1. Testing, diagnosis and prevention
It might seem odd to have a section on testing, diagnosis and prevention. After all, these are Standards for people living with HIV. So, for us, we’ve already been tested, diagnosed and are probably already being treated for HIV. But as people living with HIV, we might have some particular concerns about prevention. We might also have partners who are not living with HIV, so we need to be aware of, and involved in, prevention strategies.
HIV testing and diagnosis are crucial to stopping the HIV epidemic.
Over the past few years, the number of new HIV diagnoses in England has been falling. This is the result of ‘combination prevention’. This is what this section is about. Combination prevention involves the use of HIV drugs, called antiretrovirals (ARVs), which is why they are discussed in the 2018 Standards. There are other prevention strategies, which the 2018 Standards do not cover, but these are still important, for example, condom use or needle exchange for injecting drug users.
Combination prevention relies on several factors:
(1) Frequent testing
This includes testing at sexual health clinics, in the community, and testing at home. A quick diagnosis means fast access to treatment. Starting treatment sooner rather than later is better for your long-term health. Frequent repeat testing is recommended.
(2) Treatment as prevention (TasP)
If you test HIV positive, some forms of HIV testing need to be confirmed. These tests might show a ‘reactive result’. This means that you are probably HIV positive, but another, different, test is needed to be sure. Between the time of the reactive test and the results of the second test, suitable professional and peer support should be available. Peer support means talking with someone else who lives with HIV. This can be very helpful and reassuring.
If you are HIV positive, then HIV treatment called antiretroviral treatment (ART) should be started as soon as you’re ready. Early ART is the best option for your long-term health.
ART reduces the amount of virus in your blood. Once this level is undetectable, HIV cannot be transmitted to your sexual partners, even if you don’t use condoms. This is called ‘Undetectable equals Untransmittable’, or U=U. Starting treatment sooner rather than later reduces the chance of passing HIV to a sexual partner. This is referred to as ‘treatment as prevention’ (TasP).
(3) PrEP (pre-exposure prophylaxis)
PrEP is ART that is used by people who are HIV negative to stop them getting HIV. At present, it usually involves taking drugs on a daily basis. PrEP is dramatically effective for HIV prevention. It’s freely available in Scotland, Wales and Northern Ireland, and as of October 2020, also in England. PrEP users in England are being switched from an NHS trial to full access from the NHS. Advice on PrEP can be found on community websites such as HIV i-Base (http://i-base.info) or iwantprepnow.co.uk.
Together, these factors have helped to reduce the number of new cases of HIV. That’s why it’s called combination prevention.
Everyone having sex should be made aware of, and have access to, a complete package of HIV prevention options. This should include using condoms, access to free and repeat HIV testing, and sexual health screening. It could also include using HIV drugs called ARVs for PrEP or TasP, as required. Note that PrEP and TasP protect against HIV, but not other sexually transmitted infections (STIs). This is discussed more in Standard 5 (Sexual and reproductive health).