Surveillance systems in England, Wales and Northern Ireland are consistently improving our understanding of the changing ethnic diversity of the HIV epidemic in the UK.
Back in the early 1980s when surveillance began, information on ethnicity was only completed by clinicians on AIDS reporting forms. In 1993 information on ethnicity was requested on HIV antibody test reports from microbiology laboratories. In 1995 ethnicity was reported in only 44% of new HIV diagnoses, by 2000 this had improved to 85% of all new diagnoses. Though improvements in ethnicity reporting are warranted, the figures that are available now allow us to make meaningful conclusions about the current epidemic and extrapolations for the future.
The latest figures, released last week, clearly illustrate the significant increase in the proportion of all new HIV diagnoses among people of black African origin that has occurred in the past five years. Since 1999 more people of black ethnicity (including those of Asian and mixed race origin) have been diagnosed each year than people of white ethnicity.
Ethnicity has only been reported for 76% of new HIV diagnoses in 2001. Ethnicity reporting for 2001 should improve as follow-up to clarify route of infection is carried out during the course of this year. So far, the proportion of new HIV diagnoses in 2001 among black Africans stands at 51%. Back in 1995 black Africans constituted 25% of all new HIV diagnoses. The proportion of new diagnoses among those of white ethnicity has declined to 40%, from 67% of new HIV diagnoses made in 1995.
In terms of people receiving care in England, Wales and Northern Ireland, data are now available for 2000. In total there were 21,717 people receiving care in 2000, data on ethnicity are available for 20,111 of them (93% of the total figure).
Overall, 12,985 (65%) of people receiving care are of white ethnicity. Of the remaining 35%, the majority (4,969, or 25%) are black African, 532 (3%) black Caribbean. People from other black ethnicities including people of Indian, Pakistani, Bangladeshi, Chinese, south east Asian and mixed race origin constitute 8% of all those receiving care.
Despite the fact that one third of all people receiving care in 2000 were of black ethnicities, stark differences are observable if you look into route of infection and ethnicity. In total 9325, (90%) of the gay men of a total of 10,411 who were receiving care in 2000 were white, 202 (2%) were of black Caribbean origin, 137 (1%) of black African origin. Among heterosexuals, 3881 (59%) are of black African origin, 1867 (28%) were white, 241 (4%) black Caribbean, 241 (4%) other or mixed race and 175 (3%) Indian, Pakistani or Bangladeshi.
The overwhelming majority (90%) of people who have contracted their infection from intravenous drug use are white, as are the majority (84%) of those infected through blood or blood products.
By comparison, 71% of all children born to HIV-positive women were black African.
Whilst two-thirds of all people being seen for care in the UK in 2000 live in the London region, 88% (3991/4883) of black Africans being seen for care live in London.
Within London, among those people for whom ethnicity was recorded, 55% (6888/12,417) receiving care were white, 32% (3931) were black African, 55 (348) other black ethnicity or mixed race, 3% (414) black Carribbean and 1% (166) Indian/Pakistani/Bangladeshi.
Outside of London and the South East, the picture is very different; 80% (5915/7382) of patients receiving care, for whom ethnicity is recorded are white and 13% (952) are black African.
CDR Weekly, PHLS. 28 February 2002