In British Columbia, there are an estimated 12,000 people living with HIV. Each year, 200-300 people ranging in age from 13 to 81 years old are diagnosed with HIV infection. Despite great advances in treatment, many people with HIV become quite ill, and some die each year because they do not test for HIV until the disease is in a very late stage.
Individuals diagnosed late often take longer to respond or may not respond as well to HIV treatment. In Vancouver, over 60% of people that had a new positive HIV test in the last decade should have already been on treatment. Studies from the United Kingdom, United States, and Vancouver indicate that people diagnosed late in their infection have had multiple missed opportunities for earlier diagnosis in acute, community, and primary care settings.
Offering HIV testing to pregnant women has been implemented in BC since 1994. Experience with this strategy has shown that routine testing of a large group of individuals based on demographic factors (and not on specific risk factors) is considered generally acceptable and is a critical element in effective prevention of HIV transmission. As well, other jurisdictions such as the United Kingdom or the United States have already implemented testing guidelines which recommend more broad-based HIV testing policies.
As part of the Hope to Health HIV Prevention Program in BC, new HIV testing guidelines have been developed for use in BC and were officially released on May 12, 2014. The guidelines make the following broad recommendations as to who should be offered an HIV test in BC.
Health care providers should know the HIV status of all patients under their care.
Specifically, the guidelines recommend that providers offer HIV tests:
- Routinely, every five years, to all patients aged 18-70 years
- Routinely, every year, to all patients aged 18-70 years who belong to populations with a higher burden of HIV infection*
- Once at age 70 or older if the patient’s HIV status is not known
*These populations include gay men, people who inject drugs, people who work in the sex trade, people from countries with generalized HIV epidemics (sub-Saharan Africa and the Caribbean), and Aboriginal people.
As well, an HIV test should be offered to all patients (including adults 18-70, youth and the elderly), whenever:
- They present with a new or worsening medical condition that warrants laboratory investigation
- They present with symptoms of HIV infection or advanced HIV disease
- They or their providers identify a risk for HIV acquisition
- They request an HIV test
- They are pregnant
Implications for practice
It is expected that by implementing these new HIV testing guidelines, more individuals with HIV will be diagnosed earlier in their illness. This will allow them to get effective treatment to prevent illness and death. This will also help to reduce the number of people who may be unaware of their HIV infection and thus reduce onward transmission of HIV. As well, making HIV testing a normal part of routine screening in health care will help to reduce the stigma associated with HIV testing and infection in BC.
The new BC HIV testing guidelines are available online at: