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.
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.