New HIV diagnoses continue to fall in England

On World AIDS Day, the UK Health Security Agency (UKHSA) published its HIV testing, new HIV diagnoses, outcomes and quality of care for people accessing HIV services: 2021 report [PDF].

The report provides an update on the UK HIV epidemic against the backdrop of the emergence and continuation of the COVID-19 pandemic during 2020. COVID-19 affected all aspects of life, including sexual behaviour and access to testing and services. Significant resources continue to be required to respond to the pandemic, and the latest UKHSA report does not include HIV data from Scotland in 2020. Unless stated, this overview looks at data in England only.

The impact of COVID-19

The latest surveillance data follows figures published in September 2021, which reported a 32% drop in new sexually transmitted infections (STIs) in England. Whilst the new report reaffirms that the UK is continuing to see a downward trend in new HIV diagnoses, it is clear COVID-19, and in particular, lockdown restrictions implemented to respond to the pandemic have contributed to this decline during 2020.

  • The number of people tested for HIV in sexual health services (SHS) fell by 30%, and 47% of people who tested for HIV did so online in 2020.
  • An estimated 4,980 – 6,960 people with HIV were not seen in care during the year, either virtually or face-to-face, more than twice the number in 2019.
  • Sadly, at least 99 deaths recorded between March and June 2020 amongst people with HIV were due to COVID-19.

New diagnoses

It is now estimated that there are 106,890 people living with HIV in the UK, of which an estimated 5,150 (5%) remain undiagnosed.

The number of new HIV diagnoses fell by a third (33%) in England, from 3,950 in 2019 to 2,630 in 2020. The decrease was 47% in gay and bisexual men (GBM), but less apparent in people who likely acquired HIV via heterosexual contact (23%), although there were stark variations between different ethnicities.

In relation to GBM, it is believed the year-on-year decline is a continuation of the downward trend reported in recent years, with only a 7% fall in numbers testing for HIV, and access to pre-exposure prophylaxis (PrEP) maintained in 2020. However, the numbers of heterosexuals testing in 2020 fell considerably, and the reduced numbers of new HIV diagnoses are likely a reflection of this.

Late diagnoses

UKHSA have reclassified late HIV diagnoses in 2020, and retrospectively applied a new methodology to provide direct year-on-year comparisons. Using evidence of recent HIV seroconversion, UKHSA have removed people likely to have recent acquired HIV from the late diagnosis data.

Despite this reclassification, late HIV diagnoses continue to remain stubbornly high in England. In 2020, 42% of people first diagnosed in England were diagnosed late. UKHSA warn that in people diagnosed late in 2019 had more than a seven-fold increased risk of death within a year of diagnosis, compared to those diagnosed promptly.

Populations with more than 50% late diagnoses in 2020:

  • People aged 65+ (66%).
  • People aged 50-64 (59%).
  • People of Black African ethnicity (54%).
  • Men who likely acquired HIV from heterosexual contact (55%).
  • Women who likely acquired HIV from heterosexual contact (51%).

HIV care and treatment

For the first time the UK has surpassed the UNAIDS 95-95-95 targets, in 2020:

  • 95% of people living with HIV were diagnosed.
  • 99% of those diagnosed were on treatment
  • 97% of those on treatment had an undetectable viral load.

Coming soon: in-depth analysis of the latest HIV data

HIV Prevention England will explore the latest HIV surveillance data in more detail in a series of blog posts in early 2022. We will look at the groups most affected by HIV, as well as specific areas of interest, such as HIV testing, people living with HIV and what the latest data means for England’s new HIV Action Plan.

Resources

A new HIV Action Plan for England

The Department of Health and Social Care (DHSC) has published ‘Towards Zero – An action plan towards ending HIV transmission, AIDS and HIV-related deaths in England – 2022 to 2025’.

The Plan will support the Government’s aims to achieve zero new HIV infections, AIDS and HIV related deaths in England by 2030, and the work required to achieve ambitious interim targets by 2025:

  • To reduce the number of people first diagnosed in England from 2,860 in 2019, to under 600 in 2025.
  • To reduce the number of people diagnosed with AIDS within three months of HIV diagnosis from 219 to under 110.
  • To reduce deaths from HIV/AIDS in England from 230 in 2019 to under 115.

The publication included the news of the expansion of opt-out HIV testing in Emergency Departments (A&E) in high prevalence areas, backed by an additional £20 million over the next three years.

The HIV Action Plan looks to build on the successes achieved in England over the past decade, and will continue to strive to increase testing rates in populations most affected by HIV, and raise awareness of combination HIV prevention. The four key objectives of the HIV Action Plan are:

  • Objective 1: ensure equitable access and uptake of HIV prevention programmes.
  • Objective 2: scale up HIV testing in line with national guidelines.
  • Objective 3: optimise rapid access to treatment and retention in car.
  • Objective 4: improving quality of life for people living with HIV and addressing stigma.

A national HIV Action Plan Implementation Steering Group, chaired by Professor Kevin Fenton will look to drive forward the aims of the Plan, and will comprise of all key partners, including the voluntary sector. The Secretary of State for Health and Social Care will update Parliament on the progress of the Plan on an annual basis.

The UK Health Security Agency (UKHSA) is due to publish a monitoring and evaluation framework in early 2022. The framework will monitor progress towards the 2025 ambition at national, regional and local levels, as well as measuring the extent to which the actions set by the Plan are implemented.
HIV Prevention England will work closely with the Implementation Steering Group, DHSC and our key stakeholders to ensure our programme provides maximum impact in support of the Action Plan’s objectives.

Our annual National HIV Testing Week (NHTW) campaign, which starts Monday 7 February 2022, is a key deliverable of the HIV Action Plan. NHTW will support the National HIV Self-sampling Service to provide test kits across England to those most at risk of HIV.

Read the HIV Action Plan.

Read the DHSC Press Release.

The National HIV Prevention Programme 2021-2024

Following a competitive tender process, the Office for Health Improvement and Disparities (OHID) within Department of Health and Social Care (DHSC) have commissioned Terrence Higgins Trust to deliver a new National HIV Prevention Programme from 2021 to 2024.

The new programme will run from November 2021 to March 2024 and identify as ‘HIV Prevention England’ to retain continuity of the programme’s work and engagement with key HIV sector stakeholders from the previous 2016-2021 programme.

Programme aims

  • Improve knowledge, understanding and uptake of combination HIV prevention interventions among populations most at-risk of HIV in England.
  • Raise awareness of STIs and STI prevention strategies.
  • Reduce levels of HIV related stigma within affected communities.

What’s new?

Building on previous success and learning, the new HPE programme will be characterised by:

  • More expansive and ongoing involvement of multi-sector partners and stakeholders in development, implementation and evaluation at national and local levels.
  • Inclusion of prevention of STIs to deliver a holistic approach to sexual health.
  • New innovative and cost-efficient interventions expanding on activities of the previous programme.
  • Enhanced co-production through creative design and implementation, delivering culturally competent campaigns effectively meeting the needs of key target populations.
  • Focusing on equity to ensure equitable outcomes for all at risk of acquiring HIV and STIs.
  • Responding to recommendations from the imminent national HIV Action Plan and Sexual and Reproductive Health Strategy.

A briefing with more details on activities and how you can get involved will be circulated shortly.

SAVE THE DATE: National HIV Testing Week 2022

National HIV Testing Week will take place Monday 7 February to Sunday 13 February 2022.

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