HIV in the UK

posted: 03/12/2010

The latest report on HIV in the UK has appeared from the Health Protection Agency. They found  the number of people living with HIV in the UK reached an estimated 86,500. A quarter of these people don’t know they have HIV.
 

New diagnoses among men who have sex with men stayed high (2,760); four out of five gay and bi men probably got HIV in the UK.
 

Of the people newly diagnosed in 2009, 1,130 probably acquired their infection heterosexually, within the UK, accounting for a third of heterosexuals diagnosed.
 

One in six gay and bi men, and one in sixteen heterosexuals got HIV within the previous 4-5 months before their diagnosis.
 

6,600 new people diagnosed

A total of 6,630 people were newly diagnosed as HIV-infected. This represents a fourth year-on-year decline, largely due to fewer diagnoses among people infected heterosexually abroad, mostly in Sub-Saharan Africa – there have been fewer migrants who happen to come from countries with HIV rates of HIV.
 

Older worries

Some 65,000 individuals accessed HIV care, of whom one in five were aged 50 years or over. Since 2000 there has been a three-fold increase in the number of individuals accessing care and a fourfold increase among older (greater than 50 years) individuals.

Sue Peters, regional director of the Terrence Higgins Trust in Brighton, said they are concerned at the number of older people becoming diagnosed in recent years. She pointed out that gay and bi men over 50 have lived through the worst years of HIV and men who remain HIV negative may now feel they are not going to catch it. Some men think that they do catch HIV past their 50th birthday, they are old enough for it not to cause any really serious harm.
“The same issue is with younger people who may still not be aware of the dangers of what is a life long infection. I think people sometimes feel they are immune but they aren’t and it is something that concerns us.”
 

Becoming HIV positive after the age of 50 is not recommended. The immune system becomes less able to fight serious health problems the older we get. People over 50 with HIV tend to be diagnosed late and often need to start HIV treatment immediately. Treatment for HIV becomes more complicated with older age because we often have other long-term health problems to do with being older.

Late too
Half of adults were diagnosed with HIV at a late stage of infection in 2009 (CD4 counts less than 350 within three months of diagnosis), the stage at which treatment is recommended to begin.
 

Thirty-seven English primary care trusts (PCTs) had a prevalence of diagnosed HIV greater than 2 per 1,000 population, the threshold at which expanded HIV testing should be implemented – in NW England these are Manchester, Salford and Blackpool.
 

Uptake of HIV testing was 95% in antenatal clinics and 77% among STI clinic attendees in England.
 

The quality of HIV care received is high. Based on London data, 80% of newly diagnosed patients were seen in an HIV clinic within one month of diagnosis; 90% had an undetectable viral load (less than 50) one year after starting therapy; and 93% of those in care for more than a year had a CD4 count above 200.
 

• HPA recommendations
  
• High proportions of recently acquired HIV infections among newly diagnosed gay and bi men of all age groups underscores the need for ongoing prevention efforts tailored to all ages in this group.
• The national recommendation of universal testing for all attendees of STI clinics should be audited and improved in many clinics; the existing national standard for HIV testing in STI clinics should be reviewed so as to encourage better performance.
• In high prevalence areas (greater than 2 per 1,000 people diagnosed HIV infection) the routine offer and recommendation to accept an HIV test for all adult general practice registrants and general medical admissions should be widely implemented given the recently reported success of pilot projects. The upper age limit for application of this policy should be set with regard to local circumstances.
• Roll-out of clinical outcome indicators to assess the quality of HIV care received by patients, already in place in London, should be extended to the rest of the country.

Sources

Health Protection Agency - HIV in the UK 2010, report and PowerPoint slides

Aidsmap 
 

Brighton Argus

PinkNews

More People Treated

posted: 04/10/2010

The number of people using NHS HIV clinics has risen by 60% in just five years, official figures suggest. In 2005 46,714 people used NHS HIV clinics and this rose to 65,319 people in 2009.
In 2010 nearly 70,000 people can be expected to use NHS HIV clinics and 74,600 in 2011, health minister, Anne Milton, said in a written House of Commons answer to a question from Heidi Alexandra, Labour MP for Lewisham East (SE London).

In NW England 6,238 people used the region’s NHS HIV clinics in 2009.
 Predicting ahead

The health minister revealed how they worked out their predictions of 70,000 for 2010 and 74,600 for 2011. "The estimated numbers of diagnosed HIV-infected individuals receiving care in 2010 and 2011 (rounded to the nearest 100) have been extrapolated from the number of individuals seen for HIV care in the previous five years. Between 2005 and 2009, the annual increase in the numbers of HIV care has been between 4,200 and 5,000 and the average annual increase has been used to estimate the numbers that will be seen in 2010 and 2011."
 

HIV in NW Rises Above 6000

posted: 17/08/2010

The latest annual report on HIV in NW England shows us that there are 8% more people with HIV using HIV clinics in 2009 than the year before: for the first time there are now over 6,000 people using NW England's HIV clinics. in 2009 there were 6,238 people using clinics compared with 5,767 in 2008. Modern HIV treatments are working well for most people.
 

Infections in the UK - gay and bi men

Almost three quarters of all the new people who get HIV in the NW are gay or bisexual men. However gGay and bi men are only 43% of all the new HIV cases in the NW in 2009.

This is because many people in NW England got HIV abroad - forty-one percent of the new cases were people who were infected outside the UK. Four out of five of the new cases infected abroad are heterosexual women and men, and most had no idea they even had HIV when they left their home countries.

Some countries, especially in sub-Saharan Africa, have very much higher rates of HIV compared with the UK.
 

Five times more using HIV clinics than a dozen years ago

Now the total number of people using HIV clinics in the NW of England (6,238) is five times bigger than a dozen or so years ago. This is because there are around 800 to 900 new cases each year, and modern HIV treatments work so that very few people die with HIV now. The death rate from HIV is below half of one per cent now, while before modern HIV treatments really started working, the death rate was 9%, back in 1996.

Around the region

Greater Manchester has the largest number of people with HIV by a long way, ahead of Merseyside and Cheshire, and Cumbria and Lancashire. Greater Manchester has 3,754 people using HIV clinics – here HIV affects around 137 per 100,000 people. In 2009 there were 498 new cases in Greater Manchester. Most people with HIV in Greater Manchester live in Manchester and Salford.
Cumbria has the fewest people with HIV in the NW (131; HIV affects around 25 per 100,000 people), and there were 16 new cases in Cumbria last year.

Dr Penny Cook, the author of the HIV & AIDS in the North West of England 2009 report said:
“The number of people in treatment for HIV in the North West has now reached over 6,000. Many of the new infections were acquired in the UK and would have been entirely preventable. We must ensure that in this difficult economic time resources continue to be invested in prevention, since targeted health promotion campaigns save the NHS a substantial amount of money on treatment in the long run.”

Professor Mark A. Bellis, Director of the Centre for Public Health commented:
“As the NHS is transformed, prevention of sexually transmitted infections must be seen as a priority.”

Source - Press Release

2009 Report - HIV & AIDS in the North West of England 2009

All years - HIV in NW reports and data 1996 -2009

NW Gay HIV Stigma and Risks

posted: 04/01/2010

The NW England results of the annual Gay Men’s Sex Survey are now out. ‘Vital Statistics 2008’ gives us the latest information on the prevention needs of gay and bisexual men in the UK and our region.

It also tells us some useful things about HIV stigma across the region, the numbers of men who have never taken a HIV test, and about the numbers who take significant HIV risks.
 

Blackpool – gay hotspot missing
There had to be 20 or more men in a NHS district (Manchester, Liverpool etc) fill in a survey for results from that district to appear in this report.  Unfortunately the gay hotspot of Blackpool only had 17 men fill in the survey, so we can’t say much about gay and bisexual men’s needs there.

Stigma and rejecting men with HIV
This survey asked questions about what undiagnosed men say they would do if a potential sex partner told them he had HIV. Would they change their mind and turn down sex, have sex but be extra careful, have sex just as they planned, or do something else?
 

Men who said they’d reject positive men are showing strong signs of HIV stigma and discrimination. Across NW England half the men said they would reject any HIV positive man for sex. This really discourages diagnosed men from talking and telling any sex partners about HIV.
Things look best for positive men in Manchester and Stockport, but not much better – in Manchester 39% of undiagnosed men say they would reject any positive man for sex.
 

Are George House Trust’s anti-stigma campaigns at Pride helping to cut stigma by rejection locally? It’s difficult to say – in next door Salford the rejection rate is higher – with rejection by almost half the men, like the regional average. HIV rejection is worst of all in Cumbria and Sefton (Merseyside) at 61%, and 56% of undiagnosed men would reject any positive man in Liverpool. [See 19 in the report].

Mixed HIV status relationships
The number of men who have regular partners of a different HIV status is another way of trying to measure how much HIV stigma is about. Sadly it is almost impossible to reach a clear answer from the survey report. In Manchester around 1 in 10 do have a regular partner of a different HIV status. Another 1 in 4 have a partner of the same HIV status, which could be where both men are HIV positive, or both are HIV negative – we just don’t know.

Another 1 in 10 have a regular partner and the man has no idea whether they have the same HIV status or not – a recipe for risking HIV transmission. [See 10 in the report].

Testing or not?
Last year the Health Protection Agency advised that the amount of HIV in Manchester, Salford and Blackpool meant special measures to increase HIV testing are needed and that gay and bisexual men living there should test at least once a year.
 

1 in 5 gay and bisexual men in Manchester have still not tested, ever. Almost as many didn’t test last year but have tested at least once before.

However 28% of Manchester men in the survey have tested HIV positive. That does NOT mean 28% of gay men in Manchester have HIV – just that more men with HIV took part in the survey. A previous study shows the real HIV rate on the scene in the city is about 1 in 10. [See 13 in the report]
 

Risk taking evidence
When men were asked how they rated their chances of passing on or picking up HIV in the next year, 6% think HIV transmission is very or quite likely for them within 12 months.

77% think it is very or quite unlikely, which just shows how many men really are deluding themselves. 63% had also told the survey they had at least one partner with whom they had unprotected sex that year. And 1 in 10 Manchester men reported they had 5 or more partners a year with whom they had anal sex without condoms. [See 14 and 16 in report].
 

We thank all the men who completed either a booklet or the website survey that George House Trust promoted.

NW England 2008 ‘Vital Statistics’ report

Survey questions
UK and English regions reports (including for past years)

NW England HIV in Mid 2009

posted: 21/12/2009

HIV figures in NW England for the middle of 2009 show a continued rise. The total number of people seeing clinics rose by 9% compared to the middle of 2008. In the first half of 2009 there were 453 new cases (mainly people newly diagnosed) and the total in touch with clinics was 5601. The experts predict that the total seeing clinics by the end of 2009 will be 6211.
 

Mother to Baby - can do better

There are a lot of details in the latest half-year report. Most HIV transmissions from mother to baby are entirely preventable, as long as women are diagnosed in time and then have the right treatment and care. The national target is for at least 90% of pregnant women to be tested for HIV. Most hospitals in NW England are now above this level and getting even better.
 

However, in Manchester, where the chances of a woman with HIV having a baby are so very much higher than anywhere else (237 out of every 100,000 women in the city have HIV, compared with the regional average of 45/100,000 women) the 90% target has still not been reached (87.8% are now tested in pregnancy).

St Mary’s Hospital for Women in Manchester (beside the Manchester Royal Infirmary) has improved but there it has only reached 80%. Warrington Hospital and Highfield Maternity Unit in Wigan both reported falls in the proportion of women having a HIV test in pregnancy since this time last year and they are below the 90% target.
 

The government set the target of 90% some years ago when things were very much worse and many babies were being born with HIV. Now hospitals should all be aiming to exceed the official target and aim for 100% testing take up by pregnant women. Otherwise some babies will be harmed by having HIV when this could have been prevented.

Source - the full report is available here from the Liverpool Centre for Public Health

The main NW England HIV statistics page will additionally have the usual web data tables by the end of January - there have been some technical problems in their publication