Further decline in new HIV diagnoses in the UK

New HIV diagnoses have fallen for a third consecutive year, the latest data from Public Health England (PHE) shows. In 2018 a total of 4,484 people were diagnosed with HIV in the UK, a 6% reduction from the 4,761 diagnosed in 2017.

PHE has advised the intensification of combination prevention has been critical to the decline in HIV incidence in gay and bisexual men since 2012. Further information will be released in PHE’s annual report, which will be published in November.

The increase in HIV testing, access and availability to immediate antiretroviral therapy for people diagnosed with HIV, and the scale-up of access to pre-exposure prophylaxis (PrEP) have all played a role in the continued decline of new diagnoses.

The decline in gay and bisexual men

Since 2015 there has been a staggering 39% decline in new HIV diagnoses among gay and bisexual men. Within this group, the steepest declines have been recorded within men who are:

  • White (46% decline since 2015)
  • Born in the UK (46%)
  • Aged 15-24 (47%)
  • Resident in London (50%)

The biggest declines outside of London in gay and bisexual men were seen in:

  • West Midlands (47%)
  • Scotland (43%)
  • East Midlands (40%)

In 2018, two out of every five gay and bisexual men newly diagnosed with HIV lived in London.

The decline via heterosexual contact

During the same time period (2015-2018) the fall in new diagnoses from heterosexual contact was 24%. Within this group the biggest declines have been recorded in people who are:

  • Adults in London (40% decline since 2015)
  • Aged 25-34 (34%)
  • Born in Africa (24%)

Late diagnoses

There are still challenges for the sector despite the continued decline in new HIV diagnoses. In 2018, 43% of all diagnoses were late. PHE has once again repeated its warning that people diagnosed late face a ten-fold increased risk of short-term mortality.

Population groups with particularly high late diagnoses rates include:

  • Heterosexual men (60%)
  • Black African adults (52%)
  • Those aged 50 and older (59%)

People diagnosed late are more likely to experience an AIDS-defining illness at the time of their diagnosis: this was true of 225 people in 2018, a similar number to 2017.

People receiving HIV care in 2018

In 2018 there were 96,142 people receiving HIV care in the UK, of which:

  • 97% were receiving antiretroviral treatment
  • 97% of people on treatment were virally suppressed

The percentage of those receiving treatment was slightly less in 15-24 year olds and in people who inject drugs. Viral suppression was consistent across all population groups.

Trans people

For the second consecutive year PHE has supplied data on HIV diagnoses in trans people. In 2018, 11 trans people were diagnosed with HIV, which is a fall from 16 in the previous year.

The data from PHE now shows that 152 trans people were seen in HIV care in 2018. Of these, 33% were 50 or older and 39% were black, Asian or minority ethnic (BAME). All trans people seen in care were on treatment.

What this means for HIV prevention in England

The hard work to sustain the decline in new HIV diagnoses must continue. The combination prevention approach is working in the UK and efforts to increase awareness and knowledge of correct condom use, HIV testing, PrEP and HIV treatment are necessary to maintain this momentum.

Late diagnoses remain an area that the entire health system needs to take responsibility for, ensuring that all population groups have access to HIV testing. The HIV sector must work with primary and secondary care providers to increase opportunities for people to test outside of traditional sexual health services.

Particular attention needs to be paid to regions outside of London and to those subgroups which are not seeing as large declines in new diagnoses as witnessed in white gay and bisexual men.

National HIV Testing Week presents the next opportunity for the sector to continue to increase HIV testing and reduce late diagnoses in all groups affected by HIV across England. The campaign starts Saturday 16 November 2019. Stay informed with our plans for the campaign by signing up to our newsletter using the form on this page and following us on Twitter.

New local PHE indicators

PHE has announced a number of new HIV indicators on its Fingertips online sexual and reproductive health profiles. In addition to existing measures including HIV testing coverage and new HIV diagnoses rates you can now access local and regional information on:

  • Late diagnoses rates for MSM, heterosexual men, heterosexual women and people who inject drugs
  • Repeat HIV testing in MSM within the past year
  • Prompt ART treatment initiation in people newly diagnosed with HIV

PHE Fingertips webinar

If you would like to know more about PHE’s online health profiles, join us at 1pm on Tuesday 24 September for our webinar looking at getting the most out of PHE’s fingertips tool.

Find out more and register for this event

Official Statistics from PHE

Read HIV annual data tables

New HIV diagnoses continue to decline in the UK

New HIV diagnoses have fallen for a second consecutive year, the latest data from Public Health England (PHE) shows.

In 2017 a total of 4,363 people were diagnosed with HIV in the UK, a 17% reduction from the 5,280 diagnosed in 2016 and a 28% reduction from the 6,043 diagnosed in 2015.

PHE have attributed the latest results primarily to improvements in the uptake of antiretroviral therapy in people living with HIV and the large increases in HIV testing. Particular attention has been paid to men who chose to repeat HIV testing.

While these results are published against the backdrop of the roll-out of pre-exposure prophylaxis (PrEP) through the IMPACT trial, and the increase in predominantly gay and bisexual men accessing generic PrEP privately online, PHE advises that it is too early to know the size of impact this is having on HIV transmission rates.

Gay and bisexual men

PHE has advised that the continuing downward trend in new diagnoses is largely due to a decline in new diagnoses among gay an bisexual men: the rate in this group has decreased more than any other group affected by HIV, with a 31% fall since 2015. This drop is even more significant in London where new diagnoses fell by 44%, compared to 30% outside the capital.

Black African and Black Caribbean men and women

Numbers of new diagnoses in black African and black Caribbean heterosexuals have been falling steadily for almost a decade and experienced an even more dramatic drop of almost 25% in the last year – from 1, 040 in 2016 to 800 in 2017.

Other heterosexuals

In previous years this group had reported approximately 1,000 diagnoses per year. However, in 2017 the new PHE data shows a 20% decline, the reasons for which are currently uncertain.

Trans people

For the first time PHE have supplied data on HIV diagnoses in trans people. In 2017, eight trans women were diagnosed with HIV, a slight fall from 10 in the previous year and 15 trans women in 2015.

Late diagnoses

While the fall in new HIV diagnoses is to be celebrated, there are still challenges facing the HIV sector. Late diagnoses rates have remained stubbornly high at around 40% for the past five years, and in 2017 43% of people were diagnosed late.

PHE has repeated its warning that people diagnosed late face a ten-fold increased risk of short-term mortality. People diagnosed late are more likely to experience an AIDS-defining illness at the time of their diagnosis: this was true of 230 people in 2017.

People receiving HIV care in 2017

The UK is making great strides, continuing to ensure people living with HIV remain in care and have access to treatment which benefits their health and reduces the chance of transmission to their sexual partners. In 2017 there were 93,385 people receiving HIV care in the UK, of which:

  • 98% were receiving antiretroviral treatment
  • 97% of people on treatment were virally suppressed

Overall, gay and bisexual men continue to be the most disproportionately affected by HIV, with 43,494 people seen for HIV care in 2017, followed by black African heterosexual men and women with 27,212 people seen for care. Trans people accounted for 123 individuals seen for care, the vast majority of which were trans women.

What this means for HIV prevention in England

It is clear that the combination prevention approach to drive down new HIV diagnoses across the country is working. However, to sustain this trend the hard work must continue.

The sector must tackle late diagnoses and ensure that all groups affected by HIV know how they can take responsibility of their own sexual health, by making use of the range of HIV prevention and sexual health tools available to them.

National HIV Testing Week presents the next opportunity for the sector to continue to increase HIV testing and reduce diagnoses rates and late diagnoses in all groups affected by HIV across England. The campaign starts Saturday 17 November 2018.

Stay informed with our plans for the campaign by signing up to our newsletter and following us on Twitter.

Official Statistics from PHE

Further information from HPE

HIV Prevention England GP Engagement Strategy

HIV Prevention England GP Engagement Strategy banner

In 2016, 42% of people were diagnosed with HIV late in the UK – and late diagnosis leads to a tenfold increase in mortality compared to those diagnosed promptly (Public Health England (PHE), 2016). People outside London, of black ethnicity and those over 50 are most likely to be diagnosed late (PHE, 2017).

A key priority of the national HIV prevention programme (HPE) is to reduce late diagnosis by increasing HIV prevention and testing among GPs and other primary care providers. To achieve this, we have launched a new GP Engagement Strategy [PDF] which outlines the activities and approaches which we will adopt.

The average adult visits their GP at least three times a year (The King’s Fund, 2016). In contrast, the last national survey of sexual attitudes and lifestyles (Natsal-3) found that (Tanton et al, 2018):

  • As few as 4.9% of sexually active adults attended a sexual health clinic (SHC) in the last year.
  • More than 80% of those who reported having condomless sex had not attended a SHC in the last year.
  • 65% of men and 77% of women who had never been to a SHC were more likely to seek treatment from their GP instead.

Despite the challenges associated with delivering HIV testing and prevention interventions in primary care, GP-based HIV testing and prevention is essential for many reasons, not least that the national guidelines strongly recommend increased GP testing in areas of high and very high prevalence of diagnosed HIV.

HPE will provide significant opportunities to support GPs and primary care practitioners, through National HIV Testing Week, providing free patient resources, information briefings for professionals, and providing sector development training events.

Download the briefing

HIV Prevention England GP Engagement Strategy [PDF]

Get involved

HPE provides resources and training. If you work in primary care:

  • Take advantage of our free patient resources.
  • Sign-up to our monthly newsletter to keep up-to-date with our latest news and events (complete the form opposite).

Forthcoming events

HPE will be attending the Royal College of General Practitioners (RCGP) Annual Primary Care Conference & Exhibition in October, we welcome delegates to visit our stand in the exhibition space to talk to us about our work.

In late October we will be hosting two events for GPs and people working in primary care on pre-exposure prophylaxis (PrEP) and HIV testing in both London and Manchester. Contact us if you would like to register your interest.

National HIV Testing Week starts Saturday 17 November 2018.

Report puts spotlight on needs of women affected by HIV

Terrence Higgins Trust and Sophia forum recently launched  ‘Women and HIV: Invisible No Longer’, a report to bring attention to the needs of women living with or affected by HIV. It was co-produced with women living with and affected by HIV.

The report was developed using existing evidence and new data generated with over 340 women through surveys and workshops.

It focuses on all women, including trans women, regardless of sexuality, ethnicity, whether they do or do not have children, or are pregnant or not.

Key Findings

Some of the key findings include the following:

  • Almost half (45%) of women living with HIV in the UK live below the poverty line.
  • Over half of women living with HIV in the UK have experienced violence because of their HIV status.
  • Nearly one third (31%) have avoided or delayed attending healthcare in the past year due to fear of discrimination.
  • Two thirds of women living with HIV (67%) are not satisfied with their sex lives.
  • Two in five women living with HIV (42%) said that HIV impacted their decisions on whether to have children.
  • Despite this, half of women living with HIV (49%) described their quality of life as ‘good’ or ‘very good’, while a further 38% called it ‘acceptable’.
  • On HIV prevention, little effort has been made to define who the women at risk of HIV are.
  • Nearly half the respondents (42%) felt that barriers prevent them from testing for HIV.

Read the full report (PDF) or the executive summary (PDF).

Five key asks

The report details a number of recommendations but the writers of the report have five key asks that summarise the changes needed to ensure that women’s needs are met  appropriately in HIV prevention, care, support, research and data in the UK.

  1. Achieve gender parity in the UK HIV response, ensuring equitable investment, priority and attention to women in HIV prevention, research, data and services.
  2. Ensure that HIV research addresses specific knowledge gaps around HIV and women and supports the full participation and meaningful involvement of women.
  3. Prioritise reducing late diagnosis of HIV among women, better explore the use of innovative HIV testing approaches, and improve rates of HIV test offers and uptake in different settings.
  4. Improve data collection and disaggregation on HIV and women, ensure local level data is available, and include sexuality data for women in national reporting.
  5. Invest in HIV support services that meet women’s needs holistically and enable women to not just live well but to thrive, including peer support and support for mental health and gender-based violence.

New report finds high recognition of It Starts With Me and National HIV Testing Week

Cover of TNS reportSocial research company TNS-BMRB has published their report of the survey they conducted at the end of 2015 on the ‘It Starts With Me’ campaign, including National HIV Testing Week. The report was commissioned by Public Health England.

Two surveys were carried out online: one for gay/bisexual and other men who have sex with men (MSM); and one for men and women from Black African (BA) communities.

The results revealed that campaign recognition was high, with 84 per cent of MSM and 75 per cent of BAs recognising some element of the campaign.

The survey showed the campaign was successful in improving HIV-related knowledge and attitudes: two-thirds of MSM respondents and three-quarters of BAs realised how quick and easy testing is, thanks to the campaign. In addition, many (78 per cent MSM, 76 per cent BA) agreed that the ads made them think it’s normal to get tested for HIV.

Around half of MSM (47 per cent) and two fifths of BA (39 per cent) who were shown the ads stated that they encouraged them to get tested. In terms of actions, 35 per cent of MSM and 23 per cent of BAs who saw the campaign took steps to get tested.

The ads also motivated safer sex behaviours, with around a quarter in each group reportedly encouraged to use condoms during intercourse.

Some challenges which the survey revealed were that for MSM, 14 per cent had never had an HIV test, and 12 per cent did not know where to get tested. For Black African respondents, 23 per cent had never had a test and 12 per cent did not know where to get one.

Read the full report [PDF].