Thousands of people in England live with undiagnosed HIV. Here's how we find them

World AIDs Day is a time of focus. Focus on those we’ve lost. Focus on those who are undiagnosed. Focus on ending an epidemic.

Because in the UK it is absolutely possible to end new cases of HIV by 2030. We have all the tools necessary to halt the spread of the virus. In fact, we could be the first country in the world to do it and it would be the first time the onward transmission of a virus is stopped without a vaccine or a cure. But turbo charging HIV testing – and fast – is vital.

So, where are we looking for those with undiagnosed HIV? It turns out they’re sitting in A&E. Waiting hours and hours for an appointment to see someone. Maybe about a broken arm. Maybe about something more serious. Maybe their health problem is due to an under lying health condition affecting their immune system – one they haven’t heard of since the 1980s. 

For 18 months the NHS – at the insistence of organisations like Terrence Higgins Trust, National AIDS Trust and the Elton John AIDS Foundation – has been testing anyone having a blood test in A&E for HIV and hepatitis unless they specifically opt-out. But only in London, Brighton, Blackpool and Manchester. On average, one new person a day is found. While hundreds of others, previously diagnosed but not accessing care, have been reengaged with the support they need to live well. That means that, by any measure, the scheme has been a real triumph.

For most people, no news is good news. But for the 934 people diagnosed in A&E in those four cities, they are on a pathway to life changing treatment and a long healthy life. Because one pill a day can keep the virus at bay and ensure you cannot pass it on. That is how far we have come: those on HIV medication have zero chance of passing HIV to a sexual partner.

Not only are these numbers higher than anyone predicted, the diagnoses coming in A&Es are more likely to be in heterosexuals, women, people of Black ethnicity and older than those diagnosed in sexual health clinics. Many of them are diagnosed late but, crucially, before it is too late. In addition, it is relieving pressure in our hospitals. When Croydon Hospital started this pilot, the average stay on the ward of a newly diagnosed HIV patient was 35 days. It is now just a couple.

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And the good news this World AIDS Day is that this game-changing approach to HIV testing is being expanded, which will lead to an additional two millions HIV tests a year meaning A&E testing will make up more than half of all England’s HIV testing.

This was announced by new health secretary Victoria Atkins at an event in honour of Sir Elton John, and the huge amount he’s done around HIV through his foundation, on Wednesday. As she said: “This programme, which improves people’s health and wellbeing, saves lives and money.”

The scheme is so successful the government has announced an extension. Atkins has found £20m to boost the scheme. The government simply couldn’t ignore the evidence of how much impact this is having to ensure we end new HIV cases in the UK by 2030.

So, from April next year, 80 Emergency Departments in the country will routinely test for HIV and hepatitis. In places like Portsmouth, Birmingham, Nottingham, Luton, Milton Keynes and Liverpool. Because of this, many, many, many more will be found with undiagnosed HIV.

This is the testing turbo boost we need to find the 4,000 people in England living with undiagnosed HIV. This single action is going to change lives and put Britain in poll-position to end the epidemic. France, the Netherlands and Australia think they can beat us. We will not fall behind. Terrence Higgins Trust has this as our focus. Join us as we end this epidemic.

Richard Angell is the chief executive of Terrence Higgins Trust, the UK’s leading HIV and sexual health charity.

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