The latest annual report by Public Health England shows that, although the number of gay men who have HIV without knowing it has declined in recent years, the United Kingdom’s HIV epidemic in gay men continues unabated. Incidence (the rate of new infections) remains high, new diagnoses are higher than ever before and prevalence (total number of people living with HIV) is also up.
Across the UK, one in 20 gay men is living with HIV; in London, one in eleven.
Among heterosexual men and women, provision and uptake of HIV testing remains a significant problem, resulting in significant numbers remaining undiagnosed, especially outside London.
The National AIDS Trust responded to the data – released in a report yesterday – by calling for HIV testing and prevention programmes to be scaled up, rather than having their budgets slashed.
New diagnoses, overall prevalence
Public Health England reports that 6151 people were newly diagnosed with HIV in the United Kingdom in 2014. The largest number of diagnoses were in gay and other men who have sex with men (3360 diagnoses). Of the 2490 heterosexual men and women diagnosed with HIV, 41% were people of African ethnicity and 59% probably acquired HIV while in the UK.
There are now 103,700 people living with HIV in the country, including 18,100 who don’t know they have it. This can be broken down into risk groups.
A total of 44,980 gay, bisexual and other men who have sex with men are living with HIV (prevalence of 4.8%). This figure has continued to rise, due to reductions in premature death as a result of HIV treatment as well as continued HIV transmission.
Black African people are also disproportionately affected by HIV, with 20,120 women (prevalence 4.4%) and 9845 heterosexual men (prevalence 1.8%) living with HIV.
In terms of heterosexuals of other ethnicities, 12,560 women and 11,445 men are living with HIV. While one in five of all people living with HIV are neither gay men nor black Africans, the proportion of the general population who have HIV remains low (prevalence 0.07% for women and 0.05% for men).
In addition, 2162 people who inject drugs are living with HIV, representing a prevalence of 2.2%.
Of note, some of the data and assumptions used to produce figures for undiagnosed HIV have changed for this report, making it hard to draw comparisons with the figures given in previous reports.
Gay men
- There were 3360 new diagnoses of HIV in gay men in the UK in 2014. This represents a 2.75% increase in new diagnoses on the previous year and a 15% increase since 2010. However much of this is due to increased testing.
- Estimates for incidence (new infections, not necessarily diagnosed) suggest that 2800 gay men became HIV positive in 2014. This figure has been stable in recent years.
- The total number of gay men living with HIV has continued to rise, due to reductions in premature death as a result of HIV treatment as well as continued HIV transmission.
- Just under half of HIV-positive gay men live in London.
- Estimates for the number of gay men living with undiagnosed HIV show a drop from 2010’s figure of 8500 men in 2010 (22% of all gay men living with HIV) to 6500 men (14%) in 2014.
- While 60% of newly diagnosed gay men were born in the UK, 20% were born elsewhere in Europe, 6% in Asia and 3% in Africa.
- A third of newly diagnosed gay men probably acquired their infection in the previous six months.
- On the other hand, late diagnosis is still an issue – just under 1,000 gay men had a CD4 cell count below 350 cells/mm3 when diagnosed in 2014.
Heterosexual men and women
- Rates of undiagnosed HIV are much higher outside London than in the capital. There are estimated to be 7,400 heterosexuals with undiagnosed HIV outside London (24% of heterosexuals living with HIV in those areas) and 2,400 heterosexuals with undiagnosed HIV in London (12%).
- Late diagnosis remains a very significant problem – over half (55%) of heterosexuals diagnosed with HIV have a CD4 cell count below 350 cells/mm3 when diagnosed.
- The proportion of heterosexuals attending sexual health clinics who are tested for HIV remains low, with significant variations between different clinics.
- Among people newly diagnosed, the proportion who probably acquired HIV while living in the UK has risen from 52% in 2010 to 59% in 2014.
- The average age at which heterosexuals are diagnosed with HIV is rising. In women, it has risen from 32 years in 2005 to 37 years in 2014. In men, it has risen from 37 years to 43 years.
Reaction
“If we are going to reduce the number of people who have HIV and don’t know it, we need the number of people diagnosed with HIV to further increase,” said Cary James of Terrence Higgins Trust. “We can only achieve this through more testing. That’s why National HIV Testing Week is so important.”
“Today’s announcement by Public Health England that 103,700 people are now living with HIV in the UK is yet more proof that HIV is a growing issue,” commented Deborah Gold of the National AIDS Trust. “We need to scale up our HIV testing and prevention efforts, but instead the Government cut £200million off the budget this year used to pay for both.
"Next week the Government will announce their spending plans and we are expecting more cuts to public health. The direct result of this Government action will be more people getting HIV, more people getting diagnosed late and more people dying because of their HIV status.”