HPA calls for practice nurses to offer HIV testing to more patients

Practice nurses should offer patients an HIV test when they register with a new general practice, according to the Health Protection Agency (HPA).

Frontline nurses should routinely offer thousands more patients HIV testing, public health experts have said.

This follows an estimated major rise in transmission.Tests should become routine in general practices, hospitals and other settings where the prevalence of the disease is above average, according to the Health Protection Agency.

The HPA said that national testing guidelines, published in September by the British HIV Association and the British Association for Sexual Health and HIV, must be implemented.

In areas with the highest prevalence of HIV (see map), the guidance says that nurses should offer testing to all men and women aged 15–59 who are admitted to hospital or register with a new practice.

The HPA last week published its HIV statistics that suggested an estimated 77,400 people were living with HIV in the UK
in 2007, with nearly one-third unaware of their infection. This compares with 73,000 reported to have the infection in 2006.

Dr Valerie Delpech, head of HIV surveillance at the HPA, said: 'It is worrying that so many people remain unaware of their HIV status. Wider HIV testing in high-prevalence areas of the UK is urgently needed to reduce the number of undiagnosed infections.'

She said it would be the job of nurses in general practice and in hospitals, including A&E departments, to offer HIV testing on a routine basis.

'We need to train staff so that they learn to normalise HIV testing in these settings. They need to know that HIV is now
a long-term condition – stigma and discrimination are still there and we need to change that culture,' she said.

Dr Delpech cited the example of antenatal HIV testing. 'Initially nurses were uncomfortable with offering this but, with the right training, it has become normal,' she said. The figures show that 94% of pregnant women take the test when offered.

Jacky Rogers, chairperson of the RCN sexual health forum, said HIV testing had 'gone off the agenda' for a lot of healthcare professionals.

'We need to refocus and normalise HIV testing within practice and hospital settings. Practice nurses need to think about having a discussion and offering every new person registered a test,' she said. 'Nurses need to get their heads round it, be more proactive and be careful not to categorise people in terms of risk.'

Ms Rogers said that nurses could seek training and advice through sexual health clinics and PCTs' sexual health leads.

Kathy French, a freelance sexual health nurse consultant, welcomed the suggestion of routine testing. However, she warned that there was an issue of training if HIV testing was to become the norm outside sexual health clinics.

'Where stigma and discrimination still exist in the workforce, knowledge and training are needed,' she said. 'Developing testing as part of the local care pathways must be done in the context of proper training for nurses.'