Objectives: To assess the extent of nondisclosure of known
HIV status among sexual health clinic attendees and to quantify the impact of
nondisclosure on estimates of undiagnosed HIV prevalence and of the proportion
of patients remaining undiagnosed on leaving the clinic.
Methods: Serum samples from the unlinked anonymous survey of
clinic attendees’ archive were tested for antiretrovirals. Estimates of
undiagnosed HIV were adjusted using the findings.
Results: Antiretrovirals were detected in 27% of samples
taken from ‘previously undiagnosed’ attendees, who did not have an HIV test but
were HIV positive as detected by unlinked anonymous testing, indicating
nondisclosure; 24% of such samples from MSM had antiretrovirals present
compared with 32% of heterosexual men and women. Antiretrovirals were detected
in 33% of samples from London clinics and in 21% from non-London clinics.
Following adjustment, the estimated prevalence of undiagnosed HIV decreased
nonsignificantly from 3.04% to 2.66%
(2.35–3.01) among men who have sex with men (MSM), 0.31% (0.26–0.37) to 0.30%
(0.25–0.36) in heterosexual men and 0.40% (0.35–0.46) to 0.37% (0.32–0.43) in
women; 7% of MSM who do not have an HIV test at a clinic visit will be infected
with HIV and remain unaware of their infection.
Conclusion: Nondisclosure of HIV status to healthcare
professionals occurs among clinic attendees. Adjustment for nondisclosure
results in a small, nonsignificant decrease in the prevalence of undiagnosed
HIV estimated from the unlinked anonymous survey in sexual health clinics.
Testing the population of MSM not having an HIV test remains a priority as
levels of undiagnosed HIV are high.
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