Thousands In UK Do Not
Know They Have AIDS
BBC News

Note - Try to imagine how many people worldwide don't know...
Many people are unaware they are carrying the virus that causes Aids
Thousands of people in the UK are unknowingly carrying the virus that causes Aids, according to a series of anonymous surveys.
The government's Prevalence of HIV in England and Wales report shows that over two-thirds of HIV positive pregnant women do not know they are putting their babies at risk.
And even among gay and bisexual men - the most HIV-aware section of the community - as many as 40% of people attending sexually transmitted disease (STD) clinics do not know they are carrying the virus.
The anonymous surveys have been carried out in prisons, ante-natal units, STD clinics and hospitals around the country between 1990 and 1997.
Future picture
The aim of the surveys is to give health officials an idea of what the future outlook for HIV is in England and Wales.
Drugs can reduce HIV levels, but there is no cure or vaccine for AIDS yet. The surveys used leftover blood samples. Specimens were not taken from patients who objected to being tested.
They showed that people in London continued to be at more risk of HIV infection than the general population.
Gay and bisexual men were most at risk. In 1997, one in 11 men who attended STD clinics in London being HIV positive, compared with one in 26 elsewhere.
One in 16 gay and bisexual men under 25 were infected in London.
Just under 3% had been diagnosed since 1996, showing that Aids prevention programmes are not getting through to many people.
Much of the early prevention work was aimed at gay and bisexual men and brought a reduction in the number of new cases.
But health officials fear this may now be wearing off. The survey calls for campaigns to educate "new generations" at risk.
Drug users
However, the message seems to be getting through to drug users outside London.
One in 268 men and one in 245 women drug users outside London are HIV positive.
In London, the numbers are not falling. One in 25 men and one in 66 women in London carry the virus.
Drug users who share needles are at greater risk of getting HIVMoreover, the number of people sharing needles and syringes - which helps transmit the disease from an infected person - has remained stable in the last five years.
Younger drug users and women are more likely to share needles than others.
Health officials report a rise in the number of acute hepatitis B infections since 1992, which is transmitted in a similar way to HIV - showing the risk is still "substantial".
For heterosexuals, one in 125 men and one in 142 women in London who attended STD clinics in 1997 were HIV positive.
One in 801 men and one in 978 women carry the virus outside London.
And saliva tests on inmates at eight prisons show an HIV rate of 0.3% for men and 1.2% for women, although hepatitis rates are as high as 17% for men and 23% for women.
The UK has a relatively low level of HIV infection, compared with other European countries, says the report.
Some 25,000 UK adults - around one in 1,000 people between the ages of 15 and 49 - are HIV positive.
The UK rates are similar to Ireland and slightly more than Germany, Sweden, Norway and Finland, but way below levels in Portugal, Spain, France, Switzerland and Italy.
Around one in 160 people in Portugal aged 15 to 49 is HIV positive.
The report puts the UK's low level of infection down to targeted interventions at groups indulging in high risk behaviour, education campaigns, needle exchange schemes and free and open access to STD clinics.
It calls for a continuation of targeted campaigns, the provision of routine voluntary confidential HIV testing at STD clinics, special services for African women - the highest risk group among pregnant women - and the maintenance of needle exchange schemes.
Public health minister Tessa Jowell said: "The report gives vital information which cannot be obtained in any other way.
"It is important for local planning and prevention and underpins current policy direction."
Babies Unnecessarily Dying Of Aids 11-30-98
Up to 80% of pregnant women with HIV who attend ante-natal clinics in London are ignorant that their babies' lives could be at risk.
Research shows that pregnant women are the least likely group to have had their HIV clinically diagnosed. Many wrongly assume they have been tested.
In London, one in 533 women is HIV positive, compared to one in 6,222 for the rest of England and Wales.
However, in some areas of London, prevalence is as high as one in 170.
The government is planning to reverse this trend by launching two leaflets to address the problem - one for women in London and the other for midwives around the country.
Giving women choices
The government says the problem is not that pregnant women do not want to take HIV tests.
It is that they are not being offered the choice of having one.
The UK has one of the worst mother to baby HIV infection rates in western Europe.
This is because testing is routinely offered to women in many other countries.
This means the mothers-to-be can take precautions which will reduce the likelihood of their babies contracting the disease.
For example, they can take AZT, one of the drugs used to reduce the spread of the virus which causes Aids.
They can also choose not to breastfeed as the virus is carried in the mother's milk.
Research studies have shown that the number of babies born to HIV positive mothers who themselves become infected falls by two-thirds if the mother takes AZT and does not breastfeed.
However, there is a risk that mothers who are only treated with AZT may develop resistance to treatment after the birth.
Also, many babies lose their infectivity soon after birth.
Only one in seven children born to HIV positive mothers end up carrying the virus themselves.
Another way of reducing the spread of the virus is through opting for a Caesarian section to prevent the baby becoming infected by the mother's blood as it passes down the birth canal.
Midwives are to be offered training in counselling women about taking the HIV test and in referring them for specialist care if they test positive.
The training is likely to begin early next year.
Midwives have been chosen to offer counselling and support because they are seen as trustworthy by women.
Strong recommendations
The emphasis is not on forcing women to have tests, but on giving them information about the risks they may face and strongly recommending the test in areas where there is a high prevalence of HIV.
Women will be given advice on testing face to face and in written form and will be allowed time to think over their decision and consult their partner.
Karlene Davis, general secretary of the Royal College of Midwives which has worked with the government on the leaflets, said: "Three in four pregnant women who have the virus do not know they are infected.
"Many are missing out on the new drug therapies which are prolonging lives. And babies are dying unnecessarily."
She said partnership working would be necessary to ensure the counselling and support offered to women was "seamless" and she called for extra resources for training midwives.
African women
Around 80% of HIV positive pregnant women are thought to be from Africa, where HIV is rife in some areas.
The Department of Health recommends that special attention be given to services aimed at these women.
Yvonne Moores, chief nursing officer, said efforts would be made to translate leaflets into different languages and to ensure that midwives knew of the cultural issues affecting African women, for example, it may be difficult to persuade many against the benefits of breastfeeding.
Speaking on the eve of World Aids Day, 1 December, public health minister Tessa Jowell said: "Having the courage to opt for an HIV test is an important first step in preventing babies being born with HIV.
"If we can increase the numbers of pregnant women opting for an HIV test, we will diagnose more infections in tie to offer the mothers measures that will significantly decrease the risk of HIV passing to their babies - from one in six to one in 100."
The strategy for targetting mothers-to-be is part of a review of the nature of HIV infection.
Tessa Jowell said the nature of people's need for support and care had changed in the last three to five years.
Other groups which are likely to be targeted include young gay and bisexual men.
The numbers of new cases are rising among this group after years of decline due to big publicity drives.
Dr Jeremy Metters, deputy chief medical officer, said this was because this group were not being targeted so much by health promotion groups and also because the success of combination drug therapy had led many to mistakenly believe that Aids was no longer a serious illness.