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UK HIV diagnosis rates twice as high as western Europe

Annual HIV report says over 13,000 people unaware they are infected

Mark Gould

Monday, 19 December 2016

Rates of diagnosis of new cases of HIV infection in the UK are almost twice the average rate of other western European countries, according to official statistics.

The annual report* on HIV in the UK, published today by Public Health England, reveals that last year 6,095 people were diagnosed with HIV: this represents a new diagnosis rate of 11.4 per 100,000 people. This rate is higher than most other countries in western Europe, the average being 6.3 per 100,000 people in 2015.

The report also reveals that an estimated 101,200 people were living with HIV in the UK, last year. Of those, 13,500 (13%) were unaware of their infection and at risk of passing on the virus to others. The majority, 69% were men and 31% were women. The HIV prevalence in the UK is estimated to be 1.6 per 1,000 population.

HIV incidence among gay/bisexual men remains consistently high; in England, an estimated 2,800 gay/bisexual men acquired HIV in 2015, with the vast majority acquiring the virus within the UK. Overall, in 2015, 47,000 gay/bisexual men were estimated to be living with HIV, of whom 5,800 or 12% remained undiagnosed.

Diagnosis rates, although higher than in most western European countries, have remained steady at around 6,000 for the past five years, reflecting both testing efforts and ongoing transmission of the virus.

The report also reveals that the UK epidemic is diverse "and assumptions about the characteristics of those living with HIV need to be challenged". Over half (52%) of all people diagnosed in 2015 were born in the UK, compared with 38% of people diagnosed in 2006.

This is largely due to fewer diagnoses among heterosexual men and women born abroad, particularly in sub-Saharan Africa; there were 1,110 diagnoses among black African heterosexuals in 2015, compared with 3,170 in 2006. In contrast, the number of gay/bisexual men born abroad has risen; in 2015, two in five gay/bisexual men diagnosed with HIV were born abroad - compared with two in seven in 2006.

Fewer people are diagnosed with an AIDS-defining illness or at a late stage of infection but the numbers diagnosed late remain high. In 2015, among those with data available, 39% of adults were diagnosed late, a decline from 56% in 2006. But the report notes that it is "of concern" that people diagnosed late continue to have a ten-fold increased risk of death in the first year of diagnosis compared with those diagnosed early. "This underscores the need to strengthen the application of testing policies."

On a positive note the report says that HIV care is "comprehensive and of a high standard for all". In 2015, 88,769 people received HIV care in the UK, up 73% from a decade ago (51,449 in 2006). This reflects the longer life expectancy conferred by effective antiretroviral therapy (ART), as well as consistent numbers of people newly diagnosed.

Nearly all (97%) of the 6,095 people diagnosed with HIV in 2015 were linked to specialist HIV care within three months of diagnosis, similar to previous years. Furthermore, the vast majority (94%) of people accessing HIV care in 2015 were receiving ART and as a result have undetectable virus in their blood and body fluids and are very unlikely to pass on their infection.

The report's introduction acknowledges the success of ART. "It is 20 years since the introduction of life-saving, free and effective antiretroviral therapy (ART) in the UK. Treatment has transformed HIV from a fatal infection into a chronic, manageable condition and people living with HIV in the UK can now expect to live into old age if diagnosed promptly. For many people, treatment means one daily tablet with no or few side effects. More recently, it has been demonstrated that the advantages of ART extend beyond personal clinical benefit. It is now widely understood that effective HIV treatment results in an ‘undetectable’ viral load which is protective from passing on the virus to others."

While testing and treatment for HIV in the UK is free and available to all, over 13,000 people living with HIV remain undiagnosed and rates of late diagnosis remain high.

"Late HIV diagnosis is associated with poorer health outcomes, including premature death. Furthermore, since the vast majority of people diagnosed with HIV are effectively treated, most new HIV infections are passed on from persons unaware of their infection. Condoms remain an important way to prevent HIV and other sexually transmitted infections and continue to be recommended with new and casual partners in particular.

"Symptoms due to HIV and AIDS may not appear for many years, and people who are unaware of their infection may not feel themselves to be at risk. However, anyone can acquire HIV regardless of age, gender, ethnicity, sexuality or religion and it is essential to challenge assumptions about who is at risk of HIV. As well as increasing awareness of HIV, efforts to reduce stigma and other socio-cultural barriers that prevent people from testing and seeking long-term care must be strengthened."

* HIV in the UK: 2016 report. Public Health England

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