Vegasjon, CC BY-SA 4.0, via Wikimedia Commons

It has been forty years since the first reported case of HIV, and even with the news of game-changing and innovative medicines for the prevention of HIV, there has been a rise in diagnoses. The surge in cases has a multitude of factors, from immigration to the NHS’s new testing scheme. Statistics from the UK government’s website track the increase in cases of HIV in the UK and paint a picture of why and how this is happening.  

 

HIV testing rose by 11% from 2022 to 2023, but the number of people diagnosed has risen by up to 15% (excluding those Previously diagnosed abroad). Although there is this rise in testing, The Terrence Higgins Trust reports that the testing rates still have dropped by a quarter among heterosexual men and women compared to pre-COVID despite the normalisation of free at-home HIV test kits.

 

Unfortunately, the increase in transmission is not the only significant issue, as the percentage of those who had a late presentation of HIV (when HIV has already started to damage the immune system) was 27% in 2023. But this number has slowly been decreasing according to these figures, and the promising figure is that only 180 of those diagnosed in 2023 were diagnosed with AIDS.

 

In 2023 alone, there were 6,402 new diagnoses total in the UK, with the largest number of diagnoses in the age group of 35 to 49 men, which accounts for 54.1% of this figure. There were 4,379 diagnoses the previous year, and the number of diagnoses has risen since 2020. Until 2020, the number of diagnoses decreased each year.

 

The data provided by the government highlighted that different age groups were affected by the spread of HIV. Although testing increased for ages 25 to 65 during 2023, testing decreased massively by 22% for people aged 15 to 24.

 

The rise in testing could be due to the opt-out scheme that has taken effect in the UK. In December of 2023, the government announced an investment of £20 million committed to piloting opt-out testing.  How opt-out testing works is that every time a patient has their blood taken in a UK NHS facility for any reason, their blood will automatically be tested for HIV and both hepatitis B and hepatitis C unless the patient specifically asked for it not to be. This was already a regular practice in maternity services and, as reported by The Terrence Higgins Trust, ‘helped to nearly eliminate vertical (mother to baby) transmission of HIV in the UK.’

 

The National AIDS Trust reported on the scheme’s success with ‘data shows that since opt-out testing launched in London, Manchester, Brighton, and Blackpool in 2022, almost 1,700 people have been found with HIV, Hepatitis B, and Hepatitis C in the first 10 months of this three-year programme.’

 

In this case, an increase in diagnosis may not reflect an increase in transmission but shows that the NHS’s opt-out scheme is reaching patients who may not have been aware of their diagnosis. Richard Angell, Chief Executive of Terrence Higgins Trust, said that ‘HIV testing in emergency departments isn’t just finding hundreds of people living with undiagnosed HIV, it’s finding those who are extremely unlikely to test anywhere else.’

 

The NHS website has figures that show that in the first 21 months of the opt-out scheme, 676 new patients were diagnosed with HIV, but claims that, along with these new diagnoses, ‘1,042 previously diagnosed patients, who had stopped engaging with health care services, have been brought back into the system and are accessing healthcare services.’

 

Another factor in the increase in HIV diagnoses can be linked to the nationally readily available PrEP. PrEP is the name for the current pre-exposure drug to protect the body from HIV. PrEP protects the body from contracting HIV by preventing it from getting into the body and stopping HIV from reproducing itself once in the body.  There are many forms of PrEP, and new medications are being tested in clinical trials, as reported by TheSocialTalks.

 

Louis MacGregor, who works for the Department of Population Health Sciences at the University of Bristol, has written and investigated a paper on ‘Evidence of changing sexual behaviours and clinical attendance patterns, alongside increasing diagnoses of STIs in MSM and TPSM’.

 

This paper goes into detail that, ‘given PrEP as an additional tool, MSM (men who have sex with men) and TPSM (trans persons who have sex with men) are likely to consider and re-evaluate their own HIV risk management strategies against competing interests such as maximising sexual pleasure and feeling connected to their partners.’ This means that, due to taking PrEP for granted, MSM and TPSM are more willing to risk contracting HIV, thinking that PrEP will stop all transmission.

 

But MacGregor reassures that, despite this data, ‘an increase in CAI (condomless anal intercourse) was not an unexpected or even necessarily a negative consequence of PrEP,’ but acknowledges there is a challenge to balance HIV infection rates and views on sexual pleasure because ‘we now face the challenge of addressing sexual health messaging in an era of reduced HIV anxiety and fear.’

 

Diagnosis of HIV in people born outside of the UK has increased every year that these statistics have been taken and has more than doubled between 2022 and 2023 with a 103% increase. Much of the increase is due to the arrival of people immigrating to the UK with HIV.

 

Of those who were diagnosed in the UK, only 987, which is equal to 15.4%, were born in the UK, 403 (6.3%) were born in Europe, 3,480 (54.3%) were born in Africa, 519 (8.1%) from Asia, and 523 (8.1%) from other origins.

 

For those born in the UK and Europe, the number has hardly changed, but the number from Africa has more than doubled, from 1,460 to 3,480, a staggering 138% increase. And there was a 35.9% increase in people of Asian origin.

 

The National AIDs Trust reports that ‘migrant populations in the UK are disproportionately affected by HIV. Many acquire HIV after arrival in the UK, and migrants living with HIV are more likely to be diagnosed late.’ Out of the 6,402 cases of contraction of HIV in the UK, 3,364, a percentage of 53%, were first diagnosed outside of the UK.

 

A paper by Melvina Wood Owusu for the Institute for Global Health details the reasons why migrants have a high percentage of being diagnosed late with HIV. The study found that there were many factors towards this.

 

Individual knowledge in migrants became a barrier to their diagnosis because, as this study found, there is a “low perceived risk of HIV, lack of knowledge about HIV symptoms and HIV services, lack of trust in healthcare systems, and fear of societal implications of an HIV diagnosis.”

 

The study also found many sociocultural barriers that migrants faced, including “language and communication challenges, stigma, and lack of community testing opportunities.”

 

Owusu’s paper also highlighted how impactful factors like “poverty, poor living conditions, unclear legal rights, administrative barriers to healthcare access, and lack of testing opportunities” can impact a migrant’s chance of gaining a diagnosis.

 

The European Centre for Disease Prevention and Control (ECDC) found that ‘low rates of testing and high rates of late diagnosis reflect gaps in HIV testing services for migrants.’ There is a lack of funding for surrounding HIV in what the ECDC calls “high-prevalence countries” because of the stigma and discrimination surrounding the disease. Due to this, there is a lack of HIV knowledge both in the community and with healthcare providers

 

However, the limited availability of testing services isn’t the only issue for migrants. The ECDC’s figures show that ‘the main barriers to increasing uptake of HIV testing among migrants are stigma and discrimination within migrant populations.’

 

The Global Database On HIV-Specific Travel & Residence Restrictions states that, for the UK, ‘There are no specific entry or residence regulations for people living with HIV. Neither a medical certificate nor an HIV test result is required when entering the country.’ With this said, the UK states that HIV is not a reason to receive asylum.

 

Overall, there are many contributing factors as to why the government’s database has shown such a shocking increase in the diagnoses of HIV. But by taking a closer look at these figures, they show that it is not necessarily that the infection rate has increased but that the testing rate has increased.

 

As mentioned by Oliver Brown, a Lieutenant Commander in the Royal Navy, when speaking to the National Aids Trust who was recently diagnosed with HIV in A&E after a bike accident, “had Chelsea and Westminster Hospital not been part of a routine HIV opt-out testing programme in emergency departments, I may still be unaware of my status. Routine opt-out testing in A&E departments saves lives, it saved mine and stopped me passing on the virus to others.”

 

This increase in testing due to the opt-out scheme is saving lives and is being seen as a hugely passive step towards UNAIDS’s ‘global effort to end AIDS as a public health threat by 2030.’