New HIV diagnoses in gay men fall for first time in England

24 November 2017

Testing for HIV is rising in the UK, but opportunities are being missed among some vulnerable groups.

Gay and bisexual men remain at highest risk of acquiring HIV, accounting for 54% of all new diagnoses in 2016. However, testing has increased steadily over the last five years, resulting in 104,478 gay and bisexual men being tested in 2016. This represents 89% of gay and bisexual men who tested via sexual health services (SHS) in 2016, 6% more than in 2012.

The new figures come from Public Health England’s (PHE) annual testing report and main annual summary, which reflects 2016 data gathered mainly through sexual health services, where the majority of people get tested for HIV.

The continuing success of the HIV response among gay men has seen the number of new HIV diagnoses drop by 21% between 2015 and 2016. This is the first time a decline has been observed among gay and bisexual men since the epidemic began 30-years-ago. 

It is thought to be the result of the work of five London clinics, which have been delivering high levels of HIV testing, including frequent testing of men at high risk of HIV, together with accelerated initiation of antiretroviral treatment (ART) for those testing positive. Increased access to pre-exposure prophylaxis (PrEP) online is also thought to be contributing to the success. 

These gains have resulted in a steep decline in rates of HIV-positive test results among gay and bisexual men, which dropped from 1.7% to 1.2% of all tests (a 29% decline) between 2015 and 2016.

However, although the number of gay and bisexual men being diagnosed with HIV late has reduced by 25% in the past 10 years, 77% of gay and bisexual men diagnosed with HIV through SHS in 2016 had not tested in the previous year at that clinic. This indicates that recommendations for annual testing among gay and bisexual men at high HIV risk are currently falling short.

Testing coverage among England’s second highest risk group – heterosexual black African men and women – has remained fairly static, rising from 68% testing in SHS in 2012, to 69% testing in 2016. 
PHE also reported that increasing numbers of black African men and women are declining HIV tests when offered.

In total, 24,851 black African women and 24,703 black African men tested in 2016. While those testing positive has fallen to 0.7%, this group still accounted for 14% of all HIV diagnoses made through SHS last year.

Annual HIV testing also appears to be a stumbling block among this group with only 13% of black African men and women who tested in 2016 having had a test in the previous year. However, gains are being seen through a continued decline in new HIV diagnoses among black African men and women, from 4,060 in 2007, to 2,110 in 2016 – as well as a continued decline in late diagnoses.

Other vulnerable populations in the testing report include people who inject drugs, a group PHE describes as being subject to “many missed opportunities”. Data reveals that although 77% of people who inject drugs reported ever testing for HIV in 2016, 82% of those who reported never testing had attended a clinical service in the previous year. 

Testing coverage among the 4,491 sex workers eligible for HIV testing was found to be strong, standing at 84%.
Information released by PHE in relation to testing among transgender people is limited, and only reported on in relation to PHE’s self-sampling services (75 transgender people returned PHE kits) and community services where 43 transgender people were tested for HIV.

The general rise in testing is reflected by a decrease in the number of people with undiagnosed HIV, which has reduced from 13,300 in 2015 to 10,400 in 2016. 

The most apparent declines in undiagnosed HIV were seen in gay and bisexual men in London, and black African heterosexual women, which is thought to be linked to changes in migration patterns. However, 12% of people living with HIV remain unaware of their status, 2% short of the UNAIDS target of 90% of people living with HIV to be diagnosed. 

The overall number of new infections has also fallen with 5,164 people newly diagnosed in 2016, an 18% decline from 2015.

For the first time, the death rate among people with HIV who are diagnosed promptly and on treatment is now comparable to the rest of the population. But with 42% of adults newly diagnosed with HIV in 2016 diagnosed at late-stage of infection, leaving them at high risk of death in the first year of diagnosis, AIDS-related death remains a reality for a significant proportion of people with HIV in England. 

Expanding HIV testing into a wider number of clinical and community settings has been recommended to address this issue. All parts of the country provide access to alternative HIV testing options such as HIV self-sampling services and community HIV testing activities. 

However, PHE highlights concerns over poor implementation and lack of commissioning relating to these alternative testing services, meaning their scale remains small and their overall impact on diagnosing HIV low.

Photo credit:
© Photos are used for illustrative purposes. They do not imply any health status or behaviour on the part of the people in the photo.

Written by Hester Phillips