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

Objectives:To examine the policy and practice of HIV testing in genitourinary 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 selected group of 53 clinics conducted a retrospective case note survey of the 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, genitourinary medicine clinics. Interventions: None Main outcome measures: Number of patients tested for HIV. Results: Consultants' assessments of their rate of HIV testing often exceeded the actual rates of testing in the clinic as a whole. The majority of patients 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 by clinic staff. Two fifths (51/130) of consultants felt the proportion of patients tested in their clinic was too low. The commonest reason given for this 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 those at high risk of HIV. Secondly, a lack of resources, mainly staff, which prevents some clinics from increasing their level of testing.