Stigma and lack of funding blamed as new HIV cases are missed
SPECIAL REPORT
BY HELEN MCARDLE
NEW cases of HIV in Scotland are being missed because of the stigma surrounding sexual health and a lack of funding by health boards for routine testing, charities have warned. A majority of GP practices and hospitals in Scotland and England are flouting guidelines which advise that people living in “high prevalence” HIV areas – classed as at least two cases per 1,000 of the population – should be routinely tested when they register with a new GP practice or are admitted to hospital.
In Scotland, both NHS Greater Glasgow and Clyde and NHS Lothian fall into the category, although a spokesman for NHSGGC stressed that the region was only “marginally over” the threshold.
Dr Miles Mack, chairman of the Royal College of GPs in Scotland, said doctors required funding from health boards to carry out screening, which was “not happening” in either area. He added that GPs were also pushed for time.
“When people first register with their GP, the 10-minute appointment on offer is simply too short to carry out the test along with dealing with the other issues the consultation will cover,” he said. “We have been calling through our manifesto, ‘Promot- ing general practice’, for further investment in general practice in order to facilitate longer appointments for patients and that would undoubtedly help.”
Modern HIV drugs prevent the onward transmission of the virus, even through unprotected sex, and allow carriers to live normal, healthy lives.
However, Robert McKay, national director of Terrence Higgins Trust Scotland, said there remained a “real discomfort” within the NHS about HIV.
McKay said: “About 18 months ago, I was at a GP’s and we got onto the subject of who I worked for. The GP said ‘ oh no, we don’t deal with any of that here – we just send people along the road’.
“I thought ‘well, if that’s the advice people are getting when they go to primary care it’s not going to effect the change that we need’.
“We test a lot of healthcare professionals because they’re too scared to get tested in their own services, so what’s that saying in terms of how stigmatised HIV and STI testing still is?”
The charity has funded its own national postal testing service in Scotland since 2014, at a cost of £60,000 per year. It involves a test kit and pricking a finger then submitting a droplet of blood. Of the 2,054 returned since November 2014, 18 have tested positive for HIV.
McKay said sexual health checks should be “as normal as going to the dentist”.
He said: “We have a tremendous difficulty, and we have had for a number of years now, in terms of late diagnosis because people ignore the symptoms, deny the symptoms, or they’re not even aware that the symptoms they have are related to HIV. Equally, there can be no symptoms at all.”
Vanessa Roberts, who was featured last week in a BBC Radio 4 investigation into the issue, was diagnosed in her fifties but her specialist believes she was infected aged 19. In that time she had married, had two children, divorced and remarried, and had to break the heartbreaking news to her family that she may have passed the virus on to them. Fortunately, their tests were all negative.
It is estimated that around one in six of the 100,000 people thought to be living with HIV in the UK are unaware of it.
Both the Glasgow and Lothian regions have around 1,560 known cases each, suggesting as many as 300 people in each area could be unknowingly infected.
Grant Sugden, chief executive of Testing for HIV should be ‘as normal as going to the dentist’ Waverley Care, Scotland’s HIV and hepatitis C charity, said: “Late diagnosis of HIV has been an issue for a long time in Scotland and across the UK. Many factors contribute to this including lack of awareness of symptoms and reluctance of people to come forward for testing caused largely by HIV-related stigma.”
Professor Alison McCallum, director of public health at NHS Lothian, said it took early diagnosis of HIV “extremely seriously”. She said: “It is essential for the development of a routine testing programme to be grounded on a local evidence base, and that is why we are conducting an anonymous survey of around 40,000 samples from a range of different services.
“The results of this survey will then be used to inform a decision on universal testing and to identify the service areas where routine HIV testing could be most effective.”
A spokesman for NHSGGC said it was aware of the work at NHS Lothian and would use the results to “identify the service areas where routine HIV testing could be most effective”.
When people first register with their GP, the 10-minute appointment on offer is simply too short to carry out the test along with dealing with the other issues the consultation will cover