Ayo from Manchester was in his 50s when unexplained nerve pain began spreading through his body. He lost 20 kilograms. His plans to attend university were put on hold. One evening, running a high fever with an abscess on his neck, he was rushed to Manchester Royal Infirmary's emergency department. There, as part of a pioneering NHS program, he was tested for HIV—and his result came back positive.

"If I wasn't in hospital, I wouldn't have been tested for HIV," Ayo said. "It wasn't something I thought would affect me in my 50s, but in the blink of an eye, everything changed. Now I know my status, I can protect my wife and stay well for my family."

Ayo is one of 1,900 people in England whose previously undiagnosed HIV has been identified by the NHS Blood Borne Virus Opt-Out Testing Program since it launched in April 2022. Under the initiative, adults visiting major hospital emergency departments in 88 towns and cities with high rates of diagnosed HIV—who are already having blood taken as part of their visit—are routinely tested for HIV, hepatitis B, and hepatitis C unless they choose to opt out.

The numbers reveal a program reaching exactly the people it intends to. According to research by the UK Health Security Agency, 93 percent of newly diagnosed individuals in the program had no record of ever having an HIV test before. That figure matters: roughly one in 20 people living with HIV in England does not know they have it, and many others are diagnosed only after the virus has already caused serious damage to their health.

A major economic evaluation published in The Lancet HIV and led by researchers at the University of Bristol offers a glimpse of the program's long-term impact. The study estimates that the 802 new diagnoses from the program's initial phase will prevent approximately 187 HIV-related deaths and 28 new infections over the next two decades—while delivering good value for NHS resources, since earlier diagnosis means people start life-saving antiretroviral treatment sooner, improving outcomes and reducing onward transmission.

Professor Francesca Swords, national medical director for the NHS, framed the initiative as a shift in how the health service approaches prevention. "Knowing your HIV status is as important as checking your blood pressure," she said. "Our pioneering NHS Blood Borne Virus Opt-Out Testing Program is helping hundreds of people get a diagnosis—often before they have any symptoms at all—which means they have access to life-saving treatment."

The approach is set to expand. The government's HIV Action Plan for 2025–2030, published by the Department of Health and Social Care in collaboration with UKHSA and NHS England, commits £156 million from April 2026 to March 2029 to continue and grow the program in emergency departments across very high- and high-HIV-prevalence areas. The goal: end new HIV transmissions in England by 2030.

For Ayo, that future is already unfolding. After his diagnosis, he began antiretroviral treatment and is now focused on rebuilding his health. "I can protect my wife and stay well for my family," he said.