Introduction

Indications for HIV testing 

Testing for HIV in those with Indicator Conditions (IC) is one element of a comprehensive testing approach intended to help to achieve zero HIV transmission.  BHIVA/BASHH/BIA Guidelines recommend HIV testing based on individual factors associated with a higher detected prevalence of HIV, on routine testing in settings which may be attended by populations with a higher prevalence of HIV, or on mass opt-out testing approaches in geographical areas with high or very high HIV prevalence. In Scotland, targeted routine testing is well established with very high uptake in antenatal services. Testing is routine in some but not all sexual health services, prisons and alcohol and drug recovery services with very variable uptake. A programme management approach is underway to improve rates of testing in these settings. Opt-out BBV testing in Emergency Departments is being rolled out in NHS Greater Glasgow and Clyde, NHS Lothian and NHS Grampian in 2026. Testing in indicator conditions is an important addition to these systematic approaches because it identifies people with clinical signs of possible HIV infection, who may be missed by those interventions based on individual or population-level ‘risk factors’. Indications for HIV testing include: 

Individual testing  

HIV testing should be routinely recommended to the following individuals: 

1. People presenting with symptoms and/or signs consistent with an HIV indicator condition
2. Sexual partners of people with diagnosed HIV 
3. People with demographic or behavioural factors associated with a higher prevalence of HIV: 

• • GBMSM (gay, bisexual and other men-who-have-sex-with–men) 
  • People from or who travel to from a country with diagnosed seroprevalence of >1% in adults aged 18-49 years  
  • People reporting current or prior injecting drug use 
  • People who sell or exchange sex 
  • Trans women  
  • People with a history of incarceration
  • People known to have/have had a mother living with HIV and who do not have documented HIV-negative status  

Targeted routine testing 

    4. Routine HIV testing is recommended for all people attending the following settings.  

• • Sexual and reproductive health services (where STI tests are offered, these should routinely include an HIV test) 
  • Addiction and substance use services 
  • Pregnant people attending for care in all settings (i.e including antenatal and abortion services) 
  • Healthcare services for hepatitis B and C, TB and lymphoma 
  • Prisons 

Mass opt-out testing 

     5. HIV testing is recommended for all people accessing primary and secondary healthcare in areas of high and extremely high HIV seroprevalence, including emergency departments. Mass opt-out testing approaches usually combine testing for BBVs including hepatitis B, hepatitis C and HIV. Mass opt-out approaches may be implemented in medium and low prevalence areas as part of a transmission elimination strategy.