“The number of gay and bisexual men being diagnosed with HIV in the UK reached an “all-time high” in 2011” BBC News reports, while the Daily Mail warns “A record 100,000 people in the UK with the HIV virus, but a quarter ‘do not even know they are infected’”.
As National HIV Testing week draws to a close and World AIDS day approaches, the Health Protection Agency (HPA) have published a report on HIV in the UK.
The report is wide-ranging and covers:
- the number of people living with HIV in the UK
- the number of new HIV diagnoses
- the treatments and outcomes
- prevention and control
The report makes recommendations for prevention and treatment. The findings have been widely reported in the news, with different newspapers concentrating on different aspects. Some headlines concentrated on the number of HIV diagnoses in men who have sex with men (see box below for definition), and others on the overall number of people living with HIV in the UK.
While at first glance, the fact that the number of people living with HIV in the UK has increased, this is actually due to advances in treatment. Due to the introduction of antiretroviral drugs (ARVs) in the 1990s, which help prevent the HIV virus from spreading, HIV, at least in the UK, is now rarely fatal.
ARVs have transformed HIV from a fatal condition to a chronic condition in which more people live for longer.
Also, the number of new cases of HIV has actually fallen, however, a cause for concern is the increase in the number of new cases among men who have sex with men, and now accounts for approximately 50% of all new cases of HIV.
HIV is also more common in black Africans. This may be explained by the ongoing HIV epidemic in Africa: more than half of heterosexual people with HIV living in the UK were born in Africa.
The report recommends:
- the implementation of safer sex programmes
- promoting condom use
- the introduction of regular testing for at-risk groups
- testing for people living in areas with a high prevalence of the virus
‘Men who have sex with men?’
While most of us would use the term ‘gay’ or ‘homosexual’ to describe men who have sex with men, sexual health professionals prefer the term ‘Men who have sex with men’ or MSM.
There are a number of reasons for this:
- the term gay implies exclusively homosexual sexual behaviour, but there are many men who have sex with both men and women
- there are some cultures in which having sex with men is not seen as being gay - ‘gayness’ is only associated with effeminate behaviour
What are the main findings of the report?
The report found that:
The number of people living with HIV has increased. By the end of 2011, an estimated 96,000 people were living with HIV in the UK, corresponding to 1.5 people with HIV per 1,000 of population. The explanation for the increase is that HIV infection can now be considered a chronic life-long infection due to the availability of antiretroviral therapy (ART)
It is estimated that a quarter of people living with HIV are unaware of their infection. The prevalence of HIV is highest among men who have sex with men (47 people with HIV per 1,000) and the black African community (37 per 1,000).
The number of people receiving a diagnosis of HIV has decreased. In 2011, 6,280 people were diagnosed with HIV in the UK, corresponding to one new diagnosis per 10,000 population. The decrease in the number of new diagnoses is mainly due to a decrease in the number of diagnoses reported among people from countries with high HIV prevalence.
Approximately 50% of new HIV cases were diagnosed in men who have sex with men.
Mother to baby HIV transmission rates are low, with less than 1% of babies born to women with diagnosed HIV acquiring the infection perinatally. The overall perinatal transmission rate is 2%. This is due to advances in treatment, which mean it is now usually possible to prevent a baby from acquiring an HIV infection from their mother.
Fewer people are being diagnosed late (with low CD4 cell count - a type of immune cell - the higher the CD4 count, the more advanced the disease is). However, despite this decline, approximately half of new diagnoses are late diagnoses. People diagnosed late have a tenfold increased risk of dying within a year of diagnosis.
72,660 people with HIV received care in 2011, with the majority (88%) receiving ART. Due to suppression of the virus by ART, most people (87%) were unlikely to be infectious.
There were 460 AIDS diagnoses reported in 2011, mainly in people diagnosed late. AIDS, or acquired immune deficiency syndrome, is a term used to describe the final stages of an HIV infection in which the immune system is so weakened that a person becomes vulnerable to life-threatening infections.
In 2011, there were 500 deaths among people diagnosed with HIV. Approximately 50% of people who died were aged at least 50 years old.
What recommendations does the report make?
The report recommends:
Implementing safer sex programmes promoting condom use and HIV testing are a priority, particular for higher risk groups, including men who have sex with men and black African communities.
In areas with high HIV prevalence (prevalence greater than 2 per 1,000 people aged between 15 and 59 years old), routine HIV testing should be performed for all general medical admissions and people registering at GP practices. GPs should offer and recommend HIV testing.
HIV testing should be offered to people with tuberculosis and people with HIV should be screened for tuberculosis.
The benefits of treatment with antiretroviral drug treatments should be discussed with all people receiving HIV care.
HIV care needs to be continually monitored to ensure it continues to be of high quality.
How is HIV treated in the UK?
There is no vaccine or cure for HIV, but treatments are improving. People living with diagnosed HIV in the UK can expect a near-normal life expectancy, particularly if they are diagnosed early. ART is the mainstay of HIV treatment. Standard antiviral therapy consists of a combination of antiretroviral drugs that act to suppress the virus by reducing the growth and reproduction of HIV.
How do I reduce my risk of contracting HIV?
The two most effective ways of reducing your risk are:
- always use a condom during sex, including anal and oral sex
- if you are an injecting drug user never share needles with anyone else