We have come leaps and bounds in the management of HIV over the last 30 years. People living with HIV, on antiretroviral therapy can enjoy a near normal life expectancy — if diagnosed early. Plus, people on treatment with an undetectable viral load cannot transmit the virus to their sexual partners.

Late HIV diagnosis is associated with a ten-fold increase in the risk of death within one year of diagnosis and increases the risk of onward transmission. People of Black African ethnicity in the UK are more likely to be diagnosed with HIV at a late stage of infection. In 2016, 54% of Black Africans were diagnosed late, the highest number of any ethic group[1].

Increasing access to HIV testing is critical in reducing late HIV diagnosis. However, Black Africans face a number of barriers to testing, which typically reduces access to sexual health clinics. In 2015, just 4% of female sexual health clinic attendees were Black African, but accounted for 42% of HIV diagnoses in this group[2].

This highlights the need to expand HIV testing beyond clinical settings so that Black Africans at risk have the chance to be diagnosed early. This includes strengthening HIV testing in primary care and community outreach testing in order to promote a culture of testing within the community.

While novel approaches to sexual health, including home testing, home sampling and accessing services through the internet offer the opportunity to encourage testing in this group, we need to consider how to overcome some of the barriers to adoption of these new technologies.

[1] PHE(2017) National HIV surveillance data tables

[2] PHE(2016) HIV testing in England: 2016 report