HIV/STI prevention is focused on access to sexual health services, early diagnosis and effective treatment of infection and the promotion of safer sexual behaviour. PHE activities contribute to all these aspects of HIV/STI prevention.
The incidence and prevalence of HIV and STIs are not uniformly distributed in the UK population. There are population groups at particular risk of acquiring HIV and STIs. Here we summarise surveillance data and appropriate sexual health messages for populations that require targeted prevention.
Policies and programmes which promote sexual health for all through education, health promotion, and the provision of reproductive and sexual health services contribute to the prevention and control of HIV and STIs. PHE data inform health promotion strategies and evaluate the impact of interventions, both to reduce higher risk sexual behaviours and HIV/STI prevalence.
Early diagnosis can result in timely treatment and an improved prognosis for people living with HIV. This is reflected in the Public Health Outcomes Framework (2013-16), with the inclusion of an indicator on reducing the number of people presenting with late stage HIV infection.
Expanding HIV testing, with the aim of reducing mean time from infection-to-diagnosis, decreasing the number of people living with undiagnosed HIV infections and reducing onwards transmission, is crucial to reducing HIV incidence. PHE recommends routine HIV testing be commissioned as a priority for all hospital general medical admissions in high prevalence areas.
National Chlamydia Screening Programme (NCSP) [external link]
A substantial proportion of all young adults become infected with chlamydia in a year. The aim of the NCSP is to control chlamydia through early detection and treatment of asymptomatic infection, so reducing onward transmission and the consequences of untreated infection. The NCSP vision is that all sexually active young adults be offered chlamydia testing annually, or on change of sexual partner. Approximately 1.8 million chlamydia tests are currently performed, and over 140,000 infections identified and treated, under the NCSP annually. To deliver widespread screening, local areas are encouraged to ensure young people are offered a chlamydia test during routine consultations across both clinical and non-clinical services.
The NCSP collect annual data on chlamydia screening through the Chlamydia Testing Activity Dataset (CTAD), reporting at a national and regional level on rates ofscreening coverage, the proportion of chlamydia tests that are positive and the chlamydia diagnosis rate in England.
PHE reference laboratories with specialist expertise in the diagnoses and characterisation of HIV and STIs are:
Outbreaks can occur in a range of conditions such as syphilis, lymphogranuloma venereum (LGV), HIV, hepatitis B, hepatitis C and gonorrhoea but the response to the outbreak will vary between organisms. Guidelines for the management of STIs and hepatitis outbreaks are available below:
Gonorrhoea is the second most common bacterial sexually transmitted infection (STI) in England and Wales caused by the bacterium Neisseria gonorrhoeae. The persistence of gonorrhoea, its association with poor reproductive and sexual health outcomes, and the prevalence of antimicrobial resistance have made it a major public health concern.
Data on resistance to antiretroviral treatment in HIV infected drug-naïve individuals is crucial to understanding the epidemiology of transmitted drug resistance, while data from those receiving antiretroviral treatment provides indirect evidence of the contribution of drug resistance to virological failure.