know they have the virus and are undiagnosed. Experience has shown that late diagnosis adversely affects treatment outcomes. But diagnosis can have a positive side, not just by starting treatments. After diagnosis most HIV positive people do make an effort to prevent the infection of others.

A recent study found that a third of men who have sex with men (MSM) in 3 English cities hadn’t ever been tested for HIV before and over 40 per cent of MSM diagnosed HIV positive had a sexually transmitted infection (STI) in the last year.

So there is a silence about HIV still, even in the gay community itself.“The activist slogan from the early days of the epidemic –‘Silence equals Death’ has not lost its relevance.”

Dr de Cock said screening for HIV has been shown to save money as well as lives in the long term. In the US, routine screening is now recommended for all adults and this has received little opposition. But in Britain, routine HIV testing hasn’t happened, mainly for financial reasons.But should we be proposing testing for all, Dr de Cock asked? And should people be tested against their will or without support and counselling services? It is fine to argue for universal treatment access but even in the UK we don’t have universal access because so many people do not know their HIV positive status.There is a clear resistance to change inside what Dr de Cock called the ‘Aids establishment’ but we have to normalise the clinical diagnosis of HIV and normalise HIV testing to have any chance of success against the worldwide epidemic.

Back to top