SIDA & VIH
HIV and AIDS in the UK
The UK has a relatively small HIV and AIDS epidemic in comparison with some parts of the world, with an estimated 77,400 people – or around 0.2% of the adult population – currently living with HIV.1 While the number of people living with HIV in the UK is relatively low, it has increased dramatically since the 1990s, alongside a general rise in the prevalence of sexually transmitted infections.
AIDS & HIV in the UK - the current situation
A poster which was part of the early campaign by the British government to raise awareness of AIDS
Although AIDS gets less attention from the media in the UK than it did during the early history of the UK AIDS epidemic, it’s far from a problem of the past. In fact, the epidemic has expanded, with the annual rate of new HIV diagnoses more than doubling between 1999 and 2003, and peaking in 2007.2
HIV prevalence in the UK is relatively low and currently stands at 0.2% of the population3. Statistics show that at the end of 2007 there were an estimated 77,400 people living with HIV in the UK, of whom approximately 20,700 were unaware of their infection. An estimated 7,734 people were newly diagnosed with HIV in the UK in 2007.4
Relatively low numbers of people in the UK have died from AIDS in recent years thanks to the availability of HAART (Highly Active Antiretroviral Therapy), which dramatically increases the life expectancy of people living with HIV. In 2007, around 540 HIV-infected persons died, compared to 1,726 in 1995, when antiretroviral treatment for HIV/AIDS was not available. The majority of AIDS related deaths occurred because people were diagnosed late and therefore did not start treatment early enough. In 2007, an estimated 31% of newly diagnosed, HIV-infected adults were diagnosed late.5
Although HIV is often perceived to be a ‘gay’ problem, infections acquired through heterosexual sex account for the largest number of HIV diagnoses in the UK. The majority of people who acquired HIV heterosexually were infected overseas but only became aware of their status after being tested in the UK. In terms of HIV infections actually occurring within the UK, gay men (and other men who have sex with men) accounted for two thirds of new cases.6
Despite the rising numbers of new HIV infections in the UK, public knowledge of HIV and AIDS appears to have declined. While 91% of people in the UK knew that HIV was transmitted through unprotected heterosexual sex in 2000, by 2007 this figure had fallen to 79%7.
Many UK HIV/AIDS organisations are calling for improved sexual health services. The Terrence Higgins Trust, for example, released a 2007 report stating that sexual health services in England remain woefully under prioritised and under funded. It claims that despite the government’s promise of an extra £300 million for sexual health services across the United Kingdom to modernise clinics and reduce waiting times, many GUM (Genitourinary Medicine) clinics remain cramped, out-of-date and understaffed8.
HIV transmission routes in the UK
Of all diagnoses to the end of 2007, 45% resulted from sex between men, 42% from heterosexual sex, 5% from injecting drug use, 2% from mother-to-child transmission, 2% from blood/tissue transfer or blood factor, and 4% from other or undetermined routes.9
Heterosexual sex
In 2007, 47% of people diagnosed in the UK were infected through heterosexual sex, making this the single biggest exposure category.10 Of these people just 23% became infected in the UK.11 The high rate of HIV amongst Africans in the UK reflects the severity of the AIDS epidemic in sub-Saharan Africa. In total, black Africans represented 35% of newly diagnosed infections in 2007.12
The increasing number of people infected with HIV through heterosexual sex means that the number of women with HIV is increasing. The male to female ratio of HIV diagnoses made before 1989 was more than 10 to 1, whereas in 2007 the ratio for new diagnoses was around 5 male to 3 female.13
Choose safer sex poster
HIV/AIDS and gay men in the UK
In 2007 the Health Protection Agency (HPA) announced that the number of newly diagnosed HIV infections amongst gay men had risen for the third successive year, to an all time high14. 2,679 gay men were diagnosed with HIV in the UK in 2007, representing around one third of all new HIV infections that year.15 Of those who acquired their infection in the UK, men who have sex with men (MSM) account for 63% of diagnoses. There are currently around 31,100 men who have sex with men living with HIV in the UK16.
Since HIV/AIDS treatment became available, the number of gay men dying from AIDS has fallen significantly. In fact the number of AIDS related deaths has decreased by 71% since 1997. The 170 AIDS related deaths amongst gay men represented 34% of all AIDS related deaths in the UK in 2006. The number of AIDS diagnoses was also low at 169 people, 69% of which were made at the same time as their HIV diagnosis17.
Injecting drug use
The level of HIV infection caused by injecting drug use is relatively low in the UK, with IDU prevalence in England and Wales in 2007 at 1.1%, including 3.9% in London. By the end of 2007 injecting drug users (IDUs) accounted for 5.2% (4,891) of HIV diagnoses ever reported in the UK. Around half of IDUs with newly diagnosed HIV were probably infected in the UK, with the rest probably having been infected in Southern and Eastern Europe.18
A lot of early media coverage of AIDS in the UK focused on injecting drug users. During the early Eighties it was a big problem, particularly in Scotland where areas such as Edinburgh and Dundee had a very high prevalence of HIV among IDUs. In 1986 needle exchanges began to operate all across the UK, providing clean needles and giving drug users access to information and support. These schemes were largely effective, and helped to substantially reduce the prevalence of HIV among IDUs in the nineties. From 1990 to 1996 prevalence among this group fell from nearly 6% to 0.6%, rising slightly around 2003 and remaining fairly stable since.19 Troublingly, infection levels appear to be rising among newer injectors, from 0.25% in 2002 to 1% in 2007.20
Risk taking among this group is high. While more than 90% of current and former IDUs in England, Wales and Northern Ireland have reported ever attending a needle exchange service, nearly a quarter of current injectors in the same survey said they had shared a needle in the past four weeks.21 Campaigners argue that needle exchange provision in the UK is patchy and should to be improved.22
Mother to child transmission of HIV in the UK
A high uptake of antenatal HIV testing and the availability of drugs to prevent mother to child transmission of HIV has led to a low level of HIV infections passed from mother to child in the UK. Only 1.2% of HIV infections were acquired through this transmission route in 2007.23 Of the 17 infants born in the UK in 2006 that were known to be infected with HIV; 6 were born to known HIV-infected women and 11 to HIV-infected women whose HIV infection had not been diagnosed before delivery.
In addition to infected infants born in the UK, there were also HIV-infected children who were born abroad but diagnosed after their arrival in the UK. In total, there were 85 new HIV diagnoses among children (aged under 15) in the UK in 2007 representing 1.1% of all new HIV diagnoses.24
Including children born in other countries, there have been a total of 1,661 UK diagnoses of HIV in people who acquired the virus from their mothers.25
View UK statistics by transmission route and gender
Regions of the UK most affected by HIV
London is the epicentre of the UK AIDS epidemic, accounting for around half of all HIV diagnoses in the UK. South-East London has been particularly affected, with the prevalence of HIV approaching 1% in some boroughs. However, increasing numbers of diagnoses in England are being reported in areas outside the capital, including many places that were not previously associated with HIV. In Wales, Scotland, and Northern Ireland, HIV is less prevalent than in England, but in each of these countries, it is a rising problem26.
As of the end of 2007, there have been 8,779 HIV diagnoses in England, 5,525 in Scotland, 1,526 in Wales and 593 in Northern Ireland.27
HIV/AIDS prevention in the UK
HIV prevention in the UK currently includes measures to educate people about HIV/AIDS and how it is passed on so that they can take measures to protect themselves (by using condoms for example); encourage harm reduction measures for drug users (such as needle exchange programmes); and promote HIV testing.
It is widely felt by those working in HIV/AIDS organizations and the healthcare sector that HIV prevention in the UK needs to be stepped up and improved as the number of new infections continues to rise as the level of knowledge of the virus falls.
HIV testing in the UK
According to British guidelines, HIV testing should be offered at GUM clinics as part of routine STD screening, regardless of symptoms of disease or risk factors of infection. The guidelines state that everybody taking an HIV test should have a pre-test discussion, and be offered counselling if requested, or if there is a high risk of a positive result.28
The number of people being tested for HIV and other STDs at GUM clinics (where the majority of people are tested for HIV) has risen in recent years. Almost half of sexual health screens in 2003 included an HIV test; this proportion increased to two-thirds for England, Wales and Northern Ireland in 2006. Overall, around 800,000 had an HIV test in a GUM clinic in England, Wales and Northern Ireland in 2007.29
It can be difficult to treat someone with HIV if they are diagnosed late, and in some cases late diagnosis leads to death.
A major worry is that many people infected with HIV aren’t accessing testing services soon enough. It’s estimated that nearly one third of HIV-positive adults in the UK are diagnosed late, and for heterosexual men this figure rises to 42%.30 It can be difficult to treat someone with HIV if they are diagnosed late, and in some cases late diagnosis leads to death. According to the British HIV Association (BHIVA), at least a quarter of deaths reported in HIV-positive people in the UK between 2004 and 2005 may have been avoided if HIV had been diagnosed at an earlier stage31.
BHIVA, along with other experts, say that non-HIV clinicians such as General Practitioners (GPs) need to be made more aware of the importance of early diagnosis. They have also called for HIV testing to be made a routine part of more generic healthcare services that aren’t specialised towards HIV or sexual health32. Introducing an opt-out testing policy (whereby everybody attending a GUM clinic is given an HIV test unless they specifically ask not to be tested) may be another way to reduce the number of people diagnosed late. Of previously undiagnosed HIV-infected heterosexual men and women attending GUM clinics in 2006, one quarter left the clinic unaware of their HIV infection in 200633.
AIDS treatment in the UK
All legal UK residents are eligible for free HIV/ AIDS treatment from the NHS. The first antiretroviral drug to treat HIV became widely available in the UK in 1987. Since then, the availability of HIV treatment in the UK has greatly reduced the number of people who die from AIDS related illnesses, and has profoundly improved the quality of life of many people living with HIV.
However, individuals undergoing HAART have to take medication every day for the rest of their lives, and sometimes suffer severe side effects. It has also been found that resistance to antiretroviral treatment can occur, and since HAART is a relatively new form of treatment it is not known how long an individual can continue to benefit from it.
Other issues
Stigma and discrimination: People living with HIV may face prejudice as a result of their condition, and the social stigma surrounding AIDS can stop people from discussing it. Ignorance of how HIV is transmitted can lead to dicrimination against people who have the virus.
George House Trust campaigners against HIV-related stigma and discrimination
HIV in prisons: In the past it has been found that prisoners in England and Wales are more likely to be infected with HIV than other members of the population, a problem driven by injecting drug use34. Campaigners argue that, despite a lack of recent data, this is probably still the case. The government has announced plans to provide disinfectant tablets to prisoners, which can be used to sterilise needles, although some campaigners argue that this does not go far enough and that needle exchanges should be introduced to prisons35. AVERT.org has more information about prisons, prisoners and HIV/AIDS.
Criminal transmission of HIV: There have been several high profile cases in the UK of individuals being prosecuted for reckless transmission of HIV because they have failed to tell sexual partners about their condition. These cases generated a lot of debate about how the law should deal with this issue, and in 2008 the UK Crown Prosecution service released guidelines to clarify the law. As of 2008 a person can only be convicted of reckless sexual HIV transmission if there is “a sustained course of conduct during which the defendant ignores current scientific advice regarding the use of safeguards”. This implies that a single act of unprotected sex is not enough to constitute reckless behaviour. Reckless HIV transmission is only punishable in court if HIV is actually passed on and if the defendant is aware of their HIV status36. The new legislation has been commended by various AIDS charities who have generally argued that it is right to prosecute people who deliberately pass on HIV, but that reckless transmission should not be criminalised; they argue that in such cases, education and counselling are more effective than sending the offender to prison.37
Migration and HIV in the UK: As nearly half of all new HIV diagnoses in the UK are amongst Africans, there is a clear link between migration and UK HIV incidence. Africans living with HIV in the UK face significant challenges, both due to stigma and discrimination against them and in relation to their immigration status.
The way forward
The recent history of AIDS in the UK has been marked by a number of important changes. As the situation continues to shift, government responses need to reflect these changes to minimise the future impact of AIDS in the UK.
Many of those being diagnosed in the UK now come from other countries with high HIV prevalence rates, and so the government’s commitment to tackling AIDS internationally can be seen as a part of its response to the epidemic at home. Commendably, the UK is one of the most significant international contributors of bilateral aid towards funding the epidemic in developing countries.
At the same time, campaigners argue that the government also needs to renew its domestic response to HIV. In particular, many feel that there needs to be a greater focus on, and an improvement in, the services aimed at the two groups most affected by HIV in the UK: gay men, and people of African ethnicity.
HIV infection in the UK is not limited to these groups though, and with sexually transmitted infections becoming more widespread amongst the population as a whole, it’s clear that unsafe sexual practices are common in the UK. Sexual health services in general need to be improved, and the declining awareness of HIV amongst the general public needs to be addressed. If such steps aren’t taken, it’s likely that the UK epidemic will continue to expand in coming years.
