HIV remains a serious and growing public health concern in the UK. Which groups are most affected and how are things changing?
Public Health England (PHE) have released new statistics on HIV [PDF]. This provides only part of the picture and statistics are updated annually.
In 2016 there were 5,164 new HIV diagnoses in the UK. New diagnoses have steadily declined since the peak in 2005 when nearly 7,900 were recorded. In 2016 there were 1,122 fewer cases than those reported in 2015 (6,286), this is a reduction of 18% of new diagnoses in only one year. This reduction is largely attributed to decreases in diagnoses among gay and bisexual men, primarily in London, and a sustained decline in diagnoses in black African heterosexual men and women.
Estimates of the number of people with undiagnosed HIV infection has sharply reduced by 22% to 10,400 compared to 13,300 in 2015. This reduction is largely attributed to declines in undiagnosed gay and bisexual men in London, and black African heterosexual women.
2016 saw a decline in new diagnoses among gay and bisexual men in the UK for the first time in three decades, since the start of the epidemic. In this one year alone there has been a 21% decline since the end of 2015 (3,570 in 2015 to 2,810 in 2016). The decline was mostly attributed to five London clinics delivering high levels of testing, particularly for men at high risk, and enhanced commencement of anti-retroviral therapy (ART) at diagnosis.
For the first time, all three UNAIDS 90:90:90 targets have been met or exceeded in London, however these are yet to be met in England as a whole. 90% of people living with HIV in London have been diagnosed, 97% of those diagnosed are receiving treatment, and 97% of people receiving treatment are being virally suppressed. Overall figures for England are just short of the 90% target of diagnosis (88%), but targets are exceeded for treatment (96%), and viral suppression (97%).
HIV in the UK — 2016 statistics
- An estimated 89,400 people are living with HIV in the England.
- Of these, 12% are undiagnosed and do not know about their HIV infection.
- There were 5,164 new HIV diagnoses.
- 442 people with HIV died in 2016 for all causes. The overall mortality rate for people aged 15-59 diagnosed with HIV is, for the first time, equal to that of the general population for the same age group.
- 278 people were diagnosed with an AIDS defining illness. This is less than half than those diagnosed with AIDS in 2006.
- 42% of people diagnosed with HIV in 2016 were diagnosed late.
- More than a third (38%) of people accessing care were aged over 50.
- One in seven gay and bisexual men living with HIV were from black, Asian and other minority (BAME) groups.
- 76% of people newly diagnosed have started antiretroviral treatment within 90 days.
- London continues to have the highest HIV prevalence in the country, with 40% of all people living with HIV in England living in London.
- The Midlands and the East of England region have the highest prevalence (19%) of new diagnoses outside of London.
All data is taken from Public Health England [PDF].
In 2016, an estimated 89,400 people in England were living with HIV, approximately 12% of whom were undiagnosed. For the whole of the UK, the figure for 2015 is estimated at 101,200 people. A new estimate for the whole of the UK will be released by Public Health England in 2018.
A total of 5,164 people were newly diagnosed with HIV in 2016.
The number of new HIV diagnoses among gay and bisexual has for the first time in three decades declined. In 2016, 2,810 new diagnoses were made compared to 3,570 in 2015, representing a 21% decline.
2,110 heterosexual men and women were newly diagnosed with HIV in 2016.
Black African men and women accounted for 39% of new diagnoses in heterosexuals.
Over half (55%) of new diagnoses were acquired in the UK.
42% of all people diagnosed with HIV were diagnosed late. Late diagnosis is most common in certain groups, heterosexuals in particular:
- heterosexual men (60%)
- black African heterosexual men (65%)
- heterosexual women (47%)
- black African heterosexual women (49%)
- people who inject drugs (51%)
Gay and bisexual men had the lowest proportion of late diagnoses, at 32%.
More than a third of people accessing HIV care were aged over 50 (38%).
Early government public health campaigns were successful in raising public awareness about the risks posed by HIV. The measures initially taken by UK governments in the 1980s, including condom and safer sex education, needle exchanges and harm reduction programmes - alongside strong efforts by the UK’s gay communities and activists – contributed to the fact that we have far lower prevalence rates of HIV than some of our European neighbours.
France, Spain and Italy each have almost twice the rates of people living with HIV than the UK.
For people living with HIV in the UK, the development (and availability on the National Health Service) of more effective anti-HIV drugs in the mid-1990s, and most significantly the discovery of protease-inhibitors, meant that they could stay healthier for longer. These treatment developments have continued and now people diagnosed early enough, and taking medication as recommended, can expect to live a near-normal life expectancy. Now in 2016 the overall mortality rate for people aged 15-59 diagnosed with HIV is, for the first time equal to that of the general population for the same age group.
However, improved treatment and health outlook of people living with HIV means that to some extent public and political complacency over the risks of HIV and other sexually transmitted infections in the UK crept in.
Partly because of this, the number of new cases of HIV being diagnosed began to rise through the 1990s and early 2000s until turning a corner in 2005. 2016 saw this decline accelerate as there was an overall fall in UK-wide HIV diagnosis among gay and bisexual men observed for the first time since the epidemic was detected over 30 years ago.
Today, men who have sex with men continue to be most at risk from HIV, in addition to black African heterosexual men and women.
In 2016, there were 89,400 people estimated to be living with HIV in England.
The two groups most affected in the UK are men who have sex with men (MSM) and black African heterosexual men and women.
Approximately 3,320 MSM (men who have sex with men) were diagnosed in 2015, 54% of the total. MSM are still the highest-risk group for HIV within the UK. In 2015 approximately two thirds (68%) of newly diagnosed MSM probably acquired HIV in the UK.
A similarly large proportion of people diagnosed with HIV in the UK in 2015 (39%) were infected through heterosexual sex. In 2015, 28% of newly diagnosed heterosexual men and 18% of newly diagnosed heterosexual women were aged 50 or older. Just less than half of those infected heterosexually were black African (47%).
Looking at probable country of infection, 57% of all heterosexuals diagnosed acquired HIV in the UK, compared to 68% of infections diagnosed in MSM in 2015. Over the past 10 years the proportion of HIV infections acquired in the UK has gradually decreased in MSM and increased in heterosexual people being diagnosed.
The proportion of new diagnoses among people born in Africa has decreased from 41% of total diagnoses in 2006 to 16% in 2015. The number of new diagnoses reported in this group is less than a third of what it was in 2005.
Needle exchange and harm reduction programmes have been very effective and new diagnoses of HIV infection acquired through injecting drug use (210 in 2015) 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, and none since 2002.
Around two fifths (40%) of all those living with diagnosed HIV in England 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.
The proportion of UK HIV diagnoses in London has also fallen due to declines in HIV diagnoses amongst gay and bisexual men living in London. This decline was focussed in five ‘large fall’ London clinics, which delivered high levels of HIV testing, including frequent testing of men at high risk of HIV.
These five clinics (Dean Street, Mortimer Market, Homerton, St Mary’s and St Thomas) collectively reported 28% of all the new HIV diagnoses made in gay and bisexual men in England in 2016, and their methods are being replicated at clinics across the country.
The area covering the Midlands and East of England was second to London for number of new diagnoses, with 19% of the total recorded there.
In 2016 there were 5,164 new HIV diagnoses in the UK.
The estimated number of people with undiagnosed HIV infection in England is 10,400. This represents 12% of the estimated 89,400 people living with HIV in England.
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 CD4 cells (a type of important immune system cell) in their bloodstream has dropped below a certain level (350cells/mm3).
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, look after their own health and take steps to ensure they don’t pass the virus on.
In 2016, an estimated 42% of adults (2,159) diagnosed with HIV were diagnosed with CD4 counts below 350, indicating that their immune systems may have already been damaged by the virus. New treatment guidelines recommend that people with HIV should start taking medication as soon as possible after diagnosis. This is a change in old guidelines that recommended treatment to start when an individuals CD4 count was below 350.
Public Health England annually produce HIV and STI statistics from around the UK. We edit these into the regional and national bulletins of HIV or STI statistics which you can download here.