There was a modest fall in the number of
new HIV diagnoses in London in 2011, new figures show. A total of 2637 new
diagnoses were made in the UK capital in 2011, a 4% fall compared to 2010.
However, this decline was attributed to
changing patterns of migration with a fall in the number of new diagnoses
involving black Africans. The number of new diagnoses among gay and other men
who have sex with men (MSM) actually increased between 2010 and 2011, and there
was also a modest increase in the number of diagnoses due to heterosexual
transmission that occurred in the UK.
“HIV continues to be a major public health
issue for London,” Public Health England (PHE) states in its new report on HIV epidemiology in London. The number of new
diagnoses in London in 2011 was 11% higher than in 2000. Almost 50% of all UK
diagnoses in 2011 were made in London, and about half of all HIV-positive
people receiving HIV care in the UK are in the capital.
The new figures showed the seriousness of
the ongoing HIV epidemic in MSM. A total of 1427 new diagnoses (54%) occurred in
this group, a slight increase on the year before, and maintaining a long-term
upward trend with the number of new diagnoses involving MSM 20% higher than in
The PHE data showed the international
character of the HIV epidemic among MSM. Only 45% of new diagnoses involved
UK-born MSM; a fifth involved men born in another western European country and
12% were in men born in Latin America.
Overall, 43% of diagnoses in 2011 involved
heterosexual men and women, a modest fall compared to 2010. Almost a third
(30%) of new HIV cases in 2011 were in heterosexual men and women infected in
Africa, a fall compared to 2010.
A total of 317 heterosexual cases were
probably as a result of transmission in UK. The PHE figures showed that the
number of new diagnoses involving UK heterosexual transmission has doubled
Approximately 5% of new infections were in
black Caribbeans, a proportion largely unchanged compared to 2010.
Only 39 new diagnoses involved injecting drug users.
MSM newly diagnosed with HIV tended to live
in central and inner London boroughs, whereas newly diagnosed heterosexuals were
dispersed across the capital.
Rates of new AIDS diagnoses and HIV-related
deaths were low (159 and 169 respectively), further evidence of the success of
antiretroviral therapy and the excellent prognosis of people receiving HIV
care in the UK.
This low mortality rate, coupled with the
high number of new diagnoses, means that more people than ever were receiving
HIV care in the capital. The total number for 2011 was 31,000, an increase of
5% compared the year before. Eighteen of the 20 UK boroughs with the highest
prevalence of diagnosed HIV infection are in London.
The PHE data showed that up to a fifth
of all HIV infections in London are undiagnosed. Late diagnosis was also common.
In 2011, 44% of London patients were diagnosed when their CD4 cell count was
below 350 cells/mm3, the current threshold for starting
antiretroviral therapy. Moreover, a quarter of newly diagnosed people were diagnosed very
late, with a CD4 cell count that was below 200 cells/mm3, indicating
a high risk of serious HIV-related illness.
These high rates of undiagnosed infection
and late diagnoses are also of public health significance. The report
highlighted data showing that an estimated 50% of all new HIV transmissions
originate in individuals whose HIV has not been diagnosed.
“Taking measures to improve diagnosis of
HIV through normalising and expanding HIV testing is key to reducing late and
undiagnosed HIV,” says the report. However, figures show that only one in three
primary care trusts in high-prevalence boroughs commissioned routine HIV
screening in primary care, and only 20% commissioned new tests for medical
“Testing should be promoted among…higher
risk groups to ensure individuals are aware of their HIV status,” PHE
Specifically, MSM are advised to have an
HIV/sexually transmitted infections screen at least annually, or every three
months if they are having unprotected sex with new or casual partners. Black
African and Caribbean people are recommended to have an HIV test and a regular screening
for HIV and other sexually transmitted infections if they are having
unprotected sex with new or casual partners.
“To reduce late diagnoses and undiagnosed
infections, expanded HIV testing should be commissioned in acute clinical
admission units and primary care in areas of high prevalence,” suggests PHE.