Scotland reports its lowest number of HIV diagnoses since 2003

A report released on Tuesday by Health Protection Scotland shows that 2016 saw the lowest number of people diagnosed with HIV within Scotland since 2003.

Last year, 285 people were diagnosed with HIV in Scotland. This contrasts with 6095 people diagnosed in the whole of the UK in 2015, the last year for which we have complete figures, meaning that roughly 5% of UK HIV diagnoses are in Scotland compared with roughly 10% of the population.

These 285 diagnoses represent a 21% fall from the previous year, and a 35% fall from the peak year for HIV diagnoses since 2000, which was 2007.

Eighty per cent of those diagnosed were male. The probable route of transmission was sex between men in 48% of cases, sex between men and women in 33%, and injecting drug use in 13%. These percentages exclude 15 people where the route of transmission is as yet undetermined.

The decline in diagnoses was seen in most groups. Diagnoses in gay men fell 23% from 2015 and 31.5% from 2007. Among heterosexuals they fell 15% from 2015 and 57% from 2007, in other words by well over half. And among young people (aged 15-24) the 16 diagnoses seen represent half the number seen in the previous year and a quarter of the number seen in 2007.

In gay men, there was a marked fall in infections in men who appeared to have acquired HIV within Scotland (from 107 to 67), but an increase in infections acquired outside the UK (from 29 to 38).

In heterosexuals the opposite was the case: there was an increase in diagnoses of infections acquired within Scotland (from 23 to 31), though there is no clear increase over the long term. In contrast there was a decrease in infections acquired outside the UK (from 77 to 55).

Infections among people who inject drugs were high in both 2016 (36 infections) and 2015 (56 infections, the year with the largest number of infections in this group this century). Up till 2014, infections among people who inject drugs represent no more than 6% of the annual total, but in 2015 it was 15% and last year 13%.

Health Protection Scotland estimates that 5277 people diagnosed with HIV are currently living in Scotland. Of these 89% are in regular care and 84.5% on antiretroviral therapy.

The policy organisation HIV Scotland said the apparent drop in sexually transmitted HIV was encouraging but would need to be confirmed. “Some possible reasons could include changes in test rates, increase in people living with HIV reaching levels of viral undetectability (meaning they are unlikely to be able to pass on the virus thanks to the effects of the treatment they are on), or the increased use of pre-exposure prophylaxis (PrEP).”

David Goldberg of Health Protection Scotland told The Herald that his team was looking into whether the fall is real and its possible causes. “From an MSM perspective, it is possible that the decline in reports among those acquiring their infection within Scotland represents a real reduction in HIV transmission among this population,” he said. He suggested that the decline in diagnoses among people born in high-prevalence countries may be due to changes in rates of migration. Fewer diagnoses in both populations could be due to a reduction in the uptake of HIV testing.