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Published :23 November 2007, Volume 1, No 47 (PDF file, 332 KB)

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HIV and other sexually transmitted infections in the United Kingdom, 2007

The Health Protection Agency has released its annual surveillance report on HIV and other sexually transmitted infections (STIs) in the United Kingdom (UK). This year's report, Testing Times, launched ahead of World AIDS Day provides up-to-date, detailed information on the continuing HIV and STI epidemics, as well as recommendations aimed at stemming their spread.

An estimated 73,000 adults are now living with HIV in the UK. This figure includes both those who have been diagnosed and also around a third (21,600) who remain unaware of their HIV status. During 2006, 7,093 people were diagnosed with HIV in the UK. Tthis number is expected to rise to an estimated 7,800 in 2006 when all reports are received, a comparable figure to the estimated 7,900 received in 2005.

The report highlights high levels of HIV transmission in gay men in whom over 2,700 new diagnoses of HIV infection are expected in 2006. In recent years there has been a steady increases in all sexually transmitted infections (STI), including HIV, in gay men and since 2003, the number of HIV diagnoses reported annually has consistently increased and exceeded the annual number of diagnoses throughout the 1980s and 1990s. Increased testing will have contributed in part to these recent high numbers of HIV diagnoses, but there is no suggestion that the overall level of underlying HIV transmission in gay men has fallen. Unprotected sex continues to be a very high risk activity for HIV and STI transmission in this group.

Sexual health of young adults has worsened in 2006 with increases in sexually transmitted herpes and warts viruses. One in ten young adults screened through the National Chlamydia Screening Programme in 2006 tested positive for the infection.

In 2006, there were an estimated 750 new HIV diagnoses thought to be due to heterosexual HIV transmission within the UK, many in black ethnic minority communities. This compares to an estimated 700 cases reported in 2005 and 500 in 2003 showing that heterosexual HIV transmission is steadily increasing.

The number of cases who may have acquired HIV heterosexually in Africa has remained stable. When all reports are received this number will be around 3,450 in 2006 compared to 3,700 the previous year and a peak of 3,850 in 2003.

While there have been some encouraging developments in HIV and STI prevention in the last year such as the increase in HIV testing, a marked reduction in waiting times at STI clinics and wider chlamydia testing for young adults, the total number of STI diagnoses increased 2.4% from 606,600 in 2005 to 621,300 in 2006.

The control of HIV and STI transmission is a major public health challenge and testing for STIs, including HIV, in the UK needs to be increased still further. The report makes a number of key recommendations particularly aimed at reducing transmission of HIV and other STIs in the key prevention groups, namely men who have sex with men (MSM), young people and the black communities.

Full copies of the report are available from the HPA's Centre for Infections ( HIV/STI@hpa.org.uk ) or from the local Health Protection Units of the HPA (see http://www.hpa.org.uk/lars_homepage.htm to find your local HPU).

Alternatively, electronic copies of the annual report, and a slide set of all the tables and figures can be downloaded from: <http://www.hpa.org.uk/infections/topics_az/hiv_and_sti/publications/AnnualReport/default.htm>.

In addition, more extensive statistics by organism, geography, prevention group and surveillance system are available at: <http://www.hpa.org.uk/infections/topics_az/hiv_and_sti>.

Tabular data on the National Chlamydia Screening Programme is accessible at: http://www.chlamydiascreening.nhs.uk

Confirmed measles cases in England and Wales – an update to end of October 2007

Measles cases have continued to occur since numbers were last published on the 21 September [1]. Up to the end of October, there have been 769 cases confirmed in England and Wales (compared to 596 up to 21 September). Twenty-two percent (172/769) had onset dates after the end of August 2007 (September 83 cases and October 89 cases). During September and October, more cases were reported from London than the rest of England and Wales (figure). Many of these cases were associated with continuing outbreaks in religious communities with poor vaccine coverage (70 cases in London, 11 in North West and two in North East regions), travelling communities, and smaller outbreaks in schools and nurseries. All recent cases without a history of travel where a genotype has been identified have been shown to be the same D4 sequence (MVs/Enfield.GBR/14.07).

During 2007, the majority of cases have been reported in the south east of England (73%): London region (307), South East (97), and East of England (155), although 87 and 58 cases have been reported from Yorkshire and Humberside and the East Midlands respectively (table).

Table Confirmed cases of measles by age group and region, England and Wales: cumulative total for 2007 up to 31 October 2007

 

Region/Country

Age Group (years)

<1

1-4

5-9

10-14

15-19

20-24

>25

Total

North East

–

1

–

1

1

–

2

5

North West

3

8

6

–

2

–

2

21

Yorkshire & Humber

9

19

25

13

10

4

7

87

East Midlands

5

19

15

7

5

3

4

58

West Midlands

–

9

7

3

–

1

–

20

East of England

8

38

45

25

14

3

22

155

London

27

107

68

31

28

16

30

307

South East

8

25

32

18

6

2

6

97

South West

1

2

1

–

–

2

–

6

Wales

–

7

5

1

–

–

–

13

Total

61

235

204

99

66

31

73

769

 

Figure Confirmed cases of measles by month of onset, England and Wales: cumulative total for 2007 up to 31 October 2007

Figure Confirmed cases of measles by month of onset, England and Wales: cumulative total for 2007 up to 31 October 2007

References
1.  HPA. Confirmed cases of measles in England and Wales – an update up to 21 September 2007. Health Protection Report [serial online] 2007 [cited 28 September 2007]; 1 (39):News. Available at <http://www.hpa.org.uk/hpr/archives/2007/hpr3907.pdf>

Infection Surveillance Programme Annual Report, 2006

The third annual report from the National Blood Service (NBS)/Health Protection Agency (HPA) Centre for Infections Surveillance Programme has recently been publishedm, and is now available at <http://www.hpa.org.uk/infections/topics_az/BIBD/publications.htm>.

The Programme is comprised of a series of national schemes, which provide epidemiological information about bloodborne infections in blood, tissue and cell donors in the UK and the associated risk of transmission via transfusion or transplantation, in order to inform donor practices and public health. In addition information about antenatal samples tested by the NBS is presented. This report includes national data from all the schemes within the NBS/HPA programme, and aims further to describe the methods used and the information collected; describing any trends observed and detailing some of the applications of the data.

In addition to this annual report, some of these data from the blood donation surveillance scheme are routinely published on the HPA website [1] and in the HPR, and data from the transfusion transmitted infection surveillance scheme form a part of SHOT (Serious Hazards of Transfusion) website <http://www.shotuk.org>.

References
1. http://www.hpa.org.uk/infections/topics_az/BIBD/publications.htm

UNAIDS published revised HIV estimates

UNAIDS has published its 2007 AIDS Epidemic Update [1]. The report reflects improved understanding and expanded epidemiological data and analyses that have led to a better understanding of the global epidemic, and resulting substantial revisions in estimates.

Global HIV incidence – the number of new HIV infections per year – is now estimated to have peaked in the late 1990s at over 3 million [2.4 to 5.1 million] new infections per year, and is estimated in 2007 to be 2.5 million [1.8 to 4.1 million] new infections, an average of more than 6800 new infections each day. This reflects natural trends in the epidemic, as well as the result of HIV prevention efforts.

The number of people dying from AIDS-related illnesses has declined in the last two years, due in part to the life prolonging effects of antiretroviral therapy. AIDS is, however, still among the leading causes of death globally and remains the primary cause of death in Africa .

The current estimate of 33.2 million [30.6 to 36.1 million] people living with HIV replaces the 2006 estimate of 39.5 million [34.1 to 47.1 million]. Applying the improved methodology retrospectively to the 2006 data, the 2007 report revises that figure, now estimating that in 2006 there were 32.7 million [30.2 to 35.3 million] people living with HIV. The single biggest reason for the reduction in global HIV prevalence figures in the past year was the recent revision of estimates in India after an intensive reassessment of the epidemic in that country. The revised estimates for India , combined with important revisions of estimates in five sub-Saharan African countries ( Angola , Kenya , Mozambique , Nigeria , and Zimbabwe ) account for 70% of the reduction in HIV prevalence as compared to 2006 estimates.

UNAIDS, WHO and the Reference Group on Estimates, Modelling and Projections have recently undertaken the most comprehensive review of their methodologies and monitoring systems since 2001. The epidemic estimates presented in this year's report reflect improvements in country data collection and analysis, as well as a better understanding of the natural history and distribution of HIV infection. This information is vital in helping countries understand their epidemics and respond to them more effectively. UNAIDS and WHO are now working with better information from many more countries. In the past few years a number of countries, most notably in sub-Saharan Africa and Asia, have expanded and improved their HIV surveillance systems, conducting new, more accurate studies that provide more precise information about HIV prevalence than earlier studies. In addition, 30 countries mostly in Africa have conducted national representative population-based household surveys. These have also informed adjustments for other countries with similar epidemics that have not conducted these surveys. New assumptions have also been made as a result of a better understanding of the natural history of untreated HIV infection.

UNAIDS and WHO officials point out that the new estimates do not change the need for immediate action and increased funding to scale up towards universal access to HIV prevention, treatment, care and support services.

References
1. UNAIDS. AIDS epidemic update: December 2007. Geneva: UNAIDS, 2007. Available at <http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf>.