Numbers accessing HIV care: National Overview

In 2010, 69,424 HIV-diagnosed persons (all ages) were seen for HIV care in the UK, representing an increase of 6% on the number seen in 2009 (65,292) and a 166% increase on the number seen in 2001 (26,088). For the past five years the numerical year-on-year increase has been stable, at about 4,000 additional individuals seen for HIV-related care each year.
Based on these data and UK population estimates, there were 173 persons (15-59 years old) accessing HIV care per 100,000 populations in 2010. Prevalence was higher among men than women (226/100,000 and 120/100,000 respectively) and higher in London than in the rest of England (542/100,000 in London compared to 121/100,000 elsewhere in England).

SOPHID National Tables:

HIV Slideset and Annual Report:

Infection route and ethnicity

In 2010 where information was available, 51% (34,312) of persons living with diagnosed HIV were men and women infected via heterosexual sex (12,745 and 21,567 respectively) and 44% (29,647) were men infected through sex between men. A small proportion of persons accessing care were infected through injecting drug use (2%, 1,565) or mother-to-child transmission (2%, 1,473).
In 2010, just over half (52%, 35,983) of persons accessing HIV care where ethnicity was reported were white, the majority of whom were infected through sex between men (74%, 25,852). Over one-third of persons (35%, 24,397) seen for care were black-African, the majority (93%, 22,312) were infected through heterosexual sex.

Figure 1: HIV diagnosed persons seen for HIV care by prevention group and ethnic group, UK (PDF, 73 KB)

Figure 2: HIV diagnosed persons seen for HIV care by ethnicity, UK: 2001 and 2010 (PDF, 94 KB)

Use of antiretroviral therapy

The number and proportion of persons receiving ART has increased over the past decade. In 2010, 82% (56,071/68,683) of persons seen for HIV care were prescribed ART compared with 69% (17,456/25,477) in 2001. The 2008 British HIV Association (BHIVA) guidelines recommended that treatment commences when a patient’s CD4 cell count falls to =350 cells/mm3 (previous guidelines recommended treatment should start when CD4 cell counts reached below 200 cells/mm3). In the past five years, there was a continuing increase of the proportion of persons with a CD4 cell count =350 cells/mm3 who were prescribed ART, from 74% (12,646/16,980) in 2006 to 87% (12,675/14,638) in 2010.

Figure 3: Proportion of HIV diagnosed persons seen for HIV care receiving antiretroviral therapy, UK (PDF, 137 KB)

Age

The age distribution of people living with diagnosed HIV infection is changing, with older age-groups increasing both in number and proportion. In 2010, almost one in five adults (aged 15 year or older) were aged 50 years or older, compared to one in seven adults in 2005 and one in ten in 2000. This increase is due to effective antiretroviral therapy (ART) improving survival among the diagnosed HIV-infected population, and continued transmission at older ages.

Figure 4: HIV diagnosed persons seen for HIV care by age group, UK (PDF, 86 KB)

Geography

In England, the strategic health authorities (SHAs) that saw the largest proportional increases in the number of HIV-diagnosed persons seen for HIV care in the past five years were the West Midlands (from 2,939 in 2006 to 4,523 in 2010) and the North East (from 862 to 1,305). London SHA saw the lowest proportional increase (25%; from 23,793 to 29,738).The proportion of diagnosed persons who were resident in London continues to decrease, falling from 57% (14,652/25,580) in 2001 to 43% (29,738/69,081) in 2010. These trends reflect the increased geographical heterogeneity of individuals living with diagnosed HIV in the UK.

Figure 5: HIV diagnosed persons seen for HIV care by place of residence, UK (PDF, 111 KB)

The SHA with the highest proportion of residents accessing care who were infected through sex between men were South East Coast SHA (55%; 2,439/4,418) and North West SHA (52%; 3,184/6,149). In contrast, East of England SHA and East Midlands SHA had the highest proportions of residents accessing care who were infected through heterosexual sex (68%; 3,002/4,430 and 66%; 2,046/3,080, respectively) and among the lowest proportions infected through sex between men (27%; 1,192/4,430 and 27%; 831/3,080, respectively).

Figure 6: HIV diagnosed persons seen for HIV care by SHA and exposure category, England (PDF, 78 KB)

There were substantial variations in the ethnicity of HIV-diagnosed persons accessing HIV care between SHAs. In 2010, 70% (2,078/2,982) of persons were reported as white within South West SHA, compared with 41% (1,274/3,106) in East Midlands SHA. While black-Africans comprised 37% (22,344/63,390) of HIV-diagnosed persons seen for HIV care in England overall, they accounted for only 23% (670/3,106) in South West SHA and 52% (2,213/4,449) in East of England SHA.

Figure 7: HIV diagnosed persons seen for HIV care by SHA and ethnicity, England (PDF, 114 KB)

There is increasing cross-boundary movement between where diagnosed HIV-diagnosed persons live and where they access HIV care. Where information was available, 10% (3,324/32,735) of non-London residents used London HIV services.

Figure 8: HIV diagnosed persons resident outside the SHA which provided their HIV care, England (PDF, 92 KB)

Since 2006, the number of persons receiving HIV care resident outside London (within England) has been greater than the number resident in London. This continues to be the case in 2010 (24,662 living in London and 27,010 living elsewhere in England).

Figure 9: HIV diagnosed persons seen for HIV care: London and rest of England (PDF, 68 KB)

Suggested citation for reproduction of these graphs: SOPHID, Health Protection Services - Colindale, Health Protection Agency: 2010.