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AIDS and HIV in the UK

The UK has a relatively small HIV and AIDS epidemic in comparison with some parts of the world, with an estimated 73,000 people – or around 0.2% of the adult population – currently living with HIV.¹ The impact of HIV and AIDS has nonetheless been substantial amongst certain groups, in particular the gay community and, more recently, amongst people who have migrated to the UK from African countries.

London is the epicentre of the epidemic, accounting for almost half of all HIV diagnoses in the UK. 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 problem.²

AIDS & HIV - the current situation

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. Statistics show that the epidemic has expanded, with the annual rate of new HIV diagnoses rising almost threefold between 1995 and 2005.³

To get an accurate picture of the effect that HIV/AIDS is having in the UK today, there are certain facts worth noting:

• Although HIV is perceived to be a ‘gay’ problem, heterosexual sex is actually the most common route of HIV transmission among people diagnosed with HIV in the UK. Of these heterosexual cases, three quarters of people became infected overseas – mostly in Sub-Saharan Africa, where the global AIDS epidemic is taking its heaviest toll. Black and minority ethnic populations (mostly from African countries) accounted for 58% of HIV infections diagnosed in the UK during 2006. ⁴
• In terms of HIV infections actually occurring within the UK, gay men (and other men who have sex with men) account for most new cases. Among some parts of Britain’s gay community, condom use is low, and levels of partner change are relatively high. ⁵
• It’s estimated that one third of people living with HIV in the UK have not had their condition diagnosed.⁶ Most of these people have no idea that they are infected, and may be continuing to engage in unprotected sex or other behaviours that can pass on HIV.
• Relatively low numbers of people in the UK have died from AIDS in recent years. This is thanks to antiretroviral therapy, which allows many people living with HIV in the UK to live relatively healthy, normal lives.⁷
• Public knowledge of HIV and AIDS appears to have declined. While 91% of people in the UK knew that HIV was transmitted through unprotected sex in 2000, this figure had fallen to 79% by 2005. In London, the area most affected by HIV, it had dropped to 70%. ⁸

HIV prevention in the UK

Much of the early response to AIDS in the UK was driven by a fear that the epidemic would eventually spread widely beyond the minority groups it was originally associated with, and would have a major impact on the general population. In recent years, with HIV not spreading as widely as many had once predicted, prevention efforts have been focused on the communities most affected, including gay men, African immigrants and injecting drug users.

This shift in focus seems to have been accompanied by a decline in spending. Funding for HIV prevention in England and Wales is no longer ‘ring-fenced’, meaning it can be spent at the discretion of local health authorities; reports suggest that this has resulted in prevention money being spent on other areas of the health service. ⁹ In Scotland, HIV prevention money is still ring-fenced by the Scottish Executive.¹⁰

HIV prevention amongst the general population

There have been no national HIV prevention campaigns aimed at the UK population as a whole since the early years of the epidemic. However, the government is currently aiming to improve sexual health services and reduce levels of sexually transmitted infections (STIs) in the UK, including HIV. The 2004 white paper ‘Choosing Health’ outlined the government’s plans to provide £300 million towards sexual health services in England. This included a budget of £40 million towards contraceptive and other preventative services, although much of the money provided appears to have been spent by local primary care trusts (PCTs) on areas other than sexual health.¹¹ In Scotland, the government has been following a strategy called ‘Respect and responsibility’ since 2005, which aims to improve sexual health through better education and improved access to services.¹²

As part of ‘Choosing Health’, the UK government pledged to run a £30 million mass awareness program targeting young people, but this has had its budget reduced, with only £4 million spent on it so far. Based around the slogan ‘Condom: essential wear’, it was launched in 2006 and includes TV adverts and posters placed in pubs and bars. ¹³ There has been no guarantee that the remaining £46 million will be spent.

One way to target young people with HIV prevention is through education. In England and Wales, the government encourages secondary schools to teach pupils about HIV/AIDS as part of Sex and Relationships Education (SRE), although this is not a statutory subject on the national curriculum. OFSTED – an official body that regulates schools in England – reported in 2007 that:

"Schools gave insufficient emphasis to teaching about HIV/AIDS. Despite the fact that it remains a significant health problem, pupils appear to be less concerned about HIV/AIDS than in the past." - ¹⁴

In Northern Ireland and Scotland, HIV/AIDS is not a compulsory part of school education either. Some campaigners argue that across the UK, there needs to be a greater recognition of gay pupils’ needs if high rates of HIV among this group are to be countered. ¹⁵

Men who have sex with men

Gay men are the focus of numerous HIV prevention campaigns in the UK. An important nationally coordinated campaign is CHAPS (previously The Community HIV Prevention Strategy), which is funded by the Department of Health and run by a partnership of organisations, led by the Terrence Higgins Trust.

It’s work is currently guided by a document called ‘Making it Count’, which was last updated in 2003, and which set out plans to reduce the number of HIV infections occurring through sex between men. ¹⁶

Another important campaign is The London Gay Men’s HIV Prevention Partnership (LGMHPP) – a programme funded by several local health authorities across London, and run by seven AIDS-related organisations, including the Terrence Higgins Trust and GMFA. Interventions carried out by the LGMHPP have included condom distribution at gay bars and clubs, adverts in the gay press, a volunteer-run helpline, and internet resources.

There has recently been some dispute about the future direction of the partnership, as its funding has declined, and commissioners have proposed major changes in its approach – a reduction in information resources, in favour of interviewing gay men in person and recording their sexual behaviour on a database. ¹⁷

There is some evidence that many gay men are still ignoring safer sex messages. A study released in 2007 found that 18% of HIV-negative gay men had engaged in sex without using a condom. Worryingly, this figure rose to 37% for gay men who were HIV-positive. The same study found a relatively high number of undiagnosed HIV infections amongst men who have sex with men. ¹⁸

African communities in the UK

The Department of Health-funded National African HIV Prevention Programme (NAHIP) co-ordinates a number of regional projects aimed at African communities in Britain. In May 2007 it launched a new campaign called ‘beyond condoms’, which aims to encourage condom use and greater openness about sexual health in the African community through outreach work, posters, leaflets and community workshops.¹⁹ The National AIDS Trust (NAT), which supports NAHIP, argues that there are not enough HIV prevention campaigns aimed at African communities.²⁰

NAT has also called for greater efforts to reduce the stigma surrounding HIV in African communities in the UK, which is currently a major problem. A 2006 study found that fear of discrimination is stopping some people of African origin from accessing HIV testing services.²¹

Injecting drug users

It’s estimated that 131 injecting drug users (IDUs) became infected with HIV during 2006 – a fairly low number in comparison with some other countries. However, the proportion of IDUs living with HIV has increased, with an estimated one in fifty infected in 2006. This is around twice the level seen at the beginning of the decade.²²

The government funds some needle exchange schemes (which provide injecting drug users with clean needles), and also allows doctors to prescribe methadone as a substitute for injected drugs. Both of these harm reduction measures help to avoid needle sharing, and thus can prevent transmission of HIV and other viruses. Through methadone substitution, users can also be encouraged to reduce their dependency on drugs. Needle exchanges also provide information and support that can help people to stop taking drugs. ²³

Preventing mother-to-child-transmission (PMTCT)

All pregnant women in the UK are routinely offered (and advised to take) an HIV test as part of their antenatal care. It’s currently estimated that around 95% of HIV-infected women in the UK are diagnosed before delivery.²⁴ Where it is established that a pregnant women is HIV-positive, measures are taken to significantly reduce the chances of mother-to-child HIV transmission (MTCT), including the use of antiretroviral drugs.

These preventative measures have helped to keep the number of cases of MTCT occurring in the UK very low - fewer than 50 per year.²⁵

HIV testing in the UK

The number of people being tested for HIV and other STIs at Genito-Urinary Medicine (GUM) clinics has risen in recent years. Due to a lack of resources, GUM clinics have struggled to cope with these rising numbers, and this has led to long waiting times.²⁶ In response to this crisis, the government has pledged to provide £130 million towards improving GUM services in England, but as with other money earmarked for improving sexual health, local authorities seem to have used much of this funding to pay off existing debts. ²⁷ In Wales targets have also been set to reduce GUM waiting times, and the Welsh Assembly government has provided an extra £500,000 to help health services make the necessary changes. ²⁸

A major worry is that many people infected with HIV aren’t accessing testing services soon enough. It’s estimated that one third of HIV-positive adults in the UK are diagnosed late, and for heterosexual men this figure rises to 50%. ²⁹ 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 stage. ³⁰ 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 health. ^{31 32}

AIDS treatment in the UK

The availability of antiretroviral therapy in the UK has changed many people’s perspectives on HIV; it’s no longer seen as a ‘death sentence’. This treatment has saved lives, and has profoundly improved the quality of life of many people living with HIV.

“Back in 1995 I would say to many patients, ‘Sort out your house and pension as we might not meet again.’ Now, 10 years later, [because of antiretroviral therapy] they are still alive and I was wrong” - Dr Martin Fisher, HIV consultant ³³

Despite its benefits, antiretroviral treatment is far from a cure. Taking antiretroviral drugs is not easy; they have side effects, and a strict regime must be followed if they are to work properly. In some people, HIV becomes resistant to the drugs they are taking, leading to treatment failure. Others are diagnosed with HIV at a late stage when drug treatment is less likely to be effective. Largely for these reasons, some people still die from AIDS in the UK.

The vast majority of people in need of antiretroviral treatment in the UK are receiving it. However, people who are living in the UK illegally – failed asylum seekers and illegal immigrants – are excluded from free AIDS treatment on the National Health Service (NHS). The government has faced a great deal of criticism for this policy, which it has enforced as a response to the perceived threat of ‘treatment tourism’. Some AIDS organisations and health campaigners have argued that this policy is immoral and unjustifiable.

Another issue is financial constraints within the NHS, which are threatening to compromise the availability of more expensive AIDS drugs that some patients require. A report in 2007 found that over one third of HIV clinicians had put prescribing restrictions in place for antiretroviral drugs, or had discussed plans to do so.³⁴ If financial restraints force clinicians to be more selective about the medications they provide, it could become increasingly difficult for people who have become resistant to certain antiretroviral drugs to change their regimens.

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.
• HIV in prisons. In the past it’s 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 use. ³⁵ 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 prisons. ^{36 37}
• Criminal transmission of HIV. There have been several high profile cases in the UK where individuals have been prosecuted for reckless transmission of HIV, where a HIV-positive person fails to tell a sexual partner about their condition. These cases have generated a lot of debate about how the law should deal with this problem, or indeed if the law should come into it at all. AIDS charities generally argue 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.

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, what steps do the government, organisations and the public need to take to minimise the impact of AIDS?

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 fighting AIDS 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 black, minority and ethnic populations.

HIV infection in the UK is not limited to these groups though, and with sexually transmitted infections (STIs) 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 about 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.

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AVERT.org has more about:

• More about HIV and AIDS in the UK
• The recent history of the UK AIDS epidemic
• UK statistics summary
• Abstinence, sex education and HIV prevention