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It is estimated that there are currently 5099 people in Scotland who have been diagnosed as HIV-positive, but that around a quarter of people living with HIV remain undiagnosed. Improving rates of early diagnosis is critical for both individual and public health, and HIV testing is key to achieving this.

If diagnosed early and on effective treatments, people with HIV can live a normal life expectancy. When diagnosed at a late stage, if significant damage to the immune system has already occurred, people have poorer health outcomes and a potentially much reduced life expectancy. Furthermore, if someone is unaware of their HIV status and not on treatment then it is much more likely that they will unknowingly pass on HIV to others.

To improve the take-up of testing, people across Scotland need ready access to a range of testing options and services which are relevant to their needs, especially those who are most at risk. People also need a greater understanding of the benefits of knowing their HIV status accompanied by quality information about HIV. We must also work to ensure that opportunities to diagnose HIV in other healthcare settings are not being missed.

What's needed

There is evidence to suggest that many people who are eventually diagnosed with HIV have been in previous contact with health services regarding HIV related symptoms and that opportunities for earlier HIV testing have been missed. Although HIV infection may be difficult to recognise, particularly in its early stage, this highlights the importance that healthcare staff are trained to identify early signs of HIV infection and feel confident talking about HIV and providing testing.
HIV Scotland would like to see more routine HIV testing taking place outside of specialist settings, particularly for people who may be at an increased risk of HIV. This could be within community settings and specialist third sector organisations, where some people may feel more comfortable testing than within a clinical setting.

Take-up and outcomes of testing, as well as the numbers of people being diagnosed late, should be carefully monitored across Scotland and reported upon. This would enable trends to be identified and testing initiatives to be developed. HIV testing should also be included within national performance monitoring mechanisms such as HEAT Targets and Single Outcome Agreements, to ensure it is a priority issue for all. It is important that different options for testing be made available for people. For example home sampling, instant kits and supervised instant testing.

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