HIV infections continue to fall in UK thanks to testing and treatment
UK efforts to end the HIV epidemic by 2030 are advancing, but challenges remain around reaching those undiagnosed and those diagnosed late.
New HIV infections continue to fall year-on-year in the UK, driven largely by a dramatic fall in new infections among men who have sex with men. In a new report, HIV in the UK: towards zero HIV transmissions by 2030, Public Health England reveals a 73% decline in incident HIV infections in this group, from 2,300 in 2014 to 800 in 2018.
HIV incidence among all populations in the UK peaked in 2014 at 6,278 new infections but has since fallen to 4,453 new infections in 2018. Reduced infections among white gay and bisexual men living in London have contributed most to the decline, but new infections have also fallen by half in the last decade among heterosexual men and women – from 3,400 in 2009 to 1,940 in 2018. In this group, people living in London, people aged 25 to 34 years, people of black African ethnicity and those born abroad have experienced significant drops in rates of HIV infections.
In 2018, 51% of new infections were reported among men who have sex with men, 19% were among men reporting heterosexual sex as a probable route of transmission, 25% were among women reporting heterosexual sex, and 2.5% were among people who inject drugs. Of note, the proportion of people diagnosed aged 50 years or over increased from 13% in 2009 to 21% in 2018.
The report notes that the turnaround is the result of increased access to HIV testing, early and timely initiation of antiretroviral treatment (ART), and increased access to innovative technologies, such as pre-exposure prophylaxis (PrEP).
Dr Noel Gill, Head of STIs and HIV at Public Health England, said: “Testing is a key part of the UK’s success, if you have HIV you can benefit from life-saving treatments that also prevent further transmission of the virus. Certain groups of people are at higher HIV risk and are advised to have regular tests, including men and women who have had unprotected sex with new or casual partners from countries where HIV is common, who should test every year, and men who have sex with men.”
The goal of eliminating HIV transmission by 2030 depends upon sustaining prevention efforts and further expanding them to reach all at risk. In 2018, there were 7,500 people living with HIV who were unaware of their status, and 2 in 5 of those diagnosed in 2018 were diagnosed at an already late stage of infection. Late diagnosis results in a ten-fold increase in the risk of death in the year following treatment initiation, compared to those who are diagnosed early and start treatment immediately.
Populations most likely to be diagnosed late include black African men (65%), white men who acquired HIV heterosexually (59%), people aged over 50 years (59%) and people who inject drugs (58%).
Two years ago, the UK met the UNAIDS 90-90-90 target nationally with over 90% of people living with HIV being diagnosed, over 90% of those diagnosed being on treatment and over 90% of those on treatment having an undetectable viral load. Of the 103,800 people living with HIV in the UK in 2018, 93% were diagnosed, 97% of people diagnosed were receiving treatment and 97% of people receiving treatment were virally suppressed. What’s more, in 2018 London became the first city in the world to reach the UNAIDS 95-95-95 targets.
Dame Inga Beale, Chair of the HIV Commission said that the latest HIV statistics show real promise but also highlight challenges that remain if we are to end HIV transmission by 2030.
“We must look at what’s working well and how these successes can be further capitalised on, as well as thoroughly investigating how to tackle persistently high rates of late diagnosis and ensure the decline in new diagnoses is felt across all groups impacted by the epidemic. Progress that leaves some people behind is not progress at all.”