As World AIDS Day 2020, which falls on 1st December, is fast approaching, we thought it might be helpful to highlight some of the key points raised in the Public Health England (PHE) report about HIV testing, diagnoses and people living with HIV and AIDS.
Latest UK HIV and AIDS Data from Public Health England
The latest Trends in HIV testing, new diagnoses and people receiving HIV-related care in the United Kingdom report from PHE explains that the UK news is good, although there is always room for learning and improvement, but this is not true of data from all other countries. The BioSure team are deeply passionate about the role HIV self-testing has to play and we can also see the true challenges that exist in the global HIV landscape.
Global HIV Data
Every year we review the global HIV and AIDS reports and data, but especially this year, with the COVID-19 pandemic, it is more vital than ever that we monitor closely for changes and understand the new and continued challenges. Some forecasts suggest the HIV response could have been set back by more than 10 years because of disruptions to HIV services.
In 2014 Joint United Nations Programme on HIV and AIDS (UNAIDS) established the global 90-90-90 targets. The aim, to be achieved by 2020 was:
- for 90% of all people living with HIV to be diagnosed
- for 90% of those diagnosed to receive HIV antiretroviral treatment
- and 90% of those receiving treatment to be virally supressed (undetectable)
Their report this year shows the global target was missed, resulting in 3.5 million more HIV infections and 820,000 AIDS-related deaths since 2015 than if we had met the 2020 target.
What is the Rate of HIV in the UK?
The recent PHE figures however do shine some positive light against our fight here, against HIV. The data shows that in 2019 the UK nationally met the 90-90-90 targets for the third consecutive year, with London achieving the most significant improvements in diagnoses, treatment and viral suppression.
In the review of figures from 2019, there are an estimated 105,200 (which ranges from 103,300 -108,500) people living with HIV in the UK (96,200 in England). The total number of gay and bisexual men living with HIV, was estimated at 50,300 with parallel estimates of 50,000 heterosexual people.
UK Rate of Infection Drops for Fifth Consecutive Year
The latest 2019 figures show that new HIV diagnoses dropped for the fifth consecutive year. There have been a recorded 4,139 new diagnoses of HIV in the UK in 2019, which is a 10% drop from 4,580 in 2018. This is a decrease from a peak of 6,312 new diagnoses reported in 2014. This is due to a large combination of solutions, including increased awareness, greater choice and convenience of how to test and also the availability of PrEP (pre-exposure prophylaxis, which is a medicine that can be taken to prevent getting HIV from unprotected sex or injection drug use).
Increased Testing Reduces Rate of Infection for Key Demographics
Testing amongst gay and bisexual men (GBM) has increased 18% from 2015 (103,296) to 2019 (122,010) which demonstrates a far greater awareness of the importance of testing and the messaging that HIV is a treatable condition – but only if you test. The number of GBM diagnosed with HIV is now at its lowest point in 20 years, however, there is a strong belief this could have been reduced even further if the national roll out of PrEP had been delivered, with ambiguity around funding to some local authorities which may not have translated into delivery of provisions. There are also reports of people being turned away from clinics without PrEP and with no way of accessing this effective HIV prevention drug.
The data from Public Health England also outlines a decline in HIV diagnoses probably contracted through heterosexual contact. The 2019 figures show 1,559 new diagnoses, which is a a 6% drop from 1,664 in 2018 and a 33% fall from 2,336 in 2014. Whilst this decline in heterosexual diagnoses is of course positive, it is out of kilter when comparing with the drop in transmissions between gay and bisexual men, which has dropped by 18% from 2,079 diagnoses in 2018 to 1,700 in 2019. One of the reasons for this could be the lack of awareness in PrEP within the heterosexual community. It also certainly outlines the need for raising awareness about more frequent HIV testing and education about HIV transmission.
The number of Black African heterosexual people tested for HIV has increased far less than the national average, at only by 3%, from 43,490 in 2015 to 44,907 in 2019, so it remains that raising awareness and having access to a range of testing options are areas that need to be focused upon.
How We Test for HIV in the UK
In 2019, 1,310,731 eligible attendees were tested for HIV in sexual health services (SHS) which is an increase of 6% since 2018.
Most (77%) were tested in specialist Sexual Health Services, but of the people attending clinic 549,849 were not tested for HIV, as 46% of them were not offered a test and the remainder declined.
Our experience suggests this could be for a range of reasons, some linked to the stigma that surrounds HIV, so self-testing in these circumstances could be offered to see if there is a decrease in the number of people leaving clinic without knowing their HIV status.
Interestingly, internet services have increased and tested 232,738 people of the total number above in 2019, which is a 63% rise since 2018.
And this year, many people have experienced closure or limited access to Sexual Health and GUM clinics during lockdown, therefore self-testing is fast becoming the easiest, and fastest method to know your status.
HIV Testing During UK Lockdown
We are now in another circuit breaker lockdown to try and slowdown the transmission of the COVID-19 virus and where rapid testing is now constantly in the news, fast becoming the easiest and most cost-effective way to know your COVID-19 status.
In the Spring 2020 lockdown, HIV campaigners and organisations, particularly in the gay and bisexual community used the well-publicised ‘sex ban’ in conjunction with the closure of the staple go-to GUM clinics, to establish the hugely effective #breakthechain campaign.
In this time when people were not able to go out and meet new partners or even mix between households (84% of people surveyed during the last lockdown stated they were not meeting anyone outside of their immediate household for sex). It created the perfect opportunity to get everyone tested and if diagnosed, onto treatment so that the virus could not be passed on. The strategy silver-lined this time of encouraged abstinence, to motivate people to self-test or use postal blood collection kits to #knowyourstatus and break the chain of HIV transmission.
How Many People are Undiagnosed?
Of concern, 6,600 of people living with HIV are estimated to remain undiagnosed. This is equivalent to 6%. Nearly twice as many people estimated to be living with undiagnosed HIV infection in England live outside of London, which could be driven by a lack of access to local sexual health or simple awareness. The number of heterosexual people living with undiagnosed HIV infection in the UK fell slightly from 3,200 in 2018 to 3,100 in 2019.
Risk of Late HIV Diagnosis
Unfortunately, rates of late diagnoses remain unacceptably high, with as many as 4 in 10 people, not being diagnosed until as late as three to five years after contracting the virus. This can lead to a decline in wellbeing, ill -health and premature death as well as unknowing and preventable onward transmissions.
Increasing Awareness Through World AIDS Day
The summary of the above data highlights our need to continue everyone’s joint approach to national educational messaging around World AIDS Day, HIV and to continue to drive the conversation even further in the heterosexual community, the Black African community and those situated outside of London to make an even bigger impact.
Deborah Gold Chief Executive of the National AIDS Trust said “ The fall in the new HIV diagnoses in England shown in today’s figures is great news, showing that prevention tools are working, such as frequent testing and access to PrEP.
However, our concern is that the decline shown in recent years is slowing, and less steep in some areas, outside London and among communities.”
To have any hope of reaching the national target of ending HIV transmission by 2030, we must see a significant increase in opportunities to test outside of Sexual Health Clinics and smooth the roll-out of PrEP nationwide, include health promotion activities targeted and underserved populations such as women and those from Black African communities. “
If we can get everyone to know their own status, we can literally stop the unknowing transmission of the virus and end the HIV epidemic. The COVID-19 pandemic has really shown how we can all work together to protect communities, including testing and changing behaviour - this can also extend to other viruses. We know and understand that inequalities exist in the UK and globally, the easier we make access to testing and the more choice we can give, the less there are excuses. We will continue to do all we can to address this and will keep people talking and raising awareness. Education about testing and treatment is vital, regardless of someone’s sexuality, ethnicity, or geography, because together we will end all new HIV transmissions by 2030.
No doubt 2020, will have created new complications to access vital Sexual Health Service testing and antiretroviral drugs (PrEP). Now is the time to ensure we continue to spread the message, about how easy, effective accurate and discrete self-testing is. This World AIDS Day 2020 is the time for everyone to #knowyourstatus.