Global Treatments Working

posted: 24/11/2009

The death toll from HIV across the world fell by more than 10% over the past five years, latest figures show. The World Health Organization and the Joint UN Programme on HIV/AIDS (UNAids) say that since effective treatments first became available in 1996, some 2.9 million lives have been saved.

As the number of deaths has fallen, the number of people living with HIV has risen slightly - an estimated 33.4 million people worldwide are infected with HIV, up from 33 million in 2007 because of fewer deaths.
 

New infections fall
The latest report also shows there has been a significant drop in the number of new HIV infections. The report suggests that HIV prevention programmes are having a significant impact - new HIV infections have fallen by 17% over the past eight years.
 

In sub-Saharan Africa, the epicentre of the global pandemic, the number of new infections has fallen by around 15% since 2001 - equating to about 400,000 fewer infections in 2008 alone. In the same period, infection rates were down by nearly 25% in East Asia, and by 10% in South and South East Asia. In Eastern Europe, after a dramatic increase in new infections among injecting drug users, the rate of infection has levelled off considerably.
 

UNAids executive director Michel Sidibe said although prevention programmes had helped cut new infections, they were often "off the mark". "If we do a better job of getting resources and programmes to where they will make most impact, quicker progress can be made and more lives saved," he said.

Prioritise Gay Men in UK

Deborah Jack, chief executive of National AIDS Trust, said: “The downward trend in new infections is a testament to the work of the international HIV community. It’s the result of the roll-out of treatment and increased investment in prevention initiatives.

"However today’s report shows there are gaps in prevention programmes that meet the needs of key groups, such as over 25s and gay men. We need to get smarter about HIV prevention and also sustain efforts to find new tools such as microbicides and a vaccine, if we are to seriously reduce new infections.

"Worryingly, the global decrease in new infections is not being seen in the UK. Here new diagnoses have trebled in the past ten years. HIV diagnoses among men who have sex with men in the UK rose by 74 per cent between 2000 and 2007. The UK needs to re-prioritise HIV prevention among gay men, otherwise we risk falling further behind.”
 

UNAIDS global HIV epidemic update 2009

Source

HIV Statistics for NW England 2008

posted: 02/09/2009

The 2008 HIV statistics have recently been published. Here is a table showing the pattern of change in the number of new cases ('new cases' means new to the North West of England - it is mainly people newly diagnosed in the region, but also includes people who were diagnosed outside the region and now attended a HIV clinic in the region for the first time in 2008). The table also shows the total number of people who attended a NW HIV clinic sometime in 2008.

At first glance the number of new cases leapt by almost 100 between 2008 and 2009, and comments in the media have made much of this increase. The media also leapt on to the fact that 42% of people were infected abroad. Both points are true, but we need to read between the lines and not leap to false conclusions. 

Yes the number of new cases is up, about 100 more than in 2007, but hardly different to 2005 and 2006.

For the last 5 years new cases have been broadly around 800 – 900 a year. We need to bear in mind that the numbers testing positive in 2008 tells us nothing about when the person became HIV positive, which may have been several, or even many years ago. We shouldn't leap to conclusions about any year to year change in the numbers, because there are all kinds of explanations. Here are a few -

• More people are testing each year
• Gay men especially have recently been encouraged to test at least once a year in high prevalence areas of the NW such as Manchester, Salford and Blackpool
• A larger number of people at higher risk of HIV who attend Sexual Health clinics may now be agreeing to take HIV tests - many refuse, especially people from groups more likely to have HIV, gay men and other men who have sex with men, migrants especially from regions with high rates of HIV such as sub-Saharan Africa, people from ethnic minorities, injecting drug users
• More pregnant women may be agreeing to antenatal HIV testing
• The greater availablility of community testing services
• More people are taking more sexual risks by having unprotected sex
• Random variation - when you flip a coin 100 times you don't get 50 heads and 50 tails each time - because of random variation. Sometimes it's a few more than 50, sometimes a few less. Sometimes a lot fewer of one than the other. It's always at work in HIV statistics - it depends on thousands of people's decisions about whether and when to go get tested.  

'Infected abroad' pot stirred

The media reports picked out that 42% of the new cases in 2008 were infected abroad - particularly people from sub-Saharan Africa. This is old news - a quick look at the 2007 figures would have revealed an almost identical percentage. The explanation is simple. Britain is a global travel hub with strong ties to Commonwealth countries, many of which have high rates of HIV. Millions of people come and go here each year - as students, as workers (including doctors and nurses the NHS depends on), as visitors and tourists, and as people seeking safety here through asylum. Asylum applications are very much lower than in some previous years. Some people arriving here have HIV, but a George House Trust / Terrence Higgins Trust survey found most people have no idea of this before travelling here.

Use of NW HIV Voluntary Organisations chart

We will be carrying out a more detailed analysis of the 2008 HIV statistics for the region and will share this with you in due course.

The 2008 NW HIV Report is now published here 

You can download this report HIV&AIDS in North West England 2008 direct from us - it is a large pdf file (2.48 Mb), so please be patient.

HIV+ Gay Men Put UK Top in Europe

posted: 10/12/2008

Data from 23 European countries show that the annual number of HIV diagnoses in men who have sex with men (MSM) has increased by almost 90% between 2000 and 2006. The UK has the highest number of new diagnoses in Europe, but dramatic increases were also seen in low prevalence countries in Central and Eastern Europe.

People on the EuroHIV programme analysed new HIV diagnoses in men who have sex with men from 30 European countries (the member states of the European Union, plus Switzerland, Iceland and Norway).

In 2006 there were 7,693 new diagnoses in MSM in the 27 European countries with data (Spain, Italy and Estonia don’t have much use for HIV statistics). This means 57 cases per million adult men in the population (57/million).

Do we want to be top of the Euro-league for HIV among gay men?

However the 2,597 diagnoses in the United Kingdom in 2006 make the UK the country with the largest number of new HIV diagnoses among MSM in Europe, and also the country with the highest rate of new diagnoses among MSM per million male adults (130/million). The rate was also above 100 cases per million men in the Netherlands and Luxembourg, and above 75 cases per million men in Switzerland and Portugal. The rate was much lower in countries such as Lithuania (7/million), Hungary (11/million) and Slovenia (35/million).

In four countries, over half of new diagnoses were in men who have sex with men: Slovenia, Czech Republic, the Netherlands and Germany.

Numbers diagnosed up by about 90% in 5 years

They compared changes between 2000 and 2006 in 23 of the countries. There was an overall increase of 86% in the number of new diagnoses between 2000 and 2006. Only four countries reported a decrease (Cyprus, Iceland, Lithuania and Luxembourg).

Cases increased by 91% in the UK, and the number of annual diagnoses more than doubled in several countries, including Finland, Germany and Norway.

Despite having a comparatively low prevalence, rates also doubled in Hungary (118% increase) and tripled in Slovenia (257% increase). The authors draw attention to sexual mobility and high levels of reported risk behaviour in such countries, which they say leaves open the potential for the rapid spread of HIV there.

Fewer diagnosed late, more testing

More encouragingly, in all but one of the 18 countries which had data on late diagnosis, the proportion of cases diagnosed late had decreased. In 2000, 25% of men were diagnosed late, but by 2006 this was down to 10%.

The authors note that this latter finding indicates an increase in rates of HIV testing, which may have contributed to the number of new diagnoses, but is unlikely to account for all of the increase. They also cite increased life expectancy of HIV positive people (and therefore a larger pool of infection) as an influence on these figures.

More risk-taking

Furthermore, the authors point to studies demonstrating continued risk behaviour. Indeed, this week also saw the release of new data which identifies increases in risky sexual behaviour among MSM in Denmark.

The annual Sex Life Survey has been run in 2000, 2001, 2002 and 2006, with over 3,000 men participating in the most recent survey. The researchers report several increases in risk behaviour, each of which is statistically significant:
• In the three previous surveys, between 26% and 28% of men reported unprotected anal sex that was not known to be with a man of the same HIV status. In 2006, 33% of men reported this behaviour.
• Previously, between 84% and 86% of men reported any anal sex. In 2006, this rose to 92%.
• The average number of anal sex partners increased from 8 to 9.4.
• The proportion of men with one steady partner dropped from 26% to 20%, while the numbers who only had casual partners rose from 28% to 34%. The proportion of men with both steady and casual partners rose from 29% to 35%.

We need a European HIV prevention strategy

The authors conclude: “We have reported a recent increase in the number of HIV diagnoses among MSM in nearly all [European] countries. This, combined with the high prevalence of HIV reported in many gay community settings, the high prevalence of HIV among MSM diagnosed with STI, and the high sexual mobility of this population, highlight the need for a Europe-wide HIV prevention strategy.”

source with full reference

HIV Clinics Use At Highest

posted: 27/11/2008

The number of people using 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.

new diagnoses stay steady

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 newly tested positive for HIV.

Trebled in 10 years

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.

North West 4.5 times up on 10 years ago

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%. However in the North West of England the total number accessing hospital care has grown by 4.5 times in the last ten years (1998, excluding Cumbria 1165; 2007, including Cumbria 5212).

Striking: More Over 50s

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.

1 in 5 needing treatment have not yet started it

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 signpost for starting treatment is now normally when the CD4 count has fallen to 350. A CD4 count of 200 or less is the level at which symptomatic HIV infections become probable. The Health Protection Agency therefore recommends that “work should be undertaken to develop new care pathways that encourage earlier commencement of anti-retroviral therapy”.

Late testing

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.

Testing recommendations for Manchester and Blackpool

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 any medical care. These areas include Manchester and Blackpool in the NW of England.

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). However the majority of these heterosexual infections occured abroad, largely in sub-Saharan Africa. 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.

Gay numbers up, Heterosexual numbers down

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.

UK Heterosexual trends

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”.

Reference
Health Protection Agency. HIV in the United Kingdom: 2008 Report. .pdf file