The number of people accessing HIV clinics has trebled in ten years, reflecting the record number of people living with HIV in the UK, according to figures released today by the Health Protection Agency. Their report also highlights continuing problems with late diagnosis and treatment of HIV, as well a rise in cases of HIV acquired through heterosexual contact in the UK.
The number of new HIV diagnoses continues to be high, but has remained steady over the past four years. In 2007, a total of 7734 people tested positive for HIV.
However, much larger increases have been seen in the number of people accessing treatment and care services. In 2007, a total of 56,556 used HIV clinics, which represents a 9% increase in a single year. Moreover this is a threefold increase from the 17,911 people accessing care in 1998.
Some regions have seen particularly marked increases in the number of people accessing care over the past decade. The East of England strategic health authority has seen its patient numbers increase seven fold, while East Midlands has had a sixfold increase. The total proportion treated in London has decreased from 63% to 48%.
The report also demonstrates how the HIV-positive population has aged over the last decade. Five times as many people aged 50 and over were accessing care in 2007, compared to 1998, and they now make up 15% of those using HIV clinics.
Whilst 70% of those attending HIV clinics were prescribed antiretroviral treatment, almost one in five of those with a CD4 cell count below 200 cells/mm3 were not. The Health Protection Agency therefore recommends that “work should be undertaken to develop new care pathways that encourage earlier commencement of anti-retroviral therapy”.
Moreover, 31% of people are diagnosed late (they have a CD4 cell count below 200 cells/mm3 within three months of their diagnosis). The proportion varies widely by prevention group - 42% of heterosexual men and 36% of heterosexual women are diagnosed late, compared to 19% of gay and bisexual men.
The report therefore highlights the recommendation from new UK HIV testing guidelines that in parts of the country where HIV prevalence is high, health professionals should offer HIV tests to all adults registering in general practice or being admitted for medical care.
In terms of the proportions of new diagnoses by prevention group, 55% were in people who acquired their infection through heterosexual contact (1690 men and 2570 women). Men who have sex with men made up 41% of new diagnoses, with over 3000 men diagnosed during 2007 (compared to around 2000 men in 2002). New infections caused by injecting drug use (180 people) and mother-to-child transmission (110 babies) continue to remain low.
Whereas the number of new diagnoses among men who have sex with men has once again increased, the overall number of people acquiring HIV heterosexually has decreased by almost 15% from a peak in 2004. Nonetheless, this may be due to changes in migration patterns, as the decrease is largely in heterosexual infections acquired abroad.
In fact, there are clear signs of a steady increase in heterosexual transmission of HIV within the UK:
- The numbers of new diagnoses acquired from UK heterosexual transmission has increased from 540 to 960 cases over the past five years. Almost a quarter of heterosexual infections are now thought to have occurred in the UK.
- The prevalence of HIV among UK born women giving birth in London has increased from 0.03% in 2000 to 0.07% in 2007.
- The prevalence of undiagnosed HIV among UK born heterosexuals attending London sexual health clinics has increased from 0.25% in 2000 to 0.41% in 2007.
The HPA therefore recommends that sexual health interventions “should be strengthened and expanded to meet better the needs of those with high risk of HIV acquisition within the UK, especially black African heterosexuals and men who have sex with men”.