Trends in, and determinants of, HIV testing at genitourinary medicine clinics and general practice in England, 1990-2000.

OBJECTIVES To describe the trends in and determinants of HIV testing and positivity at genitourinary medicine (GUM) clinics and in general practice (GP) in England between 1990 and 2000. METHODS Data on all first HIV specimens from GUM and GP clinics and tested at seven sentinel laboratories were related to key demographic, clinical, and behavioural variables. RESULTS During the observation period, 202 892 eligible first HIV tests were reported. 90% (182 746) of specimens were from GUM clinics, of which 55% were from heterosexuals, 12% from men who have sex with men (MSM), and 3% from injecting drug users (IDU). In contrast, only 3% of GP specimens were from MSM and 13% from IDUs. The total number of first HIV tests increased threefold between 1990 and 2000. Overall, 1.6% of GUM and 0.9% of GP first testers were diagnosed HIV positive. In GUM clinics, HIV positivity was highest among heterosexuals who have lived in Africa (11.7%), MSM (6.9%), and IDUs (2.8%) and lowest among heterosexuals with no other specified risk (0.3%). Consistently lower prevalences were observed in GP settings. HIV positivity among GUM first testers declined in MSM, from 13.6% in 1990 to 5.2% in 2000 (p<0.01), and in IDUs, from 7.5% in 1990 to 2.0% in 2000 (p = 0.03). Prevalence remained constant in the groups heterosexually exposed to HIV infection. CONCLUSIONS HIV testing in GUM settings increased over the decade, with a concomitant reduction in HIV positivity among MSM and IDUs. Increased testing among heterosexual first testers overall was not associated with declining positivity.