A new study in the UK inidcates that doctors aren’t doing very well at diagnosing HIV. The study looks at diagnosis in primary infection, the few weeks or months when a person first becomes infected with HIV, when the virus replicates like mad and people often feel fluey. It’s an important time to catch infection, for various reasons. Firstly, up to half of HIV is passed on by people who are newly infected, and that’s in studies of married couples in Africa. In epidemics where HIV is concentrated among groups with higher risk (gay men and the sex trade, particularly) it’s likely to be higher. That’s because risk in these groups (and indeed in many other groups, too) tends to go in spurts. Epidemiologists use terms like “periodic concurrency”, but you could just as well say “slutty phase”. You move to a new city, or you break up with a partner, or you fall in with a new crowd, and you spend a few months partying harder (and getting laid more) than you normally would.
It’s in these phases that you’re most likely to get infected with HIV (because you’re sleeping around) and it is also in these phases that you’re most likely to pass on HIV (because you’re sleeping around). Oh, and because you’re also most likely to have other sexually transmitted infections, and in any case you’re at your most infectious. If we can diagnose infections in this phase, you can a) treat aggressively to bring down viral load (those that approach is still in trial) and b) help people to reduce their risky behaviour in that dangerously infectious phase.
The study showed that 43% of the people who were later found to have HIV and reported that they had had what were probably symptoms of primary HIV infection never went to health services at all. Perhaps more worryingly, nearly half of those who did go to a doctor or clinic at the time were not diagnosed as having a new HIV infection. Most of these people were gay men, overwhelmingly the most HIV-affected group in the UK. The paper notes that most gay men in the UK believe their doctors don’t know they are gay. It might help doctors to do their jobs better if we told them of our risks for ill health. But it might also help f they asked.