Up to 1999 men who have sex with men represented the majority of new diagnoses. The number of new diagnoses in gay men has however been exceeded by those infected through sex between men and women. It is notable that this change is not due to a decline in transmissions amongst gay men, 2005 saw the highest number of transmissions in this group, but to an increase in transmissions through sex between men and women. In 2005 almost two thirds of newly diagnosed infections were through sex between men and women.
Of the heterosexual infections diagnosed in the UK, most were acquired abroad. In the UK, HIV has had a devastating effect on communities of people from parts of Africa where HIV has taken hold. Of the heterosexual diagnoses in the UK in 2005, 85% were acquired abroad, of these, 89% were acquired in Africa, or were associated with exposure there. Infections were acquired in East Africa but the impact of the epidemics in Southern and Western Africa is likely to contribute to new diagnoses.
Currently over 300 HIV infected women give birth in the UK every year. Since the mid 1990s there has been an increase in the recorded number of births to HIV infected women which may reflect an improvement in antenatal diagnosis rates, following a Department of Health initiative which offers an HIV test to all pregnant women.
Although sharing needles during injecting drug use provides a route for HIV transmission, this has played a relatively small part in the UK epidemic and numbers seem to be declining. The age at which people in this group is diagnosed at has risen over time, which suggests that new diagnoses are being made on an ageing population mostly infected in the mid 1980s and that new infections have been occurring less frequently than infections are being diagnosed. However the continuing transmission of Hepatitis B and C in those aged under 25 shows the potential for further spread of HIV in this group.
In 1985 heat treatment of blood products to inactivate the virus was introduced. Since then, there have been no recorded transmissions of HIV caused by contaminated clotting factor used for treating haemophilia. Since 1985, all blood donations have also been screened for HIV antibodies. There have only been two incidents of infectious blood being accepted for transfusion in the UK since then.
[figures drawn from THT, AVERT and the Health Protection Agency]
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Extracts derived from the AIDS/HIV Quarterly Surveillance tables - Cumulative UK Data to end of July 2007, No. 75, Health Protection Agency (Communicable Disease Surveillance Centre), The Scottish Centre for Infection & Environmental Health, and The Institute of Child Health, London.
In the first six months of 2007, 2050 new diagnoses of HIV infection have already been reported - there is generally a significant reporting delay, and figures are still being received for infections diagnosed in 2006. Figures for 2006 are incomplete due to reporting delay and on the basis of previous patterns of reporting delay they will exceed those for 2005, and are expected to do so by a considerable margin. This brought the cumulative total to 88,627 diagnoses since records began in 1982. To date, 23,147 individuals have been diagnosed with AIDS, of which 17,597 have died.
From unlinked anonymous sampling of blood specimens in hospitals it is likely that approximately a third of people living with HIV in the UK do not know their HIV status. This would suggest that there approximately 70,000 people living with HIV in the UK. This is almost 1 in 1000 people. Worldwide this figure is nearer to 1 in 150, as it is thought that there are approximately 40 million people around the world living with HIV. In some countries such as Botswana and Swaziland between 30 and 50% of the population are infected with HIV. The majority of people in developing countries do not currently have access to anti-retroviral therapy.
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Table will include some records of the same individuals
which are unmatchable because of differences in the information supplied.
Numbers will rise as further reports are received, particularly
for recent years.
1 Of the 3897 heterosexuals infected in the UK with
heterosexually infected partners, 1949 of these partners were probably
infected in Africa and 964 within Europe (including the UK).
2 No evidence of partner(s) with risks other than heterosexual exposure
found.
3 Includes individuals infected with HIV through other risk exposures
such as blood/ tissue recipient, mother to infant and nosocomial.
4 Includes cases where investigation is closed and others continuing.
Since 1999, the number of HIV infections diagnosed in heterosexual men and women has exceeded those in men who have sex with men (MSM). The increase in diagnoses in those infected through heterosexual sex has been substantial, with the majority of these infections acquired abroad. For diagnoses in heterosexual men and women made in 2005, ?% (1149/2217) were infected in African countries, and ?% (291/3359) in other parts of the world (excludes UK) - denominators exclude individuals infected through a 'high-risk' partner and those for whom country of infection was not known. Although these figures include individuals infected while travelling or living abroad, they mostly represent those who were born in and who lived for most of their lives in the country where they were infected. Numbers of individuals infected through heterosexual contact within the UK, without evidence of a 'high-risk' partner, have been increasing gradually, and in 2003 represented 10% (341/3359) of new diagnoses in heterosexual men and women where probable country of infection was known.
London remains the focus of HIV in the UK, with 3181 of new diagnoses in 2005 being made there. All regions have seen increases in new diagnoses each year since 1999 including areas that previously saw relatively few HIV cases, such as the North East, Yorkshire and Humberside, Eastern England, and Wales. In each of these regions (and Wales) new diagnoses more than doubled between 1999 and 2002.
Since 1997 there has been a steadying in the number of AIDS cases and deaths [Figure 1]. There has also been a reduction in AIDS reporting since the advent of HAART (highly active antiretroviral therapy), and AIDS defining illnesses are more likely to be reported if the HIV and AIDS diagnoses are simultaneous. In 2003, 77% (545) of the 705 AIDS cases diagnosed were diagnosed at the same time as the HIV infection. Reporting of deaths is also subject to reporting delay so the figure of 497 already known about in 2006 is likely to be elevated compared to previous years. Reports of deaths occurring in HIV infected individuals in 2002 has risen from 349 at the end of March 2003 to 520 in 2007.
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* Figures for recent years will rise as delayed reports are received.
[based on the UK Health Protection Agency Summary]
UK Health Protection Agency: www.hpa.org.uk
US Government AIDS website: www.aidsinfo.nih.gov/ed_resources/
Global figures by country: www.unaids.org
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