On 3 October, the UK Health Security Agency (UKHSA) published their ‘HIV testing, PrEP, new HIV diagnoses and care outcomes for people accessing HIV services: 2023 report’. The report presents data mostly focused on activity in England in 2022.
Key highlights from the data on HIV testing include:
- The number of people testing for HIV increased by 10% between 2021 and 2022. However, there are still fewer people testing in 2022 (1,155,551) compared with 2019 (1,325,983).
- In 2022, 50% of all HIV testing at sexual health services was done via online service provision.
- Among gay, bisexual and other men who have sex with men (GBMSM), 192,503 tested for HIV, the highest number ever reported.
- Among heterosexual men and heterosexual and bisexual women, HIV testing rates remain substantially lower in 2022 (280,767 and 512,108 respectively) compared with data from 2019 (420,645 and 630,746 respectively).
- Uptake of HIV testing is particularly low among women. Of those eligible for a HIV test, only 39% tested in 2022; 40% were not offered a test when attending specialist sexual health services, and 31% declined a test.
New HIV diagnoses
In 2022, there were 3,805 HIV diagnoses in England, which represents a 22% increase from 2021. Of these diagnoses, 36% were among people who had previously been diagnosed abroad. Data on ethnicity show 44% of diagnoses previously made abroad were among people of Black African ethnicity (605), with Black African women accounting for the majority of those (414).
These figures are unlikely to represent HIV transmission in the UK as most people (96%) were linked to care within 3 months of their arrival in England. The data highlight the importance of ensuring people arriving into the UK are informed on how they can access HIV testing and treatment to ensure prompt linkage into care.
There was a 6% increase in HIV diagnoses first made in England between 2021 and 2022 (2,313 to 2,444).
Among GBMSM, HIV diagnoses continue to decline; between 2021 and 2022, there was an 8% decrease in diagnoses (784 to 724). However, data on ethnicity show HIV diagnoses increased among GBMSM of Asian (from 75 to 88), Black Caribbean (from 16 to 17) and mixed or other ethnicity (from 71 to 88) between 2021 and 2022.
In contrast to the overall decline in diagnoses among GBMSM, there was an increase of 12% in diagnoses first made in England among heterosexual men and women between 2021 and 2022 (870 to 976). Women accounted for the majority of these diagnoses (564).
Combined with high rates of testing, the decline in diagnoses among GBMSM indicate a decline in HIV transmission within this population. However, the low testing rates among heterosexual people, in particular women, alongside the increase in diagnoses suggests HIV transmission continues within this demographic in England.
Late HIV diagnoses
Late HIV diagnoses remain stubbornly high in England; 44% of diagnoses first made in England in 2022 were at a late stage of infection. Late diagnosis is a significant issue; those diagnosed late in England in 2021 were five times more likely to die within a year of their diagnosis compared to those who were diagnosed early.
Populations with more than 50% late diagnoses in 2022:
- People aged 65+ (59%)
- People aged 50-64 (61%)
- People of Indian, Pakistani or Bangladeshi ethnicity (54%)
- Men who likely acquired HIV from heterosexual contact (57%)
- People who likely acquired HIV from injecting drug use (65%)
PrEP (pre-exposure prophylaxis)
In 2022, 121,547 people were defined as having a PrEP need (determined to be at a substantial risk of HIV acquisition and will benefit from receiving PrEP) and 71% initiated or continued PrEP. However, inequalities in PrEP uptake remain; among those with PrEP need, GBMSM were most likely to initiate or continue PrEP (74%), whereas uptake among heterosexual men and women was lower (39% among heterosexual men and 36% among heterosexual and bisexual women).
A statement from BHIVA on the latest HIV data:
“BHIVA welcomes the data released by UKHSA, which shows improvements in HIV testing, linkage to care and earlier access to HIV treatment in the UK.
The report does, however, highlight the need for a more concerted effort to reach women and minoritised groups in order to reduce health inequalities regarding access to HIV treatment and care, as well as access to HIV testing and prevention (PrEP).”
HIV Prevention England will continue to explore the latest HIV surveillance data and consider the groups most affected by HIV when implementing prevention initiatives and campaigns.
Read the full report and review data tables.
