New transmissions of HIV have declined by 42% from 2019 to 2022 new data shows.
The number of new HIV diagnoses among gay and bisexual men fell by 42% from 1,239 to 724 between 2019 and 2022, according to the latest HIV Action Plan monitoring and evaluation framework (MEF), published today. However, the UK’s Government hopes to reduce transmission by 80% by 2025.
Meeting HIV targets
England also met the UNAIDS 2025 95-95-95 targets for the third time with 95% of all people with HIV being diagnosed, 98% of those diagnosed on treatment and 98% of those on treatment being virally suppressed and unable to pass on the virus.
While there has been a notable decline in cases among white gay and bisexual men from 2019 to 2022, there is a disparity among ethnic minority gay and bisexual men, with new HIV diagnoses not decreasing at a similar rate.
Ethnic minority groups still at risk
In 2022, ethnic minority groups accounted for 42% (304 out of 724) of diagnoses in GBMSM (Gay Bisexual and Men who have sex with men), compared to 34% (417 out of 1,239) in 2019.
While there was a 13% decrease in overall new HIV diagnoses in England, dropping from 2,819 in 2019 to 2,444 in 2022, there was an increase from 2,313 to 2,444 between 2021 and 2022. To meet the 2025 transmission target, there would need to be a yearly reduction of 627 in HIV transmission.
Cases of HIV have risen in Women and ethnic minority groups
The recent increase can be attributed in part to a slowdown in the progress toward the elimination in heterosexual women and ethnic minority groups. Despite a decrease in cases among heterosexual women from 589 in 2019 to 447 in 2021, there was a 26% rise from 447 to 564 in 2022.
While diagnoses among white British women declined by 39% between 2019 and 2022, there was only a 6% reduction among black African women. Among heterosexual men, new HIV diagnoses decreased by 25%, falling from 458 in 2019 to 281 in 2022.
Dr Alison Brown, Interim Head of HIV Surveillance at UKHSA, said, “England remains a world leader in efforts to reduce HIV transmission and ensure that those diagnosed have timely access to effective treatment.
“While there is much to celebrate, with numbers of HIV diagnoses continuing to decrease in certain groups, there is also much more to do. HIV diagnoses are increasing among heterosexual populations, particularly among women.
“It is concerning that testing levels in these groups has not recovered to 2019 levels, prior to Covid-19. So please, no matter your gender or sexual orientation, get regularly tested, use condoms and get PrEP if you’re eligible, to protect you and your partners’ health.”
Professor Kevin Fenton, government’s Chief Advisor on HIV and Chair of HIV Action Plan Implementation Steering Group said, “This week’s announcement to start new research on an expansion of the HIV opt-out emergency department testing programme, demonstrates the government’s commitment to keep the momentum up to end new transmissions of HIV within England by 2030.
“HIV opt-out testing is successful at reaching everyone, including women and those from ethnic minorities, who are living with HIV without knowing. It is a huge step in the right direction, and today’s research shows we need to do more to make sure these groups are effectively being targeted.
“I believe we can meet our 2030 targets and thank the UKHSA for its research to point us in the right direction – and identify where more can be done.”
Richard Angell, Chief Executive of Terrence Higgins Trust, said, “We have all of the tools we need to end new HIV cases by 2030 and diagnose those out there who are unaware they’re living with HIV. But with just six years left to achieve that goal, we need to do more and do it faster. Crucially, we also need to ensure that the progress we’re making is felt by all of the groups impacted by HIV – without exception. That includes for women, heterosexual men and people from racially minoritised communities, where testing levels continue to lag both behind pre-Covid levels and those seen among gay and bisexual men.
“The announcement of £20million funding to expand opt-out HIV testing in A&Es to an additional 46 hospitals is great news as this approach is proven to help address inequalities, with the proportion of women, older people and those of Black ethnicity diagnosed in A&Es higher than those found in sexual health. But this landmark expansion is only part of the puzzle and needs to happen in parallel with the better utilisation and availability of HIV prevention drug PrEP, ramping up testing in a wide range of settings and, of course, tackling the highs levels of stigma still surrounding HIV.”
Deborah Gold, Chief Executive of National AIDS Trust, said, “This period of time is absolutely crucial in our fight to end new HIV transmissions. Though the data shows some really encouraging progress, it also demonstrates how important it is to tackle inequalities across different communities as our key focus.
“PrEP and opt-out testing are game-changers, but they’re not enough if they’re not reaching the right people. People who adhere to their medication cannot pass the virus on. This is also known as Undetectable = Untransmissible (U=U) and it is a vital message in the ongoing fight against stigma and discrimination, however, not enough people are aware of it. Tailored engagement and interventions which involve the communities that we are trying to reach must be the starting point to addressing inequalities.”
The year 2022 also saw the highest ever number of tests in sexual health services among gay and bisexual men, but numbers have remained lower than pre-pandemic levels for heterosexual men and women.
In 2022, 40% of women attending sexual health services were not offered an HIV test compared to 27% in heterosexual men and 23% in gay and bisexual men. Women, and ethnic minority populations were also less likely start or continue PrEP.
UKHSA continues to work with DHSC and partners towards the HIV Elimination Action Plan, including supporting the evaluation of the Opt-out testing programme to increase HIV diagnoses and providing guidance to clinicians to help get people with HIV access treatment.
UKHSA will also be working to understand why women are less likely to be offered a HIV test to help tackle inequalities.