1. The case for HIV testing A presentation for the clinical team in your practice

2. Why test for HIV? Work in pairs Try to think of at least two reasons why it is good practice to offer HIV tests

3. HIV and STI Department Annual new HIV and AIDS diagnoses and deaths: UK, 1981-2012 Graph kindly provided by Public Health England ART available HIV test developed

4. Prevalence of HIV in the UK 2012 An estimated 98,400 people were living with HIV. The overall prevalence is 1.5 per 1,000 population 22% were unaware of their infection. Prevalence much higher in some communities 47 per 1,000 among men who have sex with men (MSM) 37 per 1,000 among black Africans HIV prevalence continues to be significantly higher in London than elsewhere in the UK. The most deprived areas have the highest prevalence, especially in London.

5. HIV and STI Department New HIV diagnoses by exposure group: United Kingdom, 2002 – 2012 * *Data have been adjusted for missing exposure information

6. What is late diagnosis?

7. Association between virological, immunological, & clinical events and time course of untreated HIV (Reproduced with permission from e-GP: e-Learning for General Practice, RCCP)

8. Defined by who should have started treatment already. ie when CD4 count below 350 cells/mm 3 In 2012, 47 % of adults diagnosed in the UK were diagnosed late They were ten times more likely to die within a year of diagnosis Also higher risk of permanent disability acute serious illnesses slower response to treatment onward transmission of infection Late diagnosis

9. HIV and STI Department

11. Late diagnoses of HIV by exposure group: United Kingdom, 2011

12. HIV and STI Department Late diagnoses of HIV by exposure group: United Kingdom, 2011

13. HIV and STI Department Late diagnoses of HIV by exposure group: United Kingdom, 2011

14. HIV and STI Department Trends in late diagnosis (CD4<350) by exposure group: UK, 2002-2011

15. Now add to your list Can you think of any more reasons that it is good practice to test for HIV? Add them to your list

16. Choose 3 to 6 key facts on HIV What would you want a receptionist to know? What would you want patients to know? Make a list on the flip chart Discuss and agree how you would like to circulate this -To your team? -To your patients? -Who is responsible? / completion date

17. Use HIV testing You might save a life!