Screening for HIV infection in genitourinary medicine clinics: a lost opportunity?

Objectives: To examine the policy and practice of HIV testing in genitourin ary medicine clinics in the United Kingdom. Design: All 176 consultants in charge of genitourinary medicine clinics in the United Kingdom were sent a policy and practice questionnaire. A self se lected group of 53 clinics conducted a retrospective case note survey of th e first 100 patients seen in each clinic in 1998. Setting: Genitourinary medicine clinics in the United Kingdom. Subjects: Consultants in charge of, and case notes of patients attending, g enitourinary medicine clinics. Interventions: None Main outcome measures: Number of patients tested for HIV. Results: Consultants' assessments of their rate of HIV testing often exceed ed the actual rates of testing in the clinic as a whole. The majority of pa tients deemed to be at high risk requested an HIV test. The exception were heterosexuals who had lived in sub-Saharan Africa. Among attenders at high risk of HIV who did not request a test, 57/196 (29%) were not offered one b y clinic staff. Two fifths (51/130) of consultants felt the proportion of p atients tested in their clinic was too low The commonest reason given for t his was a lack of time, especially that of health advisers. Conclusions: A substantial minority of people with HIV infection attending genitourinary medicine clinics fail to have their infection diagnosed. Two major reasons were identified. Firstly, a test was not always offered to th ose at high risk of HIV. Secondly, a lack of resources, mainly staff, which prevents some clinics from increasing their level of testing.