- New HIV diagnoses in England went down in 2020, but so did the number of tests carried out due to reduced access to sexual health clinics during lockdowns.
- For the first time in a decade, the total number of new HIV diagnoses was higher in heterosexual people than among gay and bisexual men.
- The reasons behind this change are difficult to quantify due to disrupted access to healthcare and changing sexual behaviors during the pandemic.
There has been an overall decline in new HIV diagnoses in recent years in some countries, including the United Kingdom and the United States.
HIV diagnoses peaked around 1997, and UNAIDS launched a global push to make sure 90% of people with HIV received a diagnosis by 2020, and 90% of those people had access to treatment.
When people receive an HIV diagnosis, they can access treatment that can reduce viral load and prevent transmission of HIV. According to UNAIDS, globally, 1.5 million people received a diagnosis of HIV in 2020 compared to 3 million in 1997. Women and girls accounted for 50% of these diagnoses in 2020.
While women made up less than one-third of new diagnoses in the U.K. in 2020, figures released by the U.K. Health Security Agency on December 2, 2021, show that heterosexual people made up the majority of new HIV diagnoses in the U.K. in 2020.
The figures showed that of the total number of people who received a diagnosis of HIV in England in 2020, 45% were gay and bisexual men, and 49% were heterosexual people. The total number of people who received a diagnosis for HIV in England in the same year was 2,630.
The number of new diagnoses among gay and bisexual men fell from 1,500 in 2019 to 890 in 2020, representing a 41% year-on-year drop. Diagnoses in heterosexual people fell from 1,310 in 2019 to 1,010 in 2020, a 23% drop. It is important to note that testing in sexual health clinics dropped by 30%.
HIV testing dropped 33% among heterosexual people and 7% among gay and bisexual men.
In a telephone interview, Liam Beattie, public affairs officer at the Terrence Higgins Trust, a U.K. HIV and sexual health charity, told Medical News Today that lockdowns had a significant impact on access to sexual health clinics and, therefore, testing in the U.K.
“We did see that significant drop in sexual health services, so [testing] dropped by over half during periods, but we did see an increase in online testing. But in terms of breaking it down within demographics, we’ve seen online testing is significantly more popular among gay and bisexual men than among heterosexual men, for example. So, we’re not seeing that same level of enthusiasm we may want to see for online testing being played out across all the demographics that need to be tested.”
The U.K. Health Security Agency concluded that while the reduction in new HIV diagnoses among gay and bisexual men was likely due to a “true reduction in transmission,” the reduction in new [diagnoses] among heterosexual people was likely due to a drop in testing.
In its report, the agency also noted that pre-exposure prophylaxis drugs (PrEP) to protect against HIV first became available via U.K’s National Health Service in October 2020. This followed a 3-year IMPACT trial that made the treatment available to tens of thousands of people at increased risk of contracting HIV between October 2017 and July 2020.
However, 96% of the people taking PrEP as part of the IMPACT trial were gay and bisexual men, with women making up just 3% of participants and 1.5% identifying as Black African.
PrEP was a “game-changer,” said Beattie, who pointed to recently presented data that suggested the availability of PrEP had halved possible infections in 2021.
However, “We’re seeing the groups most impacted by that are gay and bisexual men, and we’re not seeing that in reach of access among other populations impacted by HIV,” he said.
Professor Katharina Hauck, professor in Health Economics at Imperial College London, was more reserved in her analysis of the cause of the drop in infections.
She told MNT in an interview: “I found it interesting, actually, how far the Health Security Agency went with interpreting these trends, which could be associations or could be causal effects, which are very difficult to say, without doing a proper statistical analysis of the data. I think if it were me, I would have been more careful [when] interpreting the data.”
She pointed out that comparing men who have sex with men and heterosexual people was unhelpful, as sexual behaviors, adherence to treatment, and other factors differed between groups and during the pandemic.
In 2019, the U.K. Government committed to reducing HIV transmission in the U.K. to zero by 2030. While these trends are promising, Beattie pointed out that many people with HIV had stopped receiving treatment during the pandemic and had been lost from the system. Work needs to be done to reach these individuals now, he said.