HIV Diagnoses Rising According to Government Database

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. The HIV database from the UK Government’s website shows the increase in cases of HIV in the UK and paint a picture of why and how this is happening.  

 

Transmission from sex between men has remained at a low rate since its all-time low in 2020. Male to male transmission only accounts for 23.1% of all new diagnoses, whereas sex between men and women has reached an all-time high of 3,789 in 2023 alone, accounting for 59.2% of all infections for that year. This figure had been declining since 2014 until it began to rise again in 2020.

 

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 those 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, but 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. 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.

 

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.

 

Despite cases of HIV rising, there are still positive figures that appear on the government’s database. One is the ongoing decrease in transmission due to intravenous drug use. During the AIDS epidemic, one of the biggest causes of infection was intravenous drug use. Now, only 1.1% of the infections in the UK are from intravenous drugs, this figure has decreased every year, but there still remains a small percentage every year. Only 71 diagnoses were contracted through intravenous drug use in 2023, and the highest figure was from 2015 of 191, but this still made a very small portion of the total number of diagnoses.

 

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 digesting these figures can show that it is less that the infection rate has increased but more that the testing rate has increased. This progress in testing will help towards the UNAIDS’s ‘global effort to end AIDS as a public health threat by 2030.’