Exclusive: Half of GPs to back opt-out HIV tests

Almost half of GPs would be willing to offer their patients opt-out HIV tests, a survey by GP has revealed.

The findings coincide with a letter to all practices from the CMO for England Sir Liam Donaldson urging GPs and healthcare staff to test patients for HIV to improve early diagnosis.

People often present to their GPs with the first signs of HIV, although symptoms can vary.

'HIV testing in general practice would therefore expedite referral directly to HIV services, saving time and decreasing morbidity,' wrote Sir Liam.

An audit by the British HIV Association has shown that late diagnosis accounts for at least one in three HIV-related deaths.

Out of 226 respondents to the survey, 46 per cent said they would be willing to provide opt-out HIV tests, even though there is currently no payment for the service.

Among those who said they would not want to offer opt-out HIV tests, 80 per cent said insufficient time for counselling was a major reason.

The lack of payment, the problem of contact tracing and concerns over legal or insurance issues were other common factors.

But in his letter, Sir Liam says lengthy pre-test counselling is not needed and that HIV tests, if negative, do not need to be disclosed to insurers.

Dr Chris Ford, north London GP and a member of the RCGP sex, drugs and HIV task group, said: 'HIV testing is not difficult to do. We are pushing for normalisation of the test.

'The RCGP is working towards making GPs aware of common diagnoses that may be the first signs of HIV.'

Shingles, unusual skin rashes including sebaceous dermatitis, genital and chest infections that fail to respond as expected to treatment, unusual weight loss and even impetigo all warrant a test for HIV, said Dr Ford.

The survey found that 17 per cent of GPs said they never carried out HIV tests. But almost a fifth said they carried them out weekly or monthly.

Deputy GPC chairman Dr Richard Vautrey said: 'GPs will do it if they think it clinically appropriate, but they won't do it on a general basis unless there are resources.'

Dr Colm O'Mahony, a consultant in sexual health and spokesman for the British Association for Sexual Health and HIV, said: 'If they're going to do extra work they're going to have to be paid for it.

'Through the quality framework would be ideal.'

Both practice nurses and GPs 'have to do asymptomatic screening and HIV tests,' he added.

Dr Sarah Jarvis, RCGP spokeswoman for women's health, said: 'There is certainly a push to do more HIV testing in primary care, but I'm not sure that GPs will make more time for it unless it is incorporated within the contract.'

When asked what was the most important thing general practice could do to improve patients' health, 42 per cent of GPs said education and promotion of safe sex.

Additionally, 22 per cent said it was important that patients found their GPs open to discussion about sexual health.

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