HTB

HIV diagnoses in England jump by 51% in 2023: missing targets and highlighting disparities in access to care

6 October 2024. Related: Special reports.

Simon Collins, HIV i-Base

On 1 October 2024, the latest HIV statistics up to December 2023, predominantly for England, were published in a summary report together with data tables. [1, 2]

  • 51% increase in new HIV diagnoses, but only 15% increase in people first diagnosed in the UK,
  • 53% of new diagnoses had previously been diagnosed outside the UK. >200% increase in previous first-diagnoses outside the UK.
  • There was >6% increase in all-cause mortality.
  • There was increased access to PrEP.
  • Generally lower use of PEP.
  • Disparities in access to care and key outcomes are reported for all metrics, often related to ethnicity..

Most notably, HIV testing among gay and bisexual men has increased but so have the numbers of new HIV diagnoses, by more than 50% compared to 2022, and disproportionally affecting men from ethnically minoritised communities.

Disparities in care are also reported for late diagnoses, mortality and access to PrEP.

The summary report and tables cover diagnosis, treatment and HIV prevention compared to the previous years, with detailed demographics that include age, sex, gender, risk group and geographic regions.

Summary points

HIV Testing

  • HIV testing in sexual health services increased by 11% getting back to 2019 levels.
  • Testing increased by a third in gay and bisexual men (from about 150,000 to 200,000 tests).
  • Testing decreased by 10% among women and by 22% among heterosexual men.

New HIV diagnoses

  • New HIV diagnoses in England increased to 6,008 (with 6,402 in England, Scotland and Wales). This is a more than 50% increase in England compared to 3,975 in 2022, but it was driven largely by people coming to the UK.
  • Just over half of new diagnoses (53%; 3,198 of 6,008) were previously diagnosed outside the UK.
  • 2023 numbers might be overestimated by roughly 250 to 430, due to data quality issues that still need to be confirmed.
  • New first-diagnoses increased by 15% from 2,451 in 2022 to 2,810 in 2023.
  • New diagnoses increased by 7% in gay and bisexual men (761 in 2022 to 811 in 2023). These were disproportionally among ethnically minoritsed men (33%: 266 of 811). 2023 diagnoses are still 35% lower than in 2019.
  • New diagnoses increased by 36% (445 in 2022 to 605 in 2023) among heterosexual men and by 30% (602 to 780) among heterosexual women, driven by increased rates outside London. These were disproportionately among people of Black African ethnicity (64% from 420 in 2022 to 688 in 2023).
  • The percentage of people previously diagnosed abroad increased to 53% in 2023 compared to 38% in 2022 and 27% in 2019. These increases were in all sexual groups.
  • Most people were rapidly tested and linked to care: 92% within 1 month and 96% within 3 months.
  • Roughly 70% of those with a reported viral load were virally suppressed within one month.

Late diagnoses

  • The proportion of late diagnoses increased by 3% from 896 in 2022 to 923 in 2023. This is based on a CD4 count <350 cells/mm3 and excluded recent infections. Older age and Black/Asian ethnicity were associated with later diagnosis.
  • The increase since 2022 included a 40% increase among people from ethnically minoritised communities (from 259 to 362).
  • Median CD4 count within 91 days of diagnosis was 367 cells/mm3, in 2023 vs 350 cells/mm3 in 2022.
  • Data are still not summarised for those with CD4 counts <200 and <100 cells/mm3 where risks are highest.
  • Late diagnosis was associated with a significantly higher risk of mortality (33 vs 4 deaths).

Access to treatment and care

  • 100,063 people accessed HIV care in England in 2023.
  • Over half are now older than 50 years.
  • 98% are on ART (98,395 of 99,931).
  • Although 98% are reported as having undetectable viral load the denominator is significantly lower: 90,942 of 93,099 people.
  • There were 9 new diagnoses among people who are gender diverse. 233 trans and gender diverse people accessed HIV care in 2023 vs 230 in 2022, so outcomes for 6 people are unclear. See Table 28 in the population dataset. Language relating to route of HIV acquisition is still not appropriate, appearing to misgender trans women as cis gay men for the likely route of infection.

All-cause mortality

  • The summary report only refers to all-cause mortality rather than HIV-associated deaths.
  • In 2023, there were 775 overall deaths in the UK. Of these, 658 were in England (507 men, 150 women).
  • This increased from 626 in 2022 and 560 in 2019 (both in England).
  • Since 2022, there has been a 26% increase in the number of deaths among people of Black ethnicity (137 to 172), a 21% increase among people of mixed or other ethnicity (24 in 2022 to 29 in 2023), and a 13% increase among people of Asian ethnicity (16 to 18). By contrast, this decreased by 3% (from 406 to 396) in people with white ethnicity.

HIV PrEP

  • PrEP use has increased every year since 2020.
  • Approximately 132,000 people (10%) attending sexual health clinics in England were estimated to have a need for PrEP.
  • Based on those with an estimated need, PrEP was accessed by about 85% of gay and bisexual men compared to roughly 60% of heterosexual men and women.
  • Starting or continued PrEP was reported for 75% gay and bisexual men compared to about 40% in heterosexual men and women.

HIV PEP

  • PEP use dropped by 6% overall from 8706 in 2022 to 8,222 in 2023.

comments

These top-line results are uncomfortable reading given the ambitious public health targets in England of reducing HIV diagnoses by 80%, and of reducing both AIDS-related diagnoses and HIV-related deaths by 50%, all compared to 2019 figures. [3]

A detailed explanation will be included in the HIV Action Plan which is only planned to be released in December. [3]

This needs to include a detailed assessment of the significant cuts in the sexual health budgets over the last ten years and the impact this has had on services.

References

  1. UK Health Security Agency (UKHSA). HIV testing, PrEP, new HIV diagnoses and care outcomes for people accessing HIV services: 2024 report. The annual official statistics data release (data to end of December 2023). (1 October 2024).
    https://www.gov.uk/government/statistics/hiv-annual-data-tables/hiv-testing-prep-new-hiv-diagnoses-and-care-outcomes-for-people-accessing-hiv-services-2024-report
  2. UKHSA. HIV in the UK: data tables. (1 October 2024).
    https://www.gov.uk/government/statistics/hiv-annual-data-tables
  3. UKHSA. HIV Action Plan monitoring and evaluation framework: Public health analysis of progress towards meeting the aims of England’s HIV Action Plan 2022 to 2025. (2023 report).
    https://www.gov.uk/government/publications/hiv-monitoring-and-evaluation-framework

Links to other websites are current at date of posting but not maintained.