• HIV testing
• termination of pregnancy
• women's health
• antenatal HIV testing
• sexual health
• HIV
• contraception

Anonymous unlinked seroprevalence studies estimate that the prevalence of HIV among women attending termination of pregnancy (TOP) clinics is similar to that of women attending established HIV testing sites such as genitourinary medicine (GUM) clinics and higher than women attending antenatal clinics (ANCs).1 The British HIV Association testing guidelines recommend HIV testing in TOP clinics.2 We report on the introduction of routine HIV testing in the TOP clinic at Homerton Hospital, Hackney, London, an area with a prevalence of diagnosed HIV infection of 0.8%3 and where 29.7/1000 women per year have a TOP.

All women attending for TOP between 1 April 2008 and 31 March 2011 were offered HIV serology and vulval swabs for Neisseria gonorrhoeae and Chlamydia trachomatis. Four thousand three hundred twenty-six women attended and 2308 (53%) accepted HIV testing. A further 291 (7%) had an HIV test at the time of referral to TOP. Twelve were known to be HIV positive prior to termination. An additional seven women (0.3%) tested HIV positive as part of this initiative. 2670/4326 (62%) women accepted screening for chlamydia and gonorrhoea of whom 183 (7%) had chlamydia and 12 (0.4%) had gonorrhoea.

The median age of women accepting HIV testing was 29 years (range 16–43), that of women declining testing was 26 years (range 14–51) (p<0.0005, Student two-sample t test). There was no statistical difference in ethnicity between women accepting or declining HIV testing.

Fifteen thousand seven hundred ninety-five women had an HIV test at GUM clinics during the same time period, of whom 30 (0.2%) were HIV positive. Fourteen thousand seven hundred twenty-four women were tested at ANCs, of whom 18 (0.1%) were HIV positive. The median CD4 of women diagnosed through TOP clinics was 277, compared with 384 at GUM clinics and 330 at ANCs.

This study illustrates that it is feasible and sustainable to embed HIV testing in TOP clinics. Sixty per cent of women had an HIV test at the time of TOP; nonetheless, if the prevalence of undiagnosed HIV of 0.3% was replicated in the 1911 women who declined testing, 6 HIV positive women may have remained undiagnosed after their TOP. This is a cross-sectional study and cannot comment on why some women declined testing or whether they had had a test prior to attendance at TOP.

Since 2010, other centres have started offering HIV testing as part of the TOP service, with uptakes of 82–84% and HIV prevalences of 0–0.2%.4 5 These data demonstrate that it is acceptable and effective to test women for HIV in TOP.