Latest statistics on HIV in the UK: data for 2021
1 December 2022. Related: Special reports, HIV prevention and transmission.
Simon Collins, HIV i-Base
In October 2022, UKHSA published an online summary of HIV statistics for 2021, together with supporting data tables and the final report on 1 December 2022. [1]
Data is for 2021 and covers the second year that COVID-19 affected sexual health services including HIV testing, diagnoses and overall treatment. Although COVID likely led to some delayed HIV diagnoses, the report suggests that the steady reduction in new infections before the epidemic is continuing.
Clinics responded remarkably well under very difficult circumstances, often restructuring and developing improved new services, including expanding the option for home testing and easier access to PrEP. For example, more than 61,000 people in the UK started or continued PrEP (70% of the 87,000 identified as having need), although even amongst those with a clear need, access to PrEP varied from 71% in gay and bisexual men to only 23% in women.
The report is accompanied by six sets of data tables including for PEP and PrEP, and two slide set presentations. [2]
This essential and impressive surveillance dataset is detailed, with breakdowns of figures by all key demographics (age, sex, race, sexuality, geographical region and HIV risk).
Selected results are included in Table 1 below. Differences in reporting each year means that some values are different to those included in reports from earlier years, Please refer to data tables in addition to the summary report.
Table 1: Selected results from 2021 HIV surveillance data
| 2019 | 2020 | 2021 | comment | |
| Testing | ||||
| Total tests in all sexual health clinics England | 1,319,915 | 913,383 | 1,053,169 | Numbers increased more in gay men (50% now online) than other groups. |
| Positive tests from specialised sexual health clinics – n (%) | 1523 (0.11%) | 1,005 (0.11%) | 1076 (0.10%) | Reducing % in gay men (0.25% now from 52% in 2019). Stable in women (0.04%) and MSW (0.09%). |
| Internet tests | NA ** | 423,287 | 560,130 | Increase in tests driven by online testing but disproportionally accessed by GBMSM. |
| HIV tests in GBMSM (England) | 156,631 | 144,800 | 178,466 | |
| HIV tests in women (England) | 628,607 | 441,017 | 489,727 | |
| HIV tests in heterosexual men (England) | 419,501 | 242,813 | 248,355 | |
| % of eligible people tested in clinics | 65% | 46% | 46% | |
| % of eligible people not offered a test | 16% | 38% | 38% | |
| PrEP and PEP in England (data tables include demographic details) | ||||
| % of clinic population defined as being in need of or able to benefit from PrEP. |
NA |
NA |
7.4% (87,828 out of 1,180,923) |
Need was identified in:
64.5% of GBMSM vs |
| % (n) in need who had consultation. | NA | NA | 79.1%
(69,507 out of 87,828) |
Percentage consulted:
81.0% of GBMSM vs |
| % in need who used PrEP (sexuality data not always available). |
NA |
NA |
69.6%
(61,092 out of 87,828) |
71.6% of GBMSM (n=50,152) vs 34.2% heterosexual men (n=1068) vs 23.3% women (n=1221). |
| PEP use. | 12,038 | 7,193 | 8,115 | PEP use significantly dropped in all groups during COVID years. |
| HIV treatment and care | ||||
| New diagnoses UK (includes testing in all settings). | 4,408 | 2,961 | 2,955 | Steep drop in 2020 likely due to reduced testing during COVID.
Approx 25% each year first diagnosed abroad. |
| Median CD4 in England (cells/mm3).
Data is based on ~ 80% who had a CD4 count within 3 months of diagnoses). |
357 | 349 | 337 | 2021 breakdown: MSM: 443. MSW: 221. People of Black African ethnicity: 265, Those age >65 years old: 167.
Significant differences by demographic group are driven by more frequent testing in people using PrEP, notably gay and bisexual men. |
| Late diagnosis (CD4 <350). | 41% (961 out of 2,343) | 44% (724 of 1,643) | 46% (786 of 1,715) | 2021 breakdown: GBMSM: 37%, MSW: 63%, women 50%, Black African: 56%, White: 45%.
Late diagnosis was associated with an 11-fold increased risk of death in the following year. Risk was highest in those over 65 years old. |
| Very late diagnosis (CD4 <200).
% (n) |
25% (527 out of 2343) |
28% (430 out of 1643) |
31% (513 of 1,715) |
Breakdown for this important lower threshold is not included in the summary report. However, the majority of late diagnoses <350 are actually <200. |
| Total HIV+ in care (England) . | 90,504 | 88,786 | 91,432 | |
| % in care >50 yrs old | NA | NA | 48% | This was 25% in 2012. |
| % on ART | 98% | 98% | 99% | Consistently high in all groups. |
| % <50 copies/mL (England). | 97% (79,242) | 97% (70,632)** | 98% (80,250) | High is all groups by sex, race and sexuality, but 92% linked with vertical transmission (1,325 out of 1,434), and 94% injecting drug use (1,076 out of 1,143). |
| Deaths | 584 | 814 | 797 | Increases since 2019 are likely due directly to COVID-19 or indirectly from reduced access to health care services, |
| Diagnoses of advanced HIV (AIDS) within 3 months of the HIV diagnosis *** | 216 | 178 | 177 | Few details are included about this field which is underreported. It only refers to AIDS-defining infections, not CD4 <200. |
* This value seems like an error but will be confirmed and corrected if appropriate.
** Data to be added or confirmed shortly by UKHSA.
*** Advanced HIV disease is now a more appropriate term than AIDS for symptomatic HIV-related infection (or having a CD4 count <200). It is now used by WHO instead of the term AIDS, and perhaps could also be adopted by UKHSA in future reports.
NA – Data either not included in the summary report or difficult to locate in the tables. Will be corrected if appropriate.
comment
The data tables are impressive and the summary report includes a narrative of selected data.
Although not included in the summary report, this is now the fourth year that trans and non-binary data has been collected in England and this is available in the tables on key populations. Limited baseline data are now reported for the approximately 170 trans and nonbinary people who are living with HIV and there were less than five new diagnoses among this group in both 2020 and 2021.
However, the PEP and PrEP datasets combine trans men with men and trans women with women in binary datasets. The separated data is needed to develop and fund services.
The summary report does describe demographic differences in access to care, but doesn’t comment critically on these, perhaps needing to be neutral.
The differences in CD4 count at diagnosis is particularly notable as being twice as high in gay and bisexual men compared to men who only have sex with women (443 vs 221), driven by more frequent HIV testing when using PrEP.
Similarly, and related, approximately 71% of gay and bisexual men attending sexual health clinics who could benefit from PrEP either started or continued to use PrEP, but this percentage dropped to 33% for straight men and only 23% for women.
Including separate data on very late diagnosis (CD4 <200) would also highlight that this accounts for the majority of people diagnosed late (<350). [3]
The UK HIV Action Plan published in 2021 aims to reduce HIV transmission by 80% by 2025 and to reduce it completely by 2030. Further details on this strategy are published to include progress over the last three years. [4, 5]
Including a similar at-a-glance table each year to highlight the main changes might also be useful in future reports.
References
- UKHSA. HIV testing, PrEP, new HIV diagnoses, and care outcomes for people accessing HIV services: 2022 report. (1 December 2022).
https://www.gov.uk/government/statistics/hiv-annual-data-tables - UKHSA. HIV Official Statistics. (1 December 2022).
https://www.gov.uk/government/statistics/hiv-annual-data-tables - Collins S et al. Late diagnosis of HIV in 2022: Why so little change? HIV Med. 2022; 23( 11): 1118- 1126. doi: 10.1111/hiv.13444.
https://onlinelibrary.wiley.com/doi/abs/10.1111/hiv.13444 - Department of Health and Social Care. ‘Towards Zero – An action plan towards ending HIV transmission, AIDS and HIV-related deaths in England – 2022 to 2025’. (2021)
https://www.gov.uk/government/publications/towards-zero-the-hiv-action-plan-for-england-2022-to-2025/towards-zero-an-action-plan-towards-ending-hiv-transmission-aids-and-hiv-related-deaths-in-england-2022-to-2025 - UKHSA. HIV action plan monitoring and evaluation framework. 1 December 2022.
https://www.gov.uk/government/publications/hiv-monitoring-and-evaluation-framework/hiv-action-plan-monitoring-and-evaluation-framework