The current situation

Thirty years on from the start of the UK HIV epidemic, there were 91,500 people living with HIV in 2010, more people than ever before, with one in four (24%) undiagnosed and so unaware of their infection. The forecast from these figures is that as many as 100,000 people will be living with HIV by 2012.

6,660 people were newly diagnosed with HIV in 2010, a slight increase from 2009 of 0.5% and some 15% down from the peak year of 2005. However the number of infections acquired in the UK rather than abroad continued to rise significantly at 3,640 for 2010, more than double the figure a decade previously.

Half (50%) of these people were diagnosed late, after they should have begun treatment to prevent their immune system becoming damaged. Late diagnosis increases the risk of ill-health, AIDS and death and people diagnosed late were around ten times more likely to die within a year than those diagnosed before treatment was required.

Gay men and black Africans are still at highest risk of having HIV, though many Africans were infected abroad rather than in the UK. Diagnoses of HIV in gay men reached 3,000 in 2010, their highest ever level, accounting for 73% of HIV infections sexually acquired in the UK. Numbers of people infected through heterosexual sex in the UK doubled (in the last decade) and continue to rise.

Around 69,400 people in the UK accessed care and treatment for HIV in 2010, an increase of 6% on 2009 and more than a three times the number seen in 2000. One in five adults in care were aged 50 years or older, compared with one in nine in 2001. Just over half (51%, 35,280) of HIV-diagnosed people in 2010 were infected via heterosexual sex; 65% (22,940) of these people were black African and 21% (7,550) were white. Gay and bisexual men made up 44% (30,480) of those diagnosed. Overall 82% of those in care in 2010 received antiretroviral therapy, compared with 69% (14,100/20,400) in 2000. Since 2008, national treatment guidelines have recommended earlier treatment.

680 people with HIV died in 2010 and two-thirds of these people were diagnosed late; however this is well below the peak year of 1995 when 1,723 died. To date, 120,000 people have been diagnosed with HIV in the UK, of whom 27,000 have developed AIDS and more than 20,000 have died.

Who is most affected?

The two groups most affected in the UK are men who have sex with men (MSM) and people who have migrated from regions of the world where HIV is common, such as sub-Saharan Africa.

Approximately 3,000 men who have sex with men were diagnosed in 2010, 45% of the total. This was the highest ever level reported and gay men are still the highest risk group for HIV within the UK. In 2010, four out of five (81%) of newly diagnosed MSM probably acquired HIV in the UK.

The majority of people actually diagnosed with HIV in the UK in 2010 (50%) had been infected through heterosexual sex, 31% of those infected heterosexually were black African and the majority (68%) of these people had probably acquired HIV overseas.

However, the numbers of heterosexual HIV infections that were probably acquired here in the UK have been rising steadily in the last decade- from 320 in 2001 to 1,090 in 2010, a more than three fold increase.

Looking at all HIV infections acquired within the UK, this figure now exceeds those acquired abroad. UK infections have increased from 1,950 in 2001 to 3,640 in 2010, almost double.

Needle exchange programmes have been very effective, and new diagnoses of HIV infection acquired through injecting drug use (160 in 2010) have remained low. It is also possible for the virus to be passed from mother to baby during pregnancy but improvements to antenatal HIV testing and treatments make this increasingly rare. In the past, some people also got HIV through blood products but in the UK this is now extremely rare. Since the introduction of testing for HIV in 1985, there have been three cases of transmission of the virus to patients through blood from donors.

Geography

Around two fifths (43%) of all those living with diagnosed HIV in the UK live in London. This proportion used to be much higher, but people with HIV are now living across all areas of the UK and particularly in major cities and in North West England.

In the last 10 years, the biggest increases in people living with diagnosed HIV have been in the East of England, the West Midlands and the North East.

Late diagnosis

If someone is diagnosed a long time after they have been infected with HIV, it is more likely that the virus will have already seriously damaged their immune system. Someone is said to have been diagnosed late if the number of particular immune cells (CD4 cells) in their bloodstream has dropped below a certain level. Late diagnosis is one of the biggest contributing factors to illness and death for people with HIV. It is very important that HIV is diagnosed early, so people can start treatment if they need to, look after their own health and take steps to ensure they don’t pass the virus on.

In 2010, an estimated  50% of adults diagnosed with HIV were diagnosed with CD4 levels below 350, indicating that their immune systems may have already been damaged by the virus. Treatment guidelines recommend that people with HIV should start taking medication when their CD4 levels get to 350 or below. 28% had severely compromised immune systems with CD4 levels below 200.