HIV Transmissions in the UK Continue to Decline

The United Kingdom has increased HIV testing efforts dramatically over the past decade with the intent to eliminate HIV transmission in the country by 2030. Data from 2018 show this may very well be possible.

Authors of a new report by Public Health England highlight the promising news that HIV transmission in the UK continued to fall through 2018.

The UK reached a peak of new HIV diagnoses in 2014, with a rapid decline since. In 2014, there were 6278 new cases of HIV diagnosed, compared with 4453 in 2018.

Among men who have sex with men (MSM), new diagnoses fell by 35% from 3480 in 2014 to 2250 in 2018.

The steepest fall occurred for MSM among those who are aged 25 to 49, born in the UK, white, and residing in London.

Diagnoses of heterosexual transmission have also declined. In the past decade, heterosexual transmission was reduced by almost half from 3400 in 2009 to 1940 in 2018.

The steepest declines of heterosexual transmission diagnoses took place among London residents, those aged 25 to 34 years, people of black African ethnicity, and people born abroad.

Among MSM, the number of incident infections has declined by 71% from 2800 new infections in 2012 to 800 in 2018. Estimates of newly acquired HIV infections among men whose risk is primarily heterosexual was cut in half from 550 in 2014 to 250 in 2017.

A representative from Public Health England told Contagion® that a variety of efforts were involved in producing the results they reported.

"The scale-up of combination prevention (which includes the use of condoms, HIV testing in a wide range of settings, starting antiretroviral therapy (ART) as soon as possible if positive, and the availability of Pre-exposure Prophylaxis (PrEP) for those who are negative) across the UK is working."

Estimates suggest that in 2018, there were 7500 people living with an undiagnosed HIV infection in the UK, with individuals in England accounting for 6700 of those cases. The number of MSM living with undiagnosed HIV infection has declined by about half since 2014 to 3600 in 2018.

Though the number of people diagnosed late has declined, it is worth noting that the proportion of late diagnoses has remained high. In 2009, 3353 individuals were diagnosed at a later stage of infection. In 2018, the number declined to 1883; however, 43% of diagnoses in 2018 were considered late diagnoses.

It is also worth examining the variation within populations which experience late diagnosis in the UK. The highest rates were among black African men (65%), white men who acquired HIV heterosexually (59%), individuals above the age of 50 years (59%), and people who use injection drugs (58%).

Dame Inga Beale, the Chair of the HIV Commission, said that the overall statistics represented real progress. But she cautioned that more work was ahead to achieve the elimination of transmissions by 2030.

“To make good on that commitment we must look at what’s working well and how these successes can be further capitalized on, as well as thoroughly investigating how to tackle persistently high rates of late diagnosis and ensure the decline in new diagnoses is felt across all groups impacted by the epidemic. Progress that leaves some people behind is not progress at all,” Beale said in a press release.