Why is there a need for routine HIV and STI testing in abortion services?

We describe our experience of embedding routine comprehensive HIV and sexually transmitted infection (STI) screening in an abortion service. The British HIV Association (BHIVA) recommended that HIV testing should be offered to all women attending abortion services in the UK National Guidelines for HIV Testing 2008.1 Reducing undiagnosed HIV infection is a public health priority.2 HIV is a treatable medical condition; an individual diagnosed with HIV now should remain fit and well on treatment with a normal/near normal life expectancy.2 Despite this, 24% of the estimated 107 800 people living with HIV in the UK are undiagnosed.2 Whilst unaware of their diagnosis, HIV-positive people are unable to access care to prevent morbidity, mortality and onward transmission of infection. In 2013, 42% of HIV infections were diagnosed late, and this is the greatest cause of mortality in HIV-positive patients nationally.2

The Royal College of Obstetricians and Gynaecologists (RCOG) Guideline, November 2011, on the Care of Women Requesting Induced Abortion3 states that “all women should be screened for Chlamydia trachomatis and undergo a risk assessment for other STIs (e.g. HIV, gonorrhoea, syphilis), and be screened for them if appropriate”. However, universal opt-out HIV testing compared with targeted testing according to risk assessment takes less time per patient,4 results in better uptake of testing5 and is less stigmatising. Opportunities for HIV testing and early diagnosis are currently being missed in women attending abortion services in England6 and will continue to be missed until services offer routine HIV testing instead of targeted HIV testing according to risk assessment.

The impact of STIs remains greatest in young heterosexuals aged <25 years and chlamydia is the most commonly diagnosed STI.7 Other STIs (gonorrhoea and syphilis) are subject to wide geographical variation. However, diagnosing and treating gonorrhoea appropriately …