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HIV & AIDS in the UK
The UK has a relatively small HIV and AIDS epidemic in comparison with some parts of the world. An estimated 98,400 people in the UK – or around 1.5 per 1000 of the UK population – are currently living with HIV. 1 While this number is relatively low, it has increased dramatically since the 1990s, alongside a general rise in the prevalence of sexually transmitted infections. For UK specific help and advice about HIV and AIDS see here.
Although HIV and AIDS gets less attention from the media in the UK than it did during the early years of the UK AIDS epidemic, it’s far from an issue of the past. In fact, the epidemic has expanded, with the annual number of new HIV diagnoses nearly tripling between 1996 and 2005, when the annual rate peaked at almost 8,000 diagnoses. 2 Annual diagnoses have slightly declined since then with 6,360 people diagnosed HIV-positive in 2012. 3
The UK HIV and AIDS statistics show that of the 98,400 people living with HIV in the UK at the end of 2012, approximately 22 percent were unaware of their infection. 4 This figure is declining year on year, showing the uptake of HIV testing.
Encouragingly, a 2014 study found that life expectancy for HIV-positive people on successful treatment in the UK is now considered 'normal'. 5 Life expectancy can also appear to increase as people age, reflecting the more frequent medical check-ups that older people living with HIV receive, compared to other people their age. 6
However, 'normal' life expectancy does vary depending on certain factors, such as sex, CD4 count, and lifestyle. For example, women living with HIV in the UK have a slightly higher life expectancy than men. If a person's CD4 count is low when they begin antiretroviral treatment, achieving viral load suppression and CD4 count recovery is especially important, to increase life expectancy. 7 Factors such as smoking, alcohol and drug use and the existences of comorbidities can also affect life expectancy. 8
HAART (Highly Active Antiretroviral Therapy) has contributed to relatively low numbers of people in the UK dying from AIDS-related illnesses in recent years. In 2012, around 490 HIV-infected people died, compared to 1,723 in 1995, when antiretroviral treatment for HIV was not widely available. 9 10 Over the last few years, the majority of AIDS-related deaths have occurred because people were diagnosed late and therefore did not start treatment early enough. Just under half (47 percent) of all diagnoses were at a late stage in 2012. 11
Despite rising numbers of people infected through sexual transmission within the UK, public knowledge of HIV and AIDS appears to have declined. In 2000, 91 percent of people in the UK knew that HIV was transmitted through unprotected heterosexual sex; by 2010 this figure had fallen to 80 percent. 12 A 2011 report by the House of Lords Select Committee into HIV and AIDS in the UK noted that, "awareness of HIV and AIDS in Britain has fallen below the public radar". 13
More resources directed towards HIV prevention, including wider access to HIV testing, were identified as key measures needed to reduce new HIV infections in the UK and effectively deal with the epidemic. Despite this, since the UK's previous national strategy for HIV and sexual health came to an end in 2010, the UK remained without a renewed strategy for more than two years. 14 15 In 2012, HIV Prevention England (HPE) was formed, funded by the Department of Health and managed by Terrence Higgins Trust, which focuses on men who have sex with men (MSM) and African communities. 16 17 Since the NHS reform in April 2013, HIV services are now under the guide of local authorities, rather than regional primary care trusts (PCTs). This has caused concern for the sustainability of HIV services, and their connection to sexual health services. 18
In 2013 it was announced that healthcare workers living with HIV are now allowed to undertake certain medical procedures, from which they were previously banned. Positive governmental changes like this may go a long way towards changing negative attitudes towards people living with HIV. 19
UK regions affected by HIV
In 2012 there were 5,846 new HIV diagnoses in England, 287 in Scotland, 125 in Wales and 95 in Northern Ireland. 20 London is the epicentre of the UK HIV and AIDS epidemic, accounting for roughly half of HIV diagnoses in the UK so far. 21 There is a good distribution of services around the country, with more than 80 percent of people with a diagnosed HIV infection living within five kilometres of an HIV service. 22
HIV transmission routes in the UK
Of the total HIV diagnoses reported in 2012, 51 percent resulted from sex between men, 45 percent from heterosexual sex, 2 percent from injecting drug use, and less than 2 percent combined from mother-to-child transmission, blood/tissue transfer, and other or undetermined routes. 23 Transmission from sex between men became the largest transmission route in 2011, when it overtook heterosexual sex.
Infections acquired through heterosexual sex accounted for 45 percent of diagnoses in 2012. 24 The number of people who acquire HIV heterosexually overseas is continuing to decline; conversely the number of infections acquired in the UK continues its dramatic rise from 27 percent in 2002, to 52 percent in 2011. 25
The increasing number of people infected with HIV through this route means that the number of women living with HIV is increasing. The male to female ratio of HIV diagnoses made before 1995 was around 6 to 1, whereas in 2011 the ratio for new diagnoses was around 2.1 males to 1.0 female. 26
Men who have sex with men (MSM) and HIV/AIDS in the UK
In 2012, an estimated 40,900 MSM were living with HIV in the UK, with only 17 percent of this number aware of their status. HIV prevalence among MSM is of increasing concern in the UK. 51 percent of all new HIV diagnoses in the UK were among MSM, a 10 percent increase on 2011, and the highest number ever reported in the country. 27 In Scotland, sex between men has accounted for 71 percent of all new HIV diagnoses since 2004. 28 34 percent of newly diagnosed MSM in the UK in 2012 were diagnosed late, compromising the benefits of starting treatment early. 29
There is a great need for consistent testing at least once a year, and every 3 months if having unprotected sex with new partners among this group. 30
Drug use among MSM in the UK is also on the rise, particularly in London. 31 Indeed, increasing levels of recreational drug use and polydrug use have been reported among MSM living with HIV. Moreover, these practices have been strongly associated with condom-less sex, increasing this groups risk to the transmission of HIV as well as other sexually transmitted infections. 32
The prevalence of HIV infection among people who inject drugs (PWID) is relatively low in the UK - 1 in 100 PWID are living with HIV. 33 Around 2 percent of all new HIV diagnoses in 2012 were a result of injecting drugs, and more than half of those diagnoses were amongst people who were born abroad and inject drugs. 34
Although injecting drugs isn't a major cause of HIV infection in the UK, drug users are at higher risk for HIV co-infection with hepatitis. Around 90 percent of hepatitis infections in the UK are among current or former PWID. Treatments for co-infections are complicated, requiring earlier treatment in order to prevent liver damage. 35
In 2013, a study found that HIV prevalence among men who inject image and performance enhancing drugs (IPEDs) was similar to men who inject psychoactive drugs in the UK. The study pointed out that it is not the type of substance injected that causes HIV infection, it is the injecting practice itself. 36 There are calls for more targeted HIV prevention information for this group; as many as 59,000 people used steroids in England during 2013. 37
A UK based study followed 24 steroid users who were obtaining the drugs from illicit markets, meaning they could not tell exactly what drugs were in the concoction. The participants only relied on information from their peer steroid users about injecting practices. Unknown drugs and risky injecting practices mean that there is a call for harm reduction education to be increased among steroid users. 38
Mother-to-child transmission of HIV
A high uptake of antenatal HIV testing and the availability of drugs to prevent mother-to-child transmission of HIV has contributed to a low mother to child transmission rate of just 1 percent. 39 HIV diagnoses attributed to mother-to-child transmission totalled 95 in 2011, though the majority were from infections that had actually been transmitted outside the UK. There have been nearly 2,200 UK diagnoses of HIV in people who acquired the virus from their mothers, since 1985 when the first diagnosis was reported. 40
A 2012 study found that pregnancy rates among HIV-positive women in the UK have increased. Additionally, the proportion of pregnancies that were terminated among the women taking part in the study decreased from 13 percent in 2000-01 to 3 percent in 2008-09. The investigators concluded that this increase in women choosing not to have an abortion was likely to result from increased access to prevention of mother-to-child transmission. 41
HIV infected blood/tissue transfer
Blood safety measures within the UK have minimised the risk of transmission through infected blood transfusions and tissue to such a degree that there have been no reports of HIV infection being acquired in this way, in the UK, since 2002. 42 The last recorded incident of HIV transmission through infected blood donated in the UK was in a female blood transfusion recipient in 2003. 43
To minimise the risk of receiving infected blood whilst donors are in the window period, the UK has certain restrictions on who can donate. Individuals that have ever been a sex worker or have ever injected drugs are banned from donating blood for life. Other behaviours that are considered to be high-risk result in an individual being deferred from donating blood rather than having a lifetime ban. For example, individuals that have had sex with somebody who has been sexually active in a high-prevalence country, with a sex worker or with an injecting drug user, cannot donate blood for twelve months afterwards. 44 Until 2011, men who have sex with men (MSM) were permanently excluded from donating blood in the UK. The blood donation criterion was changed in England, Scotland and Wales on 7th November 2011, bringing the donation criteria for MSM in line with other high-risk groups with a twelve-month deferral period.
Occupational exposure is very rare in the UK, with one definite documented case since 1997. 45 Medical settings have procedures in place in case of a ‘sharps injury’, which can involve PEP if there is a danger that the health care worker has been exposed to HIV infected blood.
Black Africans and HIV/AIDS in the UK
In 2012, black African people accounted for 34 percent of all HIV diagnoses in the UK. 46 In the same year, 19 percent of all new HIV diagnoses were among this group. An estimated 32,000 people from this group are thought living with HIV in the UK, 27 percent of which have undiagnosed infections. 47
HIV diagnoses among black Africans often occur at a late stage of infection - when antiretroviral treatment is less likely to work as effectively. In 2012, over 66 percent of black African heterosexual men, and 61 percent of black African women, were diagnosed late, highlighting the need to increase HIV testing uptake among this population. 48 Similarly, this trend of late diagnosis occurs among other ethnic groups in the UK. In 2012, 66 percent of black Caribbean heterosexual men and 47 percent of black Caribbean women had a late HIV diagnosis. 49
There have been calls for urgent testing campaigns with targeted messages for communities from sub-Saharan Africa. However, there is also resistance to this approach as it could fuel stigma and discrimination towards these groups. 50 The National AIDS Trust (NAT) recommend that sexually active black Africans in the UK have an HIV test annually. 51
To access information about how to get tested for HIV in the UK, see our help and advice page.
HIV and AIDS prevention in the UK
For serodiscordant couples, where one person is HIV positive and the other negative, there are various HIV prevention options available in the UK, the most common being condoms. Treatment as prevention is now recommended in some circumstances. The UK, unlike some high-income countries, is yet to prescribe pre-exposure prophylaxis due to a lack of evidence of its effectiveness. 52
Men who have sex with men (MSM)
Gay men are currently the focus of a number of HIV prevention campaigns in the UK. An important nationally coordinated campaign body is CHAPS, which is funded by the Department of Health and run by a partnership of organisations, led by the Terrence Higgins Trust. CHAPS produces various research-informed campaigns through interventions in the media, such as ‘smart arse, clever dick’. 53 Taking the view that people can be more influenced by what their peers do than what government and health agencies advise, the campaign allows men to see other men endorsing the positive aspects of condom use.
Promoting HIV prevention at MSM community events has also been found to be successful. A study of one intervention, which offered HIV and syphilis testing to men attending Birmingham Gay Pride, found that the uptake was high. 54 The study recommended testing men for HIV at other Gay Pride celebrations in the UK.
Most MSM use condoms most of the time. 55 However, there is still a need to increase overall consistency of condom use. In 2010, around a quarter of MSM had unprotected anal sex with two or more partners. 56 Risks remain even when MSM have unprotected sex with someone of the same status. This practice, known as ‘serosorting’, can put men at risk of other STIs, and if both are positive, potential reinfection with a different strain of HIV. Due to the proportion of MSM who are unaware that they are living with HIV, serosorting can also put men at risk of HIV if they both believe themselves to be negative. 57
In 2011 HIV organisations in London expressed 'disappointment' and 'concern' over 20 percent cuts to their funding for HIV prevention services in the capital city, 58 commenting,
“Targeted HIV-prevention strategies are vital, especially for those most at risk, such as gay men, and without them it could lead to infection rates going up and awareness of HIV going down.” - Deborah Jack, National AIDS Trust chief executive 59
Greater MSM-targeted HIV testing and the early initiation of antiretroviral treatment have been highlighted as two key areas that could reduce the transmission of HIV. 60 The preventative benefits of early antiretroviral therapy were endorsed by the British HIV Association (BHIVA) in 2013; this is a prevention approach that has also been identified as a priority for inclusion in national HIV prevention plans. 61 However, ' treatment as prevention' will only go so far in reducing new infections without substantial gains in HIV testing to diagnose MSM currently unaware of their status. 62 63
Africans in the UK
The National African HIV Prevention Programme (NAHIP) is a country-wide prevention campaign funded by the Department of Health. It is managed by the African HIV Policy Network and collaborates with a number of smaller organisations that aim to prevent HIV among African people in the UK.
Among the NAHIP’s most prominent initiatives are the ‘ Do It Right – Africans Making Healthy Choices’ campaign which provides information on sexual health, condoms, and where to access help. Its website features a series of soap opera-styled videos encouraging viewers to think about HIV, condom negotiation and testing. 64 The ‘Beyond Condoms’ campaign promotes debate among African communities about a wide range of issues regarding sexual health and ‘building a safer sex culture’. The campaign’s literature targets different religious groups and is available in five different languages. 65
It is important that any prevention work targeting African communities in the UK be supported by parallel activities that aim to reduce the problem of HIV-associated stigma and discrimination. 66 A 2006 study found that fear of discrimination is stopping some people of African origin from accessing HIV testing services for fear of community reaction if their result were to be positive. 67 Encouraging HIV testing uptake is a key part of preventing onward transmission of HIV in all communities. If people know their status they are less likely to pass the virus to others.
People who inject drugs
A lot of early media coverage of AIDS in the UK focused on people who inject drugs (PWID). During the early 1980s it was a big problem, particularly in Scotland where areas such as Edinburgh and Dundee had a very high prevalence of HIV among PWID. Throughout the two decades since, prevalence has remained highest among older drug users who began injecing before 1985. 68
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 PWID during the 1990s. From 1990 to 1996 prevalence among this group fell from nearly 6 percent to 0.6 percent, but then peaked again in 2005, before declining to remain fairly stable since 2006. 69 70
Needle exchange services are run by hospitals, pharmacies, drug agencies and other organisations. While over 90 percent of current and former drug users in England, Wales and Northern Ireland have used a needle exchange service, campaigners argue that needle exchange provision in the UK is patchy, out of hours provision is poor and there are disparities in the availability of equipment. 71
On average, the UK distributes 188 needles per person who injects drugs, per year, still below the internationally recommended level of 200. 72 73 Risk taking among this group has improved, but remains high. One in seven PWID continue to share needles in 2012. 74 However, recent outbreaks of HIV among groups of people who inject drugs in Scotland demonstrate the continued need to improve access to clean and safe needles. 75
Doctors in the UK are permitted to prescribe opiate medicines (methadone, buprenorphine) as substitutes for injected heroin. This form of harm reduction, known as Opioid Substitution Therapy (OST), is used to reduce dependency on drugs, and hence reduce the likelihood of HIV infection. However, the success of OST in the UK is too often based on achieving complete abstinence from opiate medicines; there are calls to end focus on this perceived 'goal'. 76
HIV/AIDS education and awareness
HIV education is a vital component of HIV prevention strategies. Educating people about HIV can help them to protect themselves and others, and can reduce the fear and stigma surrounding HIV and AIDS.
A 2010 UK survey of peoples’ attitudes to and knowledge of HIV conducted by the National AIDS Trust found that levels of understanding about HIV transmission in the UK have fallen significantly since the year 2000. It was found that in 2010, only a third of the British public could correctly identify all true and false HIV transmission routes. 77 It was also noted that there had been an increase in the proportion of people who incorrectly believe HIV can be transmitted through spitting and kissing.
The over-50 age group has also been overlooked by those providing HIV and AIDS education in the UK. In the ten year period 2002-2011, new HIV diagnoses almost doubled among the over 50s. 78 In 2012, over 63 percent of adults aged 50 years and over were diagnosed late, compared to 44 percent of adults under 50. 79
Deborah Jack, Chief Executive of the National AIDS Trust, emphasises the need to educate the general UK public about HIV:
“Ignorance about HIV increases vulnerability to infection and also contributes to stigma and discrimination. The Government must re-invest in educating the public about HIV.” 80
HIV education in schools is one way of targeting young people with HIV prevention. In the UK, state schools have to provide Sex and Relationship Education (SRE), and meet a number of requirements including statutory guidance and supplementary advice. Independent schools do not have to follow statutory requirements. 81
In a recent review of the National Curriculum, the UK government said that all state schools ‘should make provision for personal, social, health and economic education (PSHE), drawing on good practice’ 82 and that SRE is an ‘important and necessary part of all pupils’ PSHE education.' 83
Parents have the right to withdraw their children from SRE, (except sex education in National Curriculum science) though very few do so. The Terrence Higgins Trust, among other organisations, believe that sex and relationships education should be a core part of the National Curriculum in the UK:
“The lack of good sex education means many young people are leaving school ignorant about HIV and safer sex...It’s time to get our facts straight.” - Nick Partridge, Chief Executive, THT 84
In 2013, Ofsted confirmed that a third of secondary schools fail to provide sex education that is age appropriate, with calls to increase access to it. 85
Prevention of mother-to-child transmission
The UK has been very successful at preventing mother-to-child transmission of HIV. All expectant mothers are offered an HIV test and women who are identified as HIV-positive are offered antiretroviral treatment to prevent transmission to their unborn baby. Of all children born to women living with HIV in the UK, an estimated 927 have become infected. Declines in transmission through this route meant that there were only 18 reported HIV diagnoses among children in 2011. 86
HIV testing in the UK
According to British Association for Sexual Health and HIV guidelines, HIV testing should be offered at genitourinary medicine (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. People should be offered counselling if they request it or if there is a high risk of a positive result. 87
The number of people tested for HIV and other STDs at GUM clinics (where many people are tested for HIV) has risen in recent years, with 71 percent of clinic attendees being tested for HIV in 2012. 88 Many policies around preventing HIV in high-risk groups involve increasing testing. 89 Results from the Gay Men's Sex Survey in 2008 revealed that around two-thirds of MSM in England and Wales had taken an HIV test, a rate which, promisingly, is steadily rising year on year. 90 It is thought that HIV testing is becoming more 'normalised' amongst MSM in Scotland, although fear of a positive test result is still impeding some MSM from coming forward for an HIV test. 91
It can be difficult to treat someone with HIV if they are diagnosed late, and in some cases late diagnosis leads to death.
Whilst these increases in testing are encouraging, a major worry is that many people infected with HIV aren’t accessing testing services soon enough. In 2012, 47 percent of all people newly diagnosed with HIV were diagnosed late ( CD4 count below 350 cells/mm3). 92 93 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. 94
To address this issue, in August 2013 the UK government announced that HIV self-testing kits would be made available for the public to buy. 95 In April 2014, a law was passed enabling the sale of home testing kits over the counter but no kits have been approved for sale as of yet. 96
Another reason that testing is so important is that it is a preventative measure. People are more likely to take measures to ensure that they don’t infect others if they know that they are positive. Within the UK, more emphasis is being placed on ensuring that HIV-positive people lower their ‘viral load’ through treatment, to dramatically reduce the risk of transmitting the virus. For the public health benefits of this to be felt, it is vital that people are diagnosed before they have a high viral load. 97
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. This was in reaction to findings that GPs were reluctant to provide HIV testing because of a common perception that special training and lengthy counselling are required. 98 Guidelines published in 2008 suggest offering an HIV test to all adults registering with a GP in areas with a relatively high HIV prevalence (where more than 2 in 1000 people have diagnosed HIV). 99
These guidelines have since been found to improve health outcomes and save money. 100 By 2010 results from eight projects in primary care and general medical admissions showed an overall positivity rate of five per 1,000 tests conducted. Routine testing in these settings was found to be both feasible and acceptable among staff and patients. 101
"Only through more effective and more widespread testing can we make earlier diagnoses, reduce undetected HIV cases and thus halt onward transmissions." 102
Many groups continue to push for a move from ‘opt-in testing’ to ‘opt-out testing’ (where patients are given an HIV test alongside routine checks unless they explicitly say no). National Institute for Health and Clinical Excellence (NICE) has advocated for expanding testing outside clinical settings by engaging community organisations, developing local strategies to increase testing, and providing rapid HIV tests. 103
According to the NICE national costing model, for every new positive diagnosis of HIV, 0.03 cases of onward transmission are avoided, resulting in significant cost savings. 104
HIV and AIDS treatment and care in the UK
All UK residents and overseas visitors to the UK are eligible for free HIV/ AIDS treatment from the NHS. 105 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.
Economically, there is a case for investing in HIV prevention and education services within the UK. The cost to treat a person living with HIV can be very expensive. For example, it costs an estimated £5485 a year to treat a 35-year old living with HIV in the UK. 106 Therefore, if a person of this age lives for a further 37 years (the average life expectancy for someone aged 35, living with HIV in a developed country), the total lifetime treatment costs may be anywhere between £200,000 to £360,000. 107
However, antiretroviral therapy has been shown to be, not only an effective HIV treatment, but an effective form of HIV prevention. Consequently, in 2013, the British HIV Association (BHIVA) released a position statement that recommended early initiation of antiretroviral treatment in people wanting to reduce the risk of HIV transmission to a partner. 108 Part of BHIVAs support for the use of treatment as prevention was based on a study, which found the risk of HIV transmission among heterosexual couples was reduced by 96 percent when the HIV-negative partner adhered to antiretroviral therapy. Access the full BHIVA position statement.
Care and support
Care and support for people living with HIV in the UK is extremely important. Symptoms of HIV can fluctuate, making the support needs of someone living with HIV change over time. Additionally, many people experience mental health problems due to medical triggers such as medication and illness, or social triggers such as isolation or fear of stigma. Social care and peer support can help to alleviate these issues. 109 The Terrence Higgins Trust and numerous other local organisations provide such services.
In the UK, social care and support for people living with HIV has been provided since 1989 through the AIDS Support Grant (ASG). In June 2010 it was announced that £28 million allocated for HIV/AIDS support services in the country would no longer be protected. Charities such as the Terrence Higgins Trust and the National AIDS Trust expressed concern at the time that such cuts would affect local HIV organisations who rely on such funding to provide specialist social care support to HIV-positive people who are not necessarily catered for by mainstream services. 110 111 In 2010/11, over a third of local authorities did not spend all their HIV and AIDS support allocation directly on providing social care for people living with HIV, a proportion that has risen from 14 percent in 2008. 112
For many people living with HIV, it has become harder to qualify for social care. In this environment, voluntary-sector, open-access services are becoming increasingly important to meet the needs of those that don’t qualify, as well as those whose immigration status means that they cannot access government-provided services. 113
Though HIV and poverty are not directly associated, some people living with HIV are economically disadvantaged, which can deteriorate into poverty. Poverty and economic adversity, and not being able to cover basic living expenses such as food or clothing, inevitably leads to stress. Many studies have shown how stress can affect the immune system, the course of the HIV infection, and adherence to treatment. 114
There is evidence to suggest that the recent cuts to government spending have exacerbated some of these issues. According to one study, 66 percent of people living with HIV have been affected by changes to the welfare system in England, with 9 in 10 reporting a negative impact on their health or access to HIV-related services. 115
In the UK, financial support is available for people living with HIV who have difficult economic circumstances. For example, The Hardship Fund, established in 1989 by Crusaid and currently operated by the Terrence Higgins Trust, offers three streams of support for; everyday essentials, home moves, and families with a parent or child living with HIV. 116
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 discrimination against people living with HIV. More than two-thirds of people in a nation-wide survey felt there was a lot of stigma around HIV in the UK and one in three people living with HIV said they had experienced discrimination based on their status. 117
HIV in prisons
Recent HPA figures for England suggest that HIV prevalence in prisons in England is more than double that than the general population. 118 However, it has been noted that because of a lack of data in this area this number is probably an underestimation. 119 This high prevalence is partially driven by high-risk behaviour, including injecting drug use. 120 121
A 2005 survey found that prisons in the UK were lacking in many of essential preventative measures necessary to lessen the risk of HIV infection and other STDs:
“Many prisoners did not have appropriate access to condoms, disinfecting tablets, clean needles or healthcare information and so were not able to protect themselves from HIV if injecting drugs or having unprotected sex whilst in prison.”
The government announced plans to provide disinfectant tablets to prisoners, which can be used to sterilise needles, in 2005, and steps were taken to introduce disinfecting tablets into prisons in October 2007. 122However, some campaigners argue that this does not go far enough and that needle exchanges, as well as a variety of other harm reduction methods, should be introduced to prisons. 123
More up-to-date data is needed on the prevalence of HIV within prisons, and the extent and nature of HIV prevention, testing and treatment services. This can then be used to determine gaps in provision and ensure that steps can be taken to reduce new HIV infections in prisons and provide care and treatment for those already infected. 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 Crown Prosecution service released guidelines to clarify the law in England and Wales. As of 2008 reckless HIV transmission is only punishable in court in England and Wales if HIV is actually passed on and if the defendant is aware of their HIV status 124 and in 2012 Scotland released equivalent guidance on prosecutions. 125 In 2010 the Association of Chief Police Officers (ACPO) issued guidance to help police officers deal with cases of reckless transmission of HIV in a fair and sensitive way that respects the rights of people living with HIV. 126 The prosecution of the reckless transmission of HIV remains contentious; a number of HIV organisations maintain that promoting knowledge of status and safer sex are more effective in preventing transmission than prosecuting those who have transmitted the virus. 127 128
People living with HIV who migrate to the UK often encounter difficulties in accessing treatment, care and support. In 2012, treatment was made free to overseas visitors after much lobbying by campaign groups, consequently removing one of the main barriers to treatment - cost. 129 Guidelines around dispersing migrants to different parts of the country now include ensuring that those with HIV have sustained access to treatment and are placed where there are appropriate facilities. 130 There are also guidelines for people who are detained in immigration removal centres (IRCs). For example, people who are newly diagnosed should be referred to an HIV specialist and those who are removed from the UK should be given three months supply of medication. 131 Unfortunately, there are still many instances when these rights are not met. 132
Tuberculosis and HIV
Tuberculosis (TB) is one of the most common opportunistic infections among people living with HIV. Between 2002 and 2010, one in ten heterosexual adults living with HIV in the UK were also diagnosed with TB at some point after their diagnosis. Despite this proportion seeming rather high, the annual incidence of TB is declining. It is imperative to take antiretroviral treatment (ART) when diagnosed with HIV, as this reduces the chance of TB infection; TB is much more common among those not on ART. 133
Between 2000 and 2012, the transmission of multi-drug resistant (MDR) TB has actually increased in the UK. Transmission of a MDR strain is more likely due to the considerably longer amount of time needed to cure it compared to a strain that can be treated easily. The sooner a diagnosis, the more cases of transmission could be avoided. 134
The way forward
The recent history of HIV and 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 HIV and AIDS in the UK.
There is a great need to ensure that HIV prevention services, particularly testing for high-risk groups, do not get overlooked in the midst of NHS cuts and restructuring. 135 As health budgets come under pressure it is all the more important for decision makers in the UK to recognise that testing is cost-effective. Some innovative measures to combating the problems with late diagnosis in the UK have been recommended, such as sending out text message reminders to MSM and changing regulations to allow regulated home-testing HIV kits. 136
High costs of treatment, thousands of new HIV diagnoses every year, and persistently high levels of stigma and discrimination are some of the challenges that remain. A 2011 House of Lords Select Committee report into HIV and AIDS in the UK concluded that:
“Not enough is being done to respond to a steadily growing risk to public health. There are potentially huge cost implications in both the short- and long-term in failing to deal effectively with the epidemic. At a time when public health in the United Kingdom is subject to major reform, the Government should ensure that HIV and AIDS is a key public health priority. ” 137
Many campaigners 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.
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- 2. HPA (2012) ‚ ‘ United Kingdom New HIV Diagnoses to end of June 2012’
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- 9. HPA (2012, July)‚ ‘Statistics provided to AVERT by the Health Protection Agency’
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- 11. Public Health England (2013) ' HIV in the United Kingdom: 2013 report'
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- 13. Select Committee on HIV and AIDS in the United Kingdom (2011, July) ' No vaccine, no cure: HIV and AIDS in the United Kingdom'
- 14. Yusef Asad (2013, 16th January) ' Why the Government Risks Letting People With HIV Down' Huffington Post
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- 16. Health Prevention England (2012) ' Who we are'
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- 18. The Lancet (2014, January) ' England's HIV services face complex new environment'
- 19. UK Government (August 2013) ' Modernisation of HIV rules to better protect public'
- 20. Public Health England (2013) ' HIV in the United Kingdom: 2013 report'
- 21. Public Health England (2013) ' HIV in the United Kingdom: 2013 report'
- 22. Health Protection Agency (2011) ' HIV in the United Kingdom: 2011 report'
- 23. Public Health England (2013) ' HIV in the United Kingdom: 2013 report'
- 24. Public Health England (2013) ' HIV in the United Kingdom: 2013 report'
- 25. Public Health England (2013) ' HIV in the United Kingdom: 2013 report'
- 26. Public Health England (2013) ' HIV in the United Kingdom: 2013 report'
- 27. PHE (2014, April) ' Addressing Late HIV Diagnosis through Screening and Testing: An Evidence Summary'
- 28. Scottish Government (2014) ' HIV Prevention: Needs Assessment of Men Who Have Sex with Men (MSM)'
- 29. PHE (2014, April) ' Addressing Late HIV Diagnosis through Screening and Testing: An Evidence Summary'
- 30. Public Health England (2013) ' HIV in the United Kingdom: 2013 report'
- 31. The Lancet (2013, January) ' High-risk drug practices tighten grip on London gay scene'
- 32. Daskalopoulou, M. et al (2014) ' Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study' The Lancet HIV
- 33. Health Protection Agency (2012) ' Shooting Up - Infections among people who inject drugs in the UK 2011'
- 34. Public Health England (2013) ' HIV in the United Kingdom: 2013 report'
- 35. National AIDS Trust (2012) ' Hepatitis C and HIV Coinfection'
- 36. Hope. V. et al (2013) ' Prevalence of, and risk factors for, HIV, hepatitis B and C infections among men who inject image and performance enhancing drugs: a cross-sectional study' BMJ
- 37. National Institute for Health and Clinical Excellence (NICE) (2014) ' NICE public health guidance 52 - Needle and syringe programmes'
- 38. Andreas Kimergard et al (2014, June) ' Environments, risk and health harms: a qualitative investigation into the illicit use of anabolic steroids among people using harm reduction services in the UK', BMJ
- 39. Public Health England (2013) ' HIV in the United Kingdom: 2013 report'
- 40. HPA (2012)‚ ‘ United Kingdom New HIV Diagnoses to end of June 2012’
- 41. nam/aidsmap (2012) ' Pregnancy rate among HIV-positive women in the UK has increased significantly'
- 42. Public Health England (2013) ' HIV in the United Kingdom: 2013 report'
- 43. Serious Hazards of Transfusion (2003) ' Annual Report'
- 44. NHS Blood and Transplant (2011) ' Give Blood - Who Can't Give Blood'
- 45. Health Protection Agency (2008) ' Eye of the Needle'
- 46. NAT (2014, June) ' HIV and Black African Communities in the UK'
- 47. PHE (2014, April) ' Addressing Late HIV Diagnosis through Screening and Testing: An Evidence Summary'
- 48. Public Health England (2013) ' HIV in the United Kingdom: 2013 report'
- 49. Public Health England (2013) ' HIV in the United Kingdom: 2013 report'
- 50. NAT (2012) ‘ HIV Testing Action Plan to reduce late HIV diagnosis in the UK'
- 51. NAT (2012) ‘ HIV Testing Action Plan to reduce late HIV diagnosis in the UK'
- 52. aidsmap / NAM (2012) ‚ ‘ PrEP needs more study before being provided, UK physicians conclude'
- 53. CHAPS (2012) ‚ ‘ Smart arse, clever dick’
- 54. Newton R. et al (2012, December) ‘The uptake of HIV and syphilis testing in a nurse-delivered service during Gay Pride events.’ International Journal of STD and AIDS, 23 (12)
- 55. CHAPS (2012) ‚ ‘ Smart arse, clever dick’
- 56. CHAPS (2012) ‚ ‘ Smart arse, clever dick’
- 57. HPA (2011) ‚ ‘ Sexually Transmitted Infections and Men who have Sex with Men in the UK: 2011 Report'
- 58. BBC News (2011, May) ' London HIV services cut as infections rise'
- 59. TimeOut (2011, May) ' Is London set for a new HIV epidemic?'
- 60. Birrell, PJ et. al (2013, February 1st) 'HIV incidence in men who have sex with men in England and Wales 2001–10: a nationwide population study' Lancet Infect Dis S1473-3099(12)70341-9
- 61. The British HIV Association (BHIVA) and the Expert Advisory Group on AIDS (EAGA) (2013, January) ' Position statement on the use of antiretroviral therapy to reduce HIV transmission'
- 62. Phillips, N/, et al (2013) ' Increased HIV Incidence in Men Who Have Sex with Men Despite High Levels of ART-Induced Viral Suppression: Analysis of an Extensively Documented Epidemic'
- 63. Brown, A. E., et al (2013) ' HIV treatment as prevention among men who have sex with men in the UK: is transmission controlled by universal access to HIV treatment and care?'
- 64. NHS (2007) ' Do it Right website'
- 65. The National African HIV Prevention Programme, Beyond Condoms Campaign website, accessed 16/08/09
- 66. HPA (2007) ‘ Testing Times: HIV and other Sexually Transmitted Infections in the United Kingdom: 2007’
- 67. Elam G et al (2006), ‘Barriers to voluntary confidential HIV testing among African men and women in England: results from the Mayisha II community-based survey of sexual attitudes and lifestyles among Africans in England’, HIV Medicine 2006; 7(Suppl. 1): 7 (abstract no. O28)
- 68. Hope V.D. et al, Euro Surveillance (2014) ' Two decades of successes and failures in controlling the transmission of HIV through injecting drug use in England and Wales, 1990 to 2011'
- 69. Hope V.D. et al (2005), 'HIV prevalence among Injecting Drug Users in England & Wales 1990 to 2003: Evidence for increased transmission in recent years' AIDS 2005:19
- 70. Hope V.D. et al, Euro Surveillance (2014) ' Two decades of successes and failures in controlling the transmission of HIV through injecting drug use in England and Wales, 1990 to 2011'
- 71. Turning point (2007), ‘ At the sharp end: a snapshot of 21st century injecting drug use’ (pdf)
- 72. Mathers B. M. et al (2010, March) ‚ ‘ HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage’ The Lancet
- 73. WHO/UNAIDS/UNICEF (2011) ‚' Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access 2011'
- 74. Public Health England (2013) ' Shooting Up: Infections among people who inject drugs in the UK 2012'
- 75. BBC News (2012, February) ‚ ‘ Glasgow drug users warned of HIV cluster’
- 76. National AIDS Trust (2013, July) ' HIV and Injecting Drug Use'
- 77. NAT (2011, February 18th) ' One in five adults do not realise HIV is transmitted through sex without a condom between a man and a woman'
- 78. HPA (2012) ‚ ‘ United Kingdom New HIV Diagnoses to end of June 2012’
- 79. Public Health England (2013) ' HIV in the United Kingdom: 2013 report'
- 80. NAT (2008), ‘Over 90 percent of the British public do not fully understand how HIV is transmitted’
- 81. Department for Education (2013, September) ' National Curriculum in England: Framework for Key Stages 1 to 4'
- 82. Department for Education (2013, September) ' The National Curriculum in England: Key stages 3 and 4 framework document'
83. Department for Education (2013, September) '
Guidance: Personal, Social, Health and Economic (PSHE) Education' Ofsted – the 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.”
Ofsted (2007, April) 'Time for change? Personal, social and health education’
- 84. THT (2007) ‘Press release: Survey highlights shocking ignorance about HIV, 25 years after death of Terry Higgins’
- 85. BBC News (2013) ' Poor sex education leaves pupils vulnerable - Ofsted'
- 86. HPA (2012) ‚ ‘ United Kingdom New HIV Diagnoses to end of June 2012’
- 87. HPA (2007) ‘ Testing Times: HIV and other Sexually Transmitted Infections in the United Kingdom: 2007’
- 88. Public Health England (2013) ' HIV in the United Kingdom: 2013 report'
- 89. HPA (2011) ‚ ‘ Sexually Transmitted Infections and Men who have Sex with Men in the UK: 2011 Report'
- 90. Sigma Research (2010, October) 'Tactical dangers: Findings from the United Kingdom Gay Men's Sex Survey 2008'
- 91. Flowers. P. et al (2013, February) ' Has testing been normalized? An analysis of changes in barriers to HIV testing among men who have sex with men between 2000 and 2010 in Scotland, UK'
- 92. Public Health England (2013) ' HIV in the United Kingdom: 2013 report'
- 93. National AIDS Trust (2012) ‚ ‘ HIV Testing Action Plan to reduce late HIV diagnosis in the UK'
- 94. BHIVA (2006), 2005-6 Full results of mortality audit
- 95. Department of Health (2013, August) ' Modernisation of HIV rules to better protect public'
- 96. BBC News (2014, 6 April) ' UK law passes sales of HIV home tests before they exist'
- 97. National AIDS Trust (2012) ‚ ‘ HIV Testing Action Plan to reduce late HIV diagnosis in the UK'
- 98. BHIVA (2008) ‚ ‘ Letter from Dr Mary Armitage, Immediate Past Clinical Vice President, Royal College of Physicians (RCP)’
- 99. BHIVA/BASHH/BIS (2008) 'UK National guidelines for HIV testing 2008'
- 100. National AIDS Trust (2012) ‚ ‘ HIV Testing Action Plan to reduce late HIV diagnosis in the UK'
- 101. HPA (2010) 'Time to test for HIV: Expanded healthcare and community HIV testing in England - Interim report'
- 102. BBC News (2011, 7th January) 'Doctors are "reluctant" to test routinely for HIV'
- 103. NICE (2011) PH33 Increasing the uptake of HIV testing among black Africans in England: guidance
- 104. NICE (2011) ' PH33 Increasing the uptake of HIV testing among black Africans in England: costing report'
- 105. Department of Health (2012, 1st October) ' HIV Treatment for Overseas Visitors'
- 106. NICE (2011) ' Increasing the uptake of HIV testing among men who have sex with men'
- 107. NICE (2011) ' Increasing the uptake of HIV testing among men who have sex with men'
- 108. The British HIV Association (BHIVA) and the Expert Advisory Group on AIDS (EAGA) (2013, January) 'Position statement on the use of antiretroviral therapy to reduce HIV transmission'
- 109. National AIDS Trust (2011) ‚ ‘ The impact of social care support for people living with HIV: the results of NAT’s snapshot survey of healthcare professionals’
- 110. NAT (2010, June 14th) ' NAT Concerned by end of Protected Grant for Care of People with HIV'
- 111. PinkNews (2010, June 14th) ' HIV charities 'very concerned by threat to local funding'
- 112. National AIDS Trust (2011) ‚ ‘ The impact of social care support for people living with HIV: the results of NAT’s snapshot survey of healthcare professionals’
- 113. National AIDS Trust (2011) ‘ The impact of social care support for people living with HIV: the results of NAT’s snapshot survey of healthcare professionals’
- 114. HIV InSite (2006) ' Coping with Stress'
- 115. Positively UK (2014) ' The Impact of the Welfare Reforms on People Living with HIV in England'
- 116. Terrence Higgins Trust (2014, February) ' HIV and Poverty'
- 117. NAT (2011, February 18th) ' One in five adults do not realise HIV is transmitted through sex without a condom between a man and a woman'
- 118. Select Committee on HIV and AIDS in the United Kingdom (2011, July) ' No vaccine, no cure: HIV and AIDS in the United Kingdom'
- 119. Select Committee on HIV and AIDS in the United Kingdom (2011, July) ' No vaccine, no cure: HIV and AIDS in the United Kingdom'
- 120. Weild A et al (1998), 'The prevalence of HIV and associated risk factors in prisoners in England and Wales in 1997: results of a national survey', International Conference on AIDS'
- 121. Prison Reform Trust/National AIDS Trust (2005), 'HIV and hepatitis in UK prisons: addressing prisoners' healthcare needs'. Elkins T.
- 122. HM Prison Service (2007, October) ' Reintroduction of disinfecting tablets'
- 123. National AIDS Trust (2011, May), ' Tackling Blood-Borne Viruses in Prisons: A framework for best practice in the UK'
- 124. CPS (2008) ‘Policy for prosecuting cases involving the intentional or reckless sexual transmission of infection’
- 125. National Aids Trust (2012, May) ' Criminal Prosecutions'
- 126. National Aids Trust (2010, July 15th) ' New guidance for Police Investigating Criminal Transmission of HIV' !
- 127. Terrence Higgins Trust, ' Thinking on Prosecutions'
- 128. NAT ' Why NAT opposes prosecution for reckless HIV transmission'
- 129. National AIDS Trust/ Terrence Higgins Trust (October, 2012) ' Will I have to pay?'
- 130. UK Border Agency (2012) ' Healthcare needs and pregnancy dispersal guidance'
- 131. National AIDS Trust (2009) ' Detention, removal and people living with HIV' (pdf)
- 132. Medical Justice (2011) ' Detained and Denied: The clinical care of immigration detainees living with HIV'
- 133. Rice,B et al (2013) ' Decreasing incidence of tuberculosis among heterosexuals living with diagnosed HIV in England and Wales'
- 134. Laura Anderson et al (2014) ' Transmission of multidrug-resistant tuberculosis in the UK: a cross-sectional molecular and epidemiological study of clustering and contact tracing,' The Lancet
- 135. National AIDS Trust (2012)‚ ‘ HIV Testing Action Plan to reduce late HIV diagnosis in the UK'
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