Box 24 Prevalent HIV infection diagnosedundiagnosed

30 000 people living with HIV and AIDS in the UK 34% undiagnosed:

Homosexual men 28%

Heterosexual men/women 49%

Injecting drug users 6%

haematological investigations. Oral fluid can be collected from the gum/tooth margin and anti-HIV detected in this fluid. Anti-HIV can also be detected in urine.

The patient's identity and the suspected diagnosis should not be exposed to public gaze, and use of numbers or codes rather than names may be preferred. However, the risk of misidentification may thereby be increased. Patient information should only be shared over the telephone between individuals who know each other, and written reports should be sent to named members of staff, under confidential cover. Positive results should be checked on a fresh newly-drawn specimen. The consequences of breaches of these well-tried procedures may be very serious for patients and damaging to the reputation of doctors. Because of the implications of positive laboratory findings for the health of the patient and his or her family and contacts, and for the patient's social and professional life, a high level of competence and sensitivity is to be expected from all who are concerned in instigating investigation for HIV infection. Testing patients without their informed consent is unacceptable.

Laboratory tests for HIV have increased understanding of AIDS and greatly facilitated diagnosis, management, treatment and control measures. However, to derive most benefit from them and do least harm, tests must be used wisely, with proper regard to all the possible consequences for those who are being tested. Any changes to what are now well-established procedures must be carefully considered, piloted, evaluated for cost-effectiveness, and, if introduced, periodically audited to ensure that they are yielding the benefits promised.

Figure 2.7 Containing and transporting the specimens. Consult the laboratory about appropriate specimens usually clotted blood or blood collected in EDTA

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