Default testing can save lives

Universal opt-out testing does not mean compulsory checks, as Rowenna Davis reports

One in four people infected with HIV in the UK don’t know they have it. For far too many, the first they hear about it is when they are rushed to accident and emergency with pneumonia or a highly damaged immune system. Before then they could have already unknowingly passed it to others.

Experts now say that much of this trauma could be avoided if testing was given by default to everyone. So why don’t we test people routinely?

“Fear about testing is largely a hangover from a time when it was treated as difficult and dangerous,” says Sir Nick Partridge, chief executive of the Terrence Higgins Trust, which pushed for a huge increase in national testing in the run up to World Aids Day. “In the past you’d need a vial full of blood, two weeks’ waiting time for the results and poor treatment. Now it’s simple, helpful and can really save your life.”

Opponents say that individuals should be able to choose what they know about their own health. But moving to a system of opt-out testing does not make the testing compulsory; it simply means you are given it automatically unless you object. Such an approach has been introduced to pregnant mothers, who are now tested as part of their standard antenatal check-up. Experts say this shift has practically helped eliminate mother-to-child transmission of the virus in the UK.

“In the past it was uncommon to have been tested, now virtually all mums at the school gates will have been,” says Donna Bone, chief executive of Positive Action, who works with people with HIV in Hampshire. “Routine ante-natal screening is significantly destigmatising HIV testing. Of course, it can be heartbreaking to be diagnosed when you’re pregnant, but it’s better in the long run for mother and baby’s health to know.”

However, opt-out testing is less popular outside of the developed world. In the UK, you can guarantee that your information will be kept confidential and, if you do receive a positive diagnosis, that you will be covered by free and adequate treatment. That is not true everywhere, which is why charities such as NAT (National Aids Trust) argue that opt-out testing should only be introduced globally as part of a “broader approach” where rights are respected.

When it comes to the UK, Sir Nick warns that opt-out testing shouldn’t be seen as a cure-all. Most people are at the greatest risk of catching HIV when they are young and generally healthy. This age group won’t naturally be going to a GP regularly, so there needs to be other strategies too. “There is no simple or easy answer; there also needs to be education and encouragement to walk through the door,” he concludes.