Research and analysis

Annual epidemiological spotlight on HIV in London: 2023 data

Updated 11 June 2026

Summary

HIV remains an important public health issue in London. After a long period when diagnoses were declining, we have seen increases in recent years. However, interpreting trends over the period which includes 2020 and 2021, the 2 years of the COVID-19 pandemic, is challenging due to the disruptions in access to sexual health services and reduced social mixing during these years. An increasing proportion of new HIV diagnoses are in people continuing care in the UK.

In 2023, an estimated 39,750 people were living with HIV in London (95% credible interval (CrI) 39,110 to 40,450), which was 39% of all people living with HIV in England. This includes both diagnosed and undiagnosed people.

This report aims to provide key intelligence about HIV in London. For a broader context see UKHSA’s national HIV report (1).

New diagnoses

In 2023, 1,543 London residents were newly diagnosed with HIV, accounting for 26% of new diagnoses in England. This represents a rise of 11% from 2022. Nationally, there has been a long term trend for a decline in the overall number of new diagnoses, although there has been a substantial upturn since 2021.

The new diagnosis rate for London residents (17 per 100,000) was above that of England in 2023 (10 per 100,000).

In 2023, 46% of all new diagnoses in London residents were in gay, bisexual and other men who have sex with men (GBMSM), compared to 47% in 2022 and 63% in 2014. The number of GBMSM resident in London newly diagnosed with HIV (712, adjusted for missing information) was 56% lower than in 2014. Of the GBMSM newly diagnosed with HIV, 50% were White and 19% were UK-born.

The most common route for HIV transmission for new diagnoses in London residents in 2003 was heterosexual sex (50%). HIV diagnoses in Africa-born persons accounted for 62% of all heterosexually acquired cases in 2023 (n=354, of which 176 were previously diagnosed abroad), compared to 57% (n=442, of which 41 were previously diagnosed abroad) in 2014. HIV in UK-born persons accounted for 12% of all cases acquired via heterosexual sex in 2023.

Injecting drug use accounted for 1% of new diagnoses in London residents. Black Africans represented 31% of all newly diagnosed London residents in 2023 (compared to 21% in 2022 and 22% in 2014). A small proportion of new diagnoses in 2023 were in Black Caribbeans (3%).

The number of new diagnoses was highest in the 25 to 29 year age group in GBMSM, the 30 to 34 year age group in heterosexual men and the 35 to 39 year age group in women in 2023.

Late diagnoses

Reducing late HIV diagnoses is one of the indicators in the Public Health Outcomes Framework (2) and HIV Action Plan Monitoring and Evaluation Framework (3). People who are diagnosed late have a tenfold increased risk of dying within one year of diagnosis compared to those diagnosed promptly and late diagnosis results in increased healthcare costs.

It is of particular concern that a large proportion of London residents with HIV are diagnosed late (41% from 2021 to 2023, compared to 43% in England), defined by a CD4 count of less than 350 cells/mm  at diagnosis.

In London, heterosexuals were more likely to be diagnosed late (57% of males, 50% of females) than GBMSM (30%). By ethnic group, Black Africans were more likely to be diagnosed late than the White population (55% and 33% respectively).

People living with diagnosed HIV

The number of people living with diagnosed HIV in London in 2023 (38,477) was 3% higher than in 2022 and 9% higher than in 2014. This increase is partly due to the effectiveness of HIV treatment, which has reduced the number of deaths from HIV.

The diagnosed prevalence rate of HIV in London in 2023 was 5 per 1,000 residents aged 15 to 59 years. This was above that of the 2 per 1,000 observed in England as a whole (small differences may be hidden by rounding). All 33 local authorities in London had a diagnosed HIV prevalence in excess of 2 per 1,000 population aged 15 to 59 in 2023, which is the threshold for expanded HIV testing (4).

The 2 most common probable routes of transmission for London residents living with diagnosed HIV in 2023 were sex between men (51%) and sex between men and women (45%).

In 2023, 35% of those living with diagnosed HIV in London were aged between 35 and 49 years, and 53% were aged 50 years and over (up from 30% in 2014). Males represented 70% of London residents living with diagnosed HIV in 2023 and females represented 30%.

In 2023, 44% of London residents living with diagnosed HIV were White and 31% were Black Africans. However, due to the relative sizes of the White and Black African populations the rate per 1,000 population aged 15 to 59 years was much higher in Black Africans (16 per 1,000) than in the White population (3 per 1,000).

Continuum of HIV care

In London in 2023, 98% of residents diagnosed with HIV were receiving anti-retroviral HIV treatment (ART). Of these, 98% were virally suppressed (viral load <200 copies/ml – untransmissible virus) and cannot pass on HIV sexually. This compares to 98% in England as a whole receiving ART and 98% of these virally suppressed.

For London residents, the proportion starting treatment within 91 days of diagnosis for the period 2021 to 2023 was 78%. This compares to 84% for England.

People living with undiagnosed HIV

In 2023, it is estimated that 3% (Credible Interval (CrI) 2 to 4%) of people living with HIV in London were undiagnosed so they are unaware they are living with HIV. This equates to an estimated 1,243 (CrI 923 to 1,799) undiagnosed people.

It is estimated that 531 GBMSM in London are undiagnosed (CrI 291 to 1,007) and 639 heterosexuals (CrI 476 to 920), including 345 Black Africans. In London, the proportion undiagnosed varied by probable exposure group with the highest proportion of undiagnosed people being those who inject drugs (8%, CrI 2 to 18%), heterosexual women other than Black African women (4%, 3 to 6%), and heterosexual men other than Black African men (4%, 2% to 11%).

HIV testing

A total of 203,187 people were tested for HIV in specialist sexual health services (SHSs) in London in 2023, a decrease of 27% since 2019 and an increase of 12% since 2022. The HIV testing rate (per 100,000 population) at all Sexual Health Services (SHS) in London was 6,816, which compares to 2,771 across England. HIV testing rates in all specialist and non-specialist sexual health services) in London is higher in men (7,422) than women (6,033). The introduction of emergency department (ED) opt-out testing for blood-borne viruses (BBV) in April 2022 (in 2020 in Croydon) enabled services to identify over 540 previously undiagnosed London residents by the end of December 2024.

Pre-exposure prophylaxis (PrEP)

In 2023, 18% of HIV-negative London residents accessing SHSs in England were defined as having a PrEP need. Of those with PrEP need, 84% had this need identified at a clinical consultation and of these 78% initiated or continued PrEP. Among GBMSM, the group with greatest need, 74% were defined as in need of PrEP and, of these, 85% had their PrEP need identified at clinical consultation and 79% initiated or continued PrEP use. Consistent use of PrEP is an effective intervention to prevent HIV acquisition. Despite PrEP being routinely available through specialist SHS, awareness, accessibility and uptake of primary prevention initiatives is variable for different population groups. Addressing this disparity is key to HIV prevention. A pilot of digital PrEP is underway. We hope that this will support access for people who find it difficult to attend specialist SHSs.

HIV in England

The 2021 HIV Action Plan for England (5) sets an ambition to reduce HIV transmission by 80% between 2019 and 2025. The HIV Action Plan monitoring and evaluation framework report published in November 2024 (3) further summarises progress made towards the ambitions of the HIV Action Plan (4). Although considerable progress has been made, it is unlikely that the 2025 interim ambitions will be met. 

The number of people first diagnosed with HIV in England has risen by 15% in 2023 and there is further evidence of widening inequalities (3). Most of the increase in HIV diagnoses between 2022 and 2023 in England was among adults living outside London acquiring HIV through heterosexual sex (an increase of 51% among men and 44% among women. For both GBMSM and heterosexual adults, the 2023 rise has disproportionately affected minoritised ethnic groups. Further provision of services that are culturally competent and accessible to diverse key populations is needed. 

Overall testing rates have increased substantially since 2022 in England but have not fully recovered to those observed in 2019 for some demographic groups (3). The increasing levels of testing and fall in positivity over the past 5 years may be suggestive of an overall fall in HIV transmission in GBMSM, but not a continued reduction. The rise in HIV testing together with a higher and sustained positivity in Black African heterosexuals may be suggestive of ongoing transmission. However, this includes people continuing care in the UK.

In England in 2023, for the first time, over half of all HIV diagnoses were among those continuing their care in the UK (3). Most of these people have evidence of existing treatment, in the form of viral suppression within a month of their England presentation and are rapidly linked to care in England, ensuring good clinical outcomes and prevention of onward transmission. SHS need to ensure appropriate and accessible care capacity for people needing to continue their care in the UK. Most people arriving in the UK for the period July 2022 to June 2023 were non-EU nationals, recruited for work, largely using health and care visas (7).

The implementation of an NHS England-funded programme of emergency departments (ED) opt-out testing for bloodborne viruses in April 2022 has contributed to the increase in HIV diagnoses in 2023 (5). The increase in HIV diagnoses seen in 2023 is only partially due to the increase in testing effort including ED opt-out testing. This is particularly apparent outside of London, where there was a 21% increase in diagnoses after adjustment for ED opt-out testing (5). 

Access to PrEP has been increasing on an annual basis since 2020. However, inequalities in access remain with unmet needs in specific groups. 

The rising number of late diagnoses, particularly among Black African populations demonstrates an urgent need to improve access to testing and the full implementation of HIV testing guidelines (4). 

For those diagnosed and linked to services, HIV care remains excellent with 98% of people with diagnosed HIV being treated and 98% of people on treatment virally suppressed (3). An increasing proportion of people accessing HIV care belong to older age groups, with over half aged 50 years or over in 2023 compared to 10 years ago. This highlights the need for joined up health and social care services to meet the wider health and social care needs of this ageing population. The ability to access HIV care continues to be impacted by wider determinants of health that present barriers individuals and communities face.

HIV prevention messages

Combined prevention methods prevent HIV; these include HIV testing and treatment, PrEP and condoms. Using condoms consistently and correctly protects against HIV and other STIs such as chlamydia, gonorrhoea and syphilis. They can also be used to prevent unplanned pregnancy.

HIV testing is central to HIV prevention since it provides access to PrEP and health advice for those who don’t have HIV, and essential HIV treatment and care for those who do, keeping a person healthy and preventing onward transmission. Anyone having sex without a condom with new or casual partners needs a STI screen, including an HIV test, on at least an annual basis. GBMSM should be tested for HIV and STIs annually, or every 3 months if having sex without condoms with new or casual partners.

HIV PrEP is available for free from specialist SHS and can be used to reduce an individual’s risk of acquiring HIV. Consistent use of PrEP can be an efficacious and effective intervention to prevent HIV acquisition. Despite PrEP being routinely available through specialist SHS, awareness, accessibility and uptake of this primary prevention initiative remains low in many population groups (5).

HIV post-exposure prophylaxis (PEP) can be used to reduce the risk of acquiring HIV following exposure. PEP is available for free from specialist SHS and most emergency departments and is effective if taken within 72 hours.

HIV and AIDS symptoms may not appear for many years, and people who don’t know they have HIV will not realise they may pass HIV to others. Prevention messages should reinforce that anyone can acquire HIV regardless of age, gender, ethnicity, sexuality or religion, and it is important to challenge assumptions and stigma about who can acquire HIV.

People who know they are living with HIV, are on treatment and have an undetectable viral load are unable to pass on the virus to others during sex, even without PrEP or condoms. This is known as Undetectable = Untransmittable or U=U (7).

Stigma, anxiety and depression experienced by people living with HIV may stop them seeking healthcare, engaging in treatment and remaining in care (3). Reducing stigma in healthcare services and society encourages people to get the healthcare they need.

Specialist SHS are free and confidential. They offer testing and treatment for HIV and STIs, condoms, vaccination, HIV PrEP and PEP regardless of immigration status. Both clinic-based services and online testing for HIV and STIs are widely available. Information and advice about sexual health, including how to access services is available from NHS.UK and from the national sexual health helpline on 0300 123 7123.

Local and regional prevention strategies

HIV prevention strategies at a local and regional level should consider inclusion of the following areas from the national HIV Action plan monitoring and evaluation framework (5).

• implementation and monitoring of the British HIV Association (BHIVA), British Association for Sexual Health and HIV (BASHH) and British Infection Association (BIA) Adult HIV testing guidelines 2020 (4), including opt-out in sexual health services, subject to agreed support mechanisms for implementation
• continuation of ED opt-out testing in very high and high prevalence HIV areas (subject to results of the final evaluation of the programme due in October 2025)
• scaling up community testing focusing on those groups that are more likely to benefit from HIV testing in these settings such as minoritised ethnic populations
• understanding reasons behind the decline of HIV testing in women
• scaling up of partner notification.
• understanding the drivers of late diagnosis to better focus interventions
• reducing inequalities in access to and uptake of PrEP through implementation of the PrEP roadmap

Charts, tables and maps

Figure 1. Rate of new HIV diagnoses per 100,000 population (all ages) by UKHSA region of residence, 2023

Source: UKHSA, HIV & AIDS New Diagnoses and Deaths (HANDD).

The number of new diagnoses will depend on accessibility of testing as well as infection and transmission.

Figure 1 is a column chart showing new HIV diagnosis rates by English region for the year 2023. Rates are per 100,000 population and are not age-restricted. The overall England rate (10.4) is represented as a solid horizontal line.

The chart shows that London not only has the highest new HIV diagnosis rate of all English regions (17.2) but that its rate is more than 50% higher that of the region with the next highest rate (the East Midlands with 11.4). London’s population is more ethnically and socio-economically diverse than other regions and also has a younger age distribution, with 77% of the population aged under 55 years in 2023, compared to 69% for England as a whole.

Figure 2. Rate of new HIV diagnoses per 100,000 population (all ages) by local authority of residence, London residents, 2023

Source: UKHSA, HIV & AIDS New Diagnoses and Deaths (HANDD).

The number of new diagnoses will depend on accessibility of testing as well as infection and transmission. HIV diagnosed prevalence (rate per 1,000 aged 15 to 59 years as per NICE testing guidelines). Lower diagnosed prevalence less than 2, high diagnosed prevalence 2 to 5, Extremely high diagnosed prevalence more than 5. Note: the colour coding does not relate to new diagnosis but to the data in the diagnosed prevalence section later.

Figure 2 is a column chart showing new HIV diagnosis rates by London local authority for the year 2023. LAs are shown in descending order in relation to their new HIV diagnosis rate. Rates are per 100,000 population and are not age-restricted. The overall London rate (17.2) is represented as a dashed horizontal line.

The colour coding of the columns is designed to help relate new HIV diagnosis rates to the diagnosed prevalence for each local authority. A column that appears towards the left of the chart but has a mid-teal colour may indicate an local authority where diagnosis rates are increasing in relation to historical rates for that local authority. Brent is an example. By contrast, a column that appears towards the right of the chart but has a dark blue colour may indicate that diagnosis rates are decreasing in relation to those seen in the past (for example, Islington).

The chart shows that new HIV diagnosis rates tend to be higher in inner London local authorities such as Westminster, which has the highest rate (46), Kensington and Chelsea (33) and Lambeth (30). The lowest rates are found in local authorities in outer London: Redbridge (7) and Richmond upon Thames (8). Inner London local authorities tend to have more diverse populations and higher levels of deprivation than those in outer London.

Figure 3. New HIV diagnoses and deaths, London, 2014 to 2023 [note 1]

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD).

The number of new diagnoses will depend on accessibility of testing as well as infection and transmission. Numbers may rise as we receive more reports and more information. This will impact on interpretation of trends in more recent years. New HIV diagnoses are shown by UK region of residence at diagnosis. Deaths are shown by UK region of death which in some instances may not be the same as UK region of residence at diagnosis. Region of death may not be known for all deaths, particularly for those in the most recent years. Numbers for these years should be interpreted as minimum numbers (deaths reported and allocated to a region of death to date) and not as a trend.

Note 1: Numbers may rise as further reports are received and more information is obtained. This is more likely to affect more recent years, particularly 2023.

Figure 3 is a line chart showing the trend in number of new HIV diagnoses and deaths in HIV-diagnosed London residents between the years 2014 (2,560 new HIV diagnoses) and 2023 (1,543).

The new HIV diagnosis line shows the number of diagnoses falling after 2015. The decline slowed from 2017 onwards. In 2020, the main COVID-19 pandemic year, a larger decrease was seen. This larger decrease was the consequence of restrictions in access to services. In 2021, the first half of which was also affected by pandemic-related restrictions, diagnoses remained at the level seen in 2020. Numbers began to rise again from 2022 and in 2023 exceeded the number seen for 2019, the last pre-pandemic year (1,531).

Deaths began to rise in 2017. However, this coincides with improved ascertainment of deaths as a result of the National HIV Mortality Review. Additional deaths due to COVID-19 were also reported during the pandemic. Deaths tend to be subject to a greater reporting delay than diagnoses. It is important to aware of this when interpreting the number of deaths currently reported for the most recent year.

In addition, the impact of effective treatment has increased the numbers of people living with HIV who are surviving into older age groups. Older people living with HIV will be subject to additional age-related co-morbidities. Mortality rates are higher in older age groups.

Figure 4. New HIV diagnoses by whether a person had been previously diagnosed abroad, London, 2019 to 2023 [note 1]

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD).

The number of new diagnoses will depend on accessibility of testing as well as infection and transmission.

Note 1: Numbers may rise as further reports are received and more information is obtained. This is more likely to affect more recent years, particularly 2023.

Figure 4 is an area chart. It displays the trend in new HIV diagnoses in London residents between 2019 and 2023 by whether the person had been previously diagnosed abroad or not. The solid-shaded area represents new HIV diagnoses where there had been no prior diagnosis abroad and the pattern-shaded area above it represents the additional portion of diagnoses where a prior diagnosis abroad was recorded.

Distinguishing between patients previously diagnosed abroad and continuing care in the UK, and those only diagnosed in the UK is important to identify transmissions and diagnosis within the UK. This avoids distortions in our understanding of which groups remain vulnerable to a greater risk of transmission within the UK.

The chart shows that the proportion of London residents newly diagnosed with HIV who were previously diagnosed abroad rose in 2023 to 36% (563) from 29% (401) in 2022. Most people diagnosed in England who have a prior diagnosis abroad have evidence of existing treatment and are rapidly linked to care, which ensures good clinical outcomes and the prevention of onward transmission.

Figure 5a. New HIV diagnoses by probable route of acquiring HIV (adjusted for missing route information), London residents, 2014 to 2023 [note 1]

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD).

NPDA = Not previously diagnosed abroad.

The number of new diagnoses will depend on accessibility of testing as well as infection and transmission.

Note 1: Numbers may rise as further reports are received and more information is obtained. This is more likely to affect more recent years, particularly 2023.

Figure 5a is a line chart showing the trend in new HIV diagnoses in London residents by probable transmission route, grouped as sex between men, sex between men and women and other acquisition routes from 2014 to 2023. New HIV diagnoses with missing information about probable route of acquisition (16% of new HIV diagnoses in this period) were allocated proportionately to the 3 categories.

HIV exposure categories are arranged in a risk hierarchy. This hierarchy reflects what we know about transmission risk and the prevalence of HIV in different groups. If people have multiple exposures, they are allocated to the group highest in the risk hierarchy. For example, a woman who reported sex with both men and women would be allocated to the sex between men and women group, while a man who reported sex between men and injecting drug use would be allocated to the sex between men group.

For each group an additional dashed line shows the trend when people known to have been previously diagnosed abroad are excluded.

New HIV diagnoses declined in all groups until 2021, when they began to rise again for the heterosexual sex acquisition group. Year on year rises for all 3 groups were seen in both 2022 and 2023.

Excluding those with a prior diagnosis abroad has a much larger impact on changes in numbers of diagnoses in the heterosexual sex acquisition group compared to other groups. The increase in diagnoses for this group, when new HIV diagnoses in 2023 are compared to 2022, is reduced from 24% to 3%.

For the sex between men group, the rise in new HIV diagnoses in this group, when 2023 is compared to 2022, falls from 18% to 16% if those with a prior diagnosis abroad are excluded.

The ‘other’ group includes all non-sexual routes of transmission, including injecting drug use and vertical transmission, and is a much smaller group than the 2 sexually acquired transmission groups. From 2022 to 2023, new HIV diagnoses in this group increased by 18% if those with a diagnosis abroad are included or 12% if they are excluded.

Numbers for both the sex between men and ‘other’ acquisition group remained lower in 2023 than in 2019, the last pre-pandemic year. For the sex between men group, the number of new HIV diagnoses was 32% lower if those with a prior diagnosis abroad were included and 47% lower if they were excluded. By contrast, the number of new HIV diagnoses in heterosexual sex acquisition group rose by 36% between 2019 and 2023 if those with a prior diagnosis abroad are included or by 7% if they are excluded. Numbers for all 3 groups remained much lower in 2023 than in 2014, the first year included in the chart.

Figure 5b. New HIV diagnoses detailed ‘other’ route of acquiring HIV (not adjusted for missing information), London residents, 2014 to 2023 [note 1]

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD).

The number of new diagnoses will depend on accessibility of testing as well as infection and transmission.

Note 1: Numbers may rise as further reports are received and more information is obtained. This is more likely to affect more recent years, particularly 2023.

Figure 5b is a line chart which provides more detail about the HIV transmission routes grouped into ‘other routes of acquiring HIV’ in figure 5a. The group is broken down into subcategories: injecting drug use, vertical transmission and other transmission routes which include transmission via blood or tissue. The chart displays data for 2014 to 2023. There are no additional lines showing numbers when those with a prior diagnosis abroad are excluded, nor has the data been adjusted for missing information. This is because of the small number of diagnoses in these subcategories.

The chart shows that the number of new HIV diagnoses in London residents whose probable route of HIV acquisition belonged to any of these subcategories remained low and followed a declining trend until 2022, when they began to rise again for the vertical transmission and injecting drug use acquisition groups. In 2023 a rise was also seen for the ‘other’ sub-group that groups the remaining acquisition routes, for example, blood.

In 2023, almost 88% of the diagnoses making up the 3 small sub-groups within this chart were in people born abroad. This proportion tended, broadly, to increase over the 10 years from 2014 (when it was 77%) to 2023.

The low number of diagnoses makes trends for the individual sub-groups ‘noisy’, meaning that small variations in diagnosis numbers can cause large changes in the trend line. The trend line is similarly sensitive to misclassification, that is, errors in reporting or coding the route of acquisition.

Figure 6a. Number of new HIV diagnoses by age group and gender, London residents, 2023

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD).

The number of new diagnoses will depend on accessibility of testing as well as incidence.

Figure 6a is a pyramid bar chart showing the number of new HIV diagnoses by age group and gender in London residents in 2023. Diagnoses in males are on the left.

For males, the 25 to 34 year age group had by far the largest number of new HIV diagnoses (433). For females, the 35 to 44 year age group was largest (147), with the number of diagnoses in this age group only slightly lower in the 25 to 34 year age group (142).

Overall, nearly 30% of male Londoners newly diagnosed with HIV in 2023 were aged less than 30 years at diagnosis, compared to around 18% of newly diagnosed female Londoners. Over 80% of those aged 15 to 24 years at diagnosis were male. This is quite different from the picture seen for diagnoses of all new STIs, as this grouping is dominated by chlamydia which tends to be seen in females at younger ages (and for which we do targeted screening among young women), but is similar to what we see for STIs such as gonorrhoea and syphilis.

Around 11% of male Londoners newly diagnosed with HIV in 2023 were aged 55 years or older at diagnosis, compared to around 16% of newly diagnosed female Londoners. However, diagnoses in males outnumbered diagnoses in females every age group (excluding the under 15 age group which had only one diagnosis in it for each gender).

The skewing to younger age groups seen for males, compared to females, was associated with acquisition group and was also affected by whether or not a person had been previously diagnosed abroad. These factors are explored in Figure 6b.

Figure 6b. Number of new HIV diagnoses by age group and gender, split by whether first diagnosed in the UK or abroad, London residents, 2023

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD).

The number of new diagnoses will depend on accessibility of testing as well as incidence.

Figure 6b is a pair of pyramid bar charts showing the number of new HIV diagnoses in Londoners by age group and gender in 2023, subdivided by whether the person’s UK diagnosis was their first HIV diagnosis or whether they had been previously diagnosed abroad. As with figure 6a, diagnoses for males are on the left in both these charts.

The same skewing towards younger age groups is seen for males, compared to females, in both charts but the effect can be seen more strongly in the left chart, which shows diagnoses in those not previously diagnosed abroad. Just over 30% of males in this group were aged less than 30 years at diagnosis, compared to 17% of females. Among those with a prior diagnosis abroad, 29% of males were aged less than 30 years at diagnosis compared to 20% of females.

Londoners who had been previously diagnosed abroad were much less likely to belong to the oldest age group in the charts. For male Londoners, 14% of those who had not been previously diagnosed abroad were aged 55 years or older at diagnosis, compared to 6% of those who did have did have a prior diagnosis abroad. For female Londoners, the equivalent proportions were 21% and 8%.

Figure 6c. Number of new HIV diagnoses by age group and probable route of acquiring HIV, male London residents aged 15 to 64 years, 2023

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD).

The number of new diagnoses will depend on accessibility of testing as well as incidence.

Figure 6c is a pyramid bar chart showing the number of new HIV diagnoses by age group and probable route of HIV acquisition for male London residents aged 15 to 64 years in 2023.

Men who acquired HIV through heterosexual sex tend to be older at diagnosis than men who acquired HIV through sex between men. They also tend to be older at diagnosis compared to women.

For those who probably acquired HIV via sex between men (GBMSM) the 25 to 34 year group accounted for the highest number of new HIV diagnoses (279), while for those whose HIV acquisition was by any other route it was the 35 to 44 year group (83). Men who were not GBMSM tended to be older at diagnosis than GBMSM.

The side of the pyramid representing GBMSM is considerably affected by skewing, with each age group above the 25 to 34 year group markedly smaller than the one below it. A similar progression is not seen for non-GBMSM. For non-GBMSM, the 3 age groups spanning ages 24 years to 54 years are quite similar in size. The proportion of GBMSM Londoners newly diagnosed with HIV who were aged 15 to 24 years at diagnosis was 13% compared to only 3% for other male Londoners. Just over half of GBMSM were aged 25 to 34 years at diagnosis compared to 28% of men who were heterosexual.

Figure 7a. Number of new HIV diagnoses probably acquired through sex between men by age group and year of first UK HIV diagnosis, London residents aged 15 to 64 years, 2014 to 2023 [note 1]

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD).
The number of new diagnoses will depend on accessibility of testing as well as incidence.

Note 1: Numbers may rise as further reports are received and more information is obtained. This is more likely to affect more recent years, particularly 2023.

Figure 7a is a line chart showing the number of new HIV diagnoses by age group for GBMSM London residents aged 15 to 64 years from 2014 to 2023. Diagnoses in those aged between 15 and 64 years accounted for an average of 99% of diagnoses in GBMSM Londoners over the 10-year period. The final points on the lines correspond to the bars on the left hand side of figure 6c.

Prior to 2021 diagnoses had been declining in all age groups, but in 2022 they began to increase again in the younger age groups. In 2023 diagnoses rose for all age groups compared to 2022, the largest rise being seen in the 55 to 64 year age group (41%) and the smallest in the 35 to 44 year age group (4%).

Numbers of diagnoses remained significantly lower for all age groups compared to 2014 with the number of GBMSM diagnosed in 2023 only around a third of the number in 2014. Numbers of diagnoses in the age group with the most diagnoses, those aged 25 to 34 years, were 59% lower in 2023 compared to 2014.

The decline compared to 2014 was much larger for GBMSM born in the UK aged 15 to 64 years (83%) compared to those born abroad (54%). For the 25 to 34 year age group (the age group with the highest number of diagnoses in both cases), the decrease was 88% for UK-born GBMSM London residents, double the 44% seen in GBMSM London residents in this age group who were born abroad.

Migrants tend to be younger working-age people. As such, for all acquisition groups, the possibility of an interaction between age and migration trends must be considered when interpreting trends by age group. Among GBMSM Londoners newly diagnosed with HIV, the proportion born abroad increased from 62% in 2014 to 81% in 2023. However, almost half of GBMSM Londoners born abroad who were recorded as newly diagnosed with HIV in 2023 were in fact continuing treatment in the UK.

Figure 7b. Number of new HIV diagnoses probably acquired through heterosexual sex by age group (in years) and year of first UK HIV diagnosis, London residents aged 15 to 64 years, 2014 to 2023 [note 1]

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD).

The number of new diagnoses will depend on accessibility of testing as well as incidence.

Note 1: Numbers may rise as further reports are received and more information is obtained. This is more likely to affect more recent years, particularly 2023.

Figure 7b is a line chart showing the number of new HIV diagnoses by age group for heterosexual London residents aged 15 to 64 years from 2014 to 2023. Bisexual women are included. Diagnoses in those aged between 15 and 64 years accounted for an average of 96% of diagnoses in heterosexual Londoners over the 10-year period.

Diagnoses remained lower in 2023 than in 2014 for heterosexual Londoners in all age groups other than those aged 55 to 64 years. For this group, the number of diagnoses in 2023 (80 new HIV diagnoses) represented an 18% increase on the number in 2023 (68). A small decrease (2%) was seen in relation to 2022 however (82). Heterosexual Londoners in this age group who were diagnosed with HIV in 2023 were less likely to have a prior diagnosis abroad (24%) compared to all heterosexual Londoners diagnosed with HIV in that year (41%).

The 3 age groups covering adults aged 25 to 54 years all followed a similar trend: decreasing until around 2020 to 2021 (the pandemic period) and then beginning to increase. All 3 groups saw increases in 2023 compared to 2022, with the steepest being that seen for the 35 to 44 year age group: 53% (from 129 to 198 diagnoses). This was the largest age group throughout the 10 year period. In 2023, 48% of heterosexual Londoners in this age group who were newly diagnosed with HIV had a prior diagnosis abroad and were continuing care in the UK.

The 15 to 24 year age group was the smallest age group in relation to heterosexual Londoners diagnosed with HIV between 2014 and 2023. It was affected by the largest decline over the 10 year period (70%) and was also the only age group to experience a large decrease in 2023 compared to 2022 (20%). However, this age group has also seen decreases in testing and so changes in diagnoses should be interpreted with caution.

Figure 8. Number of new HIV diagnoses by ethnic group (adjusted for missing ethnic group information), London residents, 2014 to 2023 [note 1]

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD).

NPDA = Not previously diagnosed abroad.

The number of new diagnoses will depend on accessibility of testing as well as incidence.

Note 1: Numbers may rise as further reports are received and more information is obtained. This is more likely to affect more recent years, particularly 2023.

Figure 8 is a line chart showing the number of new HIV diagnoses in London residents by ethnic group from 2014 to 2023. The White and Black African ethnic groups are represented as distinct categories. All other ethnic groups are grouped into a single category. As with the probable route of acquisition line chart there is a pair of lines for each ethnic category shown, one showing all new HIV diagnoses and one showing the number once those previously diagnosed abroad are excluded. New HIV diagnoses with missing information about ethnic group (13% of new HIV diagnoses between 2014 and 2023) were allocated proportionately to the 3 categories.

All 3 of the categories show a declining trend, especially the White group. Over the 10-year period the White with 1,375 new HIV diagnoses in 2014 decreased by 62% to 520 in 2023 (or by 71% from 1,271 to 365 excluding those previously diagnosed abroad). New HIV diagnoses in the Black African group fell by 16% from 558 in 2014 to 471 in 2023 (or by 52% from 518 to 251 excluding those previously diagnosed abroad) and the category representing all other ethnic groups decreased by 12% from 627 in 2014 to 552 in 2023 (or by 38% from 592 to 365 excluding those previously diagnosed abroad). This last category is very heterogenous.

When 2023 is compared to 2022, the largest rise in new HIV diagnoses was seen for the Black African ethnic group. A 57% (or 27% excluding those with a prior diagnosis abroad) rise was seen for this group. New diagnoses rose by 5% for the ‘all other ethnic groups’ category (if those diagnosed previously abroad are included but fell by 2% if they are excluded). For the White ethnic group, decreases were seen regardless of whether those continuing treatment after being diagnosed abroad were included (9% decrease) or excluded (14% decrease).

Probable route of HIV acquisition and ethnic group correlate to some extent. Almost half of Londoners diagnosed in 2023 who acquired HIV via heterosexual sex identified themselves as Black African, while more than half of GBMSM identified themselves as White. This should be considered when interpreting trends for either variable.

Black Africans were the group most likely to have been born abroad (91% of Black Africans diagnosed between 2014 and 2023) while people in the Black Caribbean group were least likely to be born abroad (55%).

Changes in migration patterns should be considered when interpreting decreases or increases in new HIV diagnoses in different ethnic groups. However, ethnic group is not a proxy for country or world region of birth. Ethnicity is a complex concept and is self-identified within the limitations of the options that are officially provided.

Rates are for all ages but age distributions differ by ethnic group, with the White British group having the oldest age distribution, which will depress its rate as numbers of HIV diagnoses in the oldest age groups are lower.

Other important determinants, such as deprivation and issues of stigma, also vary by ethnic group. Charts and tables by ethnic group should always be interpreted in the wider context of health determinants and never in isolation.

Figure 9. Number of new HIV diagnoses by world region of birth (adjusted for missing world region of birth information), London residents, 2014 to 2023 [note 1]

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD).

NPDA = Not previously diagnosed abroad.

The number of new diagnoses will depend on accessibility of testing as well as incidence.

Note 1: Numbers may rise as further reports are received and more information is obtained. This is more likely to affect more recent years, particularly 2023.

Figure 9 is a line chart showing the number of new HIV diagnoses in London residents by world region of birth from 2014 to 2023. The UK and Africa are represented as distinct categories. All other world regions of birth are grouped into a single category. Again, there is a pair of lines for each category shown, one for all new HIV diagnoses and another showing diagnoses excluding those in people previously diagnosed abroad. New HIV diagnoses with missing information about world region of birth (20% of new HIV diagnoses between 2014 and 2023) were allocated proportionately to the 3 categories.

All 3 categories show a declining trend until 2021. New diagnoses began to rise again in 2022, however numbers for all 3 categories remained below 2014 levels.

New HIV diagnoses in those born in the UK were 71% lower in 2023 than in 2014 (down from 814 to 234 new HIV diagnoses). Excluding those with a prior diagnosis abroad results in a slightly larger decrease (73%). Comparing 2023 with 2022, this group saw a decrease of 1% (or 7% if those with a prior diagnosis abroad are excluded).

The countries of birth of London residents diagnosed with HIV between 2014 and 2023 who were born outside the UK varied widely. Over 180 countries of birth were reported over the 10-year period, encompassing every region of the world other than Antarctica.

For those born in Africa, new HIV diagnoses were 10% lower in 2023 than in 2014 (a fall from 590 to 532 new HIV diagnoses). Almost half of those born in Africa who were newly diagnosed in 2023 were continuing care in the UK and excluding those diagnoses has a much larger effect for this group, resulting in a decrease of 47%. There was an increase of 12% when 2023 is compared to 2022 if those with prior diagnoses abroad are included, but a decrease of 18% if they are excluded. West Africa was the most commonly reported African subregion of birth for Africa-born Londoners diagnosed between 2014 and 2023.

The ‘all other countries’ category is extremely heterogeneous, with countries in Europe and Latin America among the more commonly reported countries of birth. New HIV diagnoses for this group were 33% lower in 2023 compared to 2014 if those with a prior diagnosis abroad were included and 54% lower if they were excluded. A different picture is seen when 2023 is compared to 2022 however. This was the only category with an increase when those with a prior diagnosis abroad were excluded.

London is a global city (8) with large communities of people born outside the UK, including in continental Europe and other populous world regions such as Latin America and Sub-Saharan Africa. London has the highest proportion of people born abroad of any city in the UK (9). Migrants are more likely than non-migrants to be working-age adults, rather than older adults. Older adults tend to have a lower incidence of HIV. It is essential to consider the size of a community and its distributions by gender and age when interpreting the proportion of diagnoses in people within that community.

Table 1. Number of new HIV diagnoses by ethnic group and whether born abroad, London residents, 2019 to 2023 [note 1]

Ethnic group	UK-born	Born abroad	Unknown country of birth
White	466	718	558
Black African	63	711	100
Black Caribbean	65	75	36
Black Other	46	91	49
Indian/Pakistani/Bangladeshi	39	133	40
Other Asian (including Chinese)	10	122	92
Mixed/Other	88	339	220
Unknown	75	210	540

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD).

The number of new diagnoses will depend on accessibility of testing as well as incidence.

Note 1: Numbers may rise as further reports are received and more information is obtained. This is more likely to affect more recent years, particularly 2023.

Table 1 shows that the relationship between ethnic group and whether a person newly diagnosed with HIV was born abroad but didn’t have a prior diagnosis abroad. Data is for the 5-year period 2019 to 2023. To make it clear that there are differences in completeness of ascertainment of country of birth for different ethnic groups, numbers in this table are not adjusted for missing information.

For Black Africans, country of birth was known for 89% of those newly diagnosed with HIV with no prior diagnosis abroad. Of these, 92% of Black Africans newly diagnosed with HIV were born abroad (711 new HIV diagnoses).

Country of birth was known for 68% of those in the White ethnic group. Of these, a smaller proportion were born abroad but it was still the majority (61% or 718 new HIV diagnoses).

For Black Caribbeans, 80% had a known country of birth. This ethnic group had the lowest percentage born abroad: 54%, equating to 75 new HIV diagnoses.

The other Black group was more similar to the Black Caribbean than to the Black African group: 74% had a known country of birth and of these 66% (91) were born abroad.

The Asian group have been split into an Indian/Pakistani/Bangladeshi (IPB) group and a group containing all other Asians, including Chinese people. Country of birth was reported for 81% of the IPB group and of those 77% (133) had been born abroad. The other Asian group had the lowest proportion with a reported country of birth (59%) but where we did have this information 92% (122) were born abroad.

The remaining mixed/other group is extremely heterogenous. Country of birth was known for 66% of people in this category and of these 79% (339) had been born abroad.

The number of diagnoses in any group containing a large proportion of people who were born abroad is sensitive to changes in migration patterns over time.

Figure 10a. New HIV diagnoses in GBMSM not previously diagnosed abroad by whether born abroad, London residents, 2014 to 2023 [note 1]

Source: UKHSA, HANDD.

The number of new diagnoses will depend on accessibility of testing as well as incidence.

Note 1: Numbers may rise as further reports are received and more information is obtained. This is more likely to affect more recent years, particularly 2023.

Figure 10a is a line chart which displays new HIV diagnoses in GBMSM Londoners over the period 2014 to 2023 subdivided by whether born in the UK or abroad.

It shows that, when GBMSM newly diagnosed with HIV who had been previously diagnosed abroad are excluded, people born abroad were the largest sub-group in 2023 (221 diagnoses or 72% of those with a known country of birth).

This proportion was almost unchanged from the previous year, when it was 71%. Absolute numbers of new diagnoses increased compared to the previous year for GBMSM in both those born in the UK (87 in 2023, up from 53 in 2022) and born abroad (up from 132 in 2022). There was also a large increase in data completeness with country of birth reported for 96% of GBMSM Londoners diagnosed in 2023 compared to 67% in 2022. The upward trend for the UK-born and born abroad lines in the chart is affected by both these changes.

Figure 10b. New HIV diagnoses in heterosexuals not previously diagnosed abroad by whether born abroad, London residents, 2014 to 2023 [note 1]

Source: UKHSA, HANDD.
The number of new diagnoses will depend on accessibility of testing as well as incidence.

Note 1: Numbers may rise as further reports are received and more information is obtained. This is more likely to affect more recent years, particularly 2023.

Figure 10b is a line chart which displays new HIV diagnoses in heterosexual Londoners over the period 2014 to 2023 subdivided by whether born in the UK or abroad. Unless otherwise stated, in this report the term ‘heterosexuals’ means people who are believed to have acquired HIV via sex between men and women. The chart shows that, when heterosexuals newly diagnosed with HIV who had been previously diagnosed abroad are excluded, people born abroad are still by far the largest group (271 diagnoses or 81% of those with a known country of birth). This proportion represented a percentage point increase of 3% compared to 2022, when it was 78%.

Absolute numbers of new diagnoses decreased slightly compared to the previous year for heterosexuals born in the UK (65 in 2023, down from 67 in 2022) but increased for heterosexuals born abroad (up from 234 in 2022). There was also an increase in data completeness with country of birth reported for 94% of heterosexual Londoners diagnosed in 2023 compared to 86% in 2022. The trends for the UK-born and born abroad lines in the chart are affected by both these changes.

Figure 11. Percentage of new HIV diagnoses, by local authority of residence, that were diagnosed late, London, aged 15 years and over, 2021 to 2023 [note 2]

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD), HIV & AIDS Reporting System (HARS).

Note 2: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count less than 350 cells/mm³. The underlying population will impact on the proportion diagnosed late, for example, GBMSM are less likely to be diagnosed late.

Figure 11 is a column chart showing the percentage of HIV diagnoses for the period 2021 to 2023 that are estimated to have been made ‘late’ in relation to the time of acquisition by London local authority of residence. The calculation is restricted to residents aged 15 years or older with no prior diagnosis abroad and for whom there is an associated CD4 count within 91 days of diagnosis. The categorisation of an HIV diagnosis as ‘late’ is based on CD4 count at diagnosis as this count tends to decline over time in people living with untreated HIV. The chart and most of the other late diagnosis charts that follow it use 3 years’ data grouped together. This is to improve robustness given that only those new HIV diagnoses that meet the restriction criteria can be included in the denominator.

The order of local authorities is different from that seen for new HIV diagnoses with outer London local authorities, such as Hounslow (65%) and Kingston-upon-Thames (56%) having the highest percentages of late diagnoses.

At the far end of the chart, which shows local authorities with lower proportions of late diagnoses, there is one outer London local authorities, Richmond (19%) but then 2 inner London local authorities, Kensington and Chelsea and Westminster, both with a late diagnosis percentage of 26%.

When interpreting these percentages it is important to be aware that the proportion is sensitive to the geographical distribution of different acquisition groups. Local authorities with higher proportions of GBMSM tend to have lower late diagnosis percentages. This reflects greater awareness of HIV and higher testing rates for this group, compared to heterosexuals.

In addition, confidence intervals tend to be wider for these proportions, compared to new HIV diagnosis rates, as the denominator for the calculation is the number of new HIV diagnoses (that meet the additional criteria described in the note below the chart). Confidence intervals tend to be particularly wide for outer London local authorities where numbers of new HIV diagnoses are low.

Figure 12a. Percentage and number of new HIV diagnoses by probable route of acquisition that were diagnosed late, London residents, aged 15 years and over, 2021 to 2023 [note 3]

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD), HIV and AIDS Reporting System (HARS).

Note 3: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count less than 350 cells/mm³. Proportions are only shown for the sex between men, heterosexual sex (males), heterosexual sex (females) and injecting drug use exposure groups and are withheld for any of these categories if they contain fewer than 5 late diagnoses.

Figure 12a is a column chart. For each major exposure category, it shows the percentage of HIV diagnoses for the period 2021 to 2023 among London residents aged 15 years or older that are estimated to have been made late. As with the previous chart, the calculation is restricted to new HIV diagnoses where there is an associated CD4 count within 91 days of diagnosis and no evidence of a prior diagnosis abroad. Heterosexual contact refers to sex between men and women.

Men who probably acquired HIV via sex between men were least likely to be diagnosed late (30%). This reflects the higher testing rates and greater engagement with sexual health services seen in GBMSM. GBMSM resident in London were less likely to be diagnosed late than those resident in the rest of England (37%).

A late diagnosis was much more common for both men and women who probably acquired HIV through heterosexual sex, with heterosexual men having an even higher percentage (57%) than women (50%). Some women may have additional opportunities to be diagnosed via antenatal services and this may partly explain some of the difference between men and women in this group. Heterosexual male Londoners had a similar likelihood of being diagnosed late to those in the rest of England (57% in London compared to 56% elsewhere in England). For heterosexual female Londoners a greater difference is seen, with 50% of heterosexual female Londoners diagnosed late compared to 45% elsewhere in England.

For those who probably acquired HIV via injecting drug use the percentage diagnosed late was 56%. The confidence interval for this group is much larger however as the number of new HIV diagnoses in this group was much smaller.

Figure 12b. Percentage and number of new HIV diagnoses by ethnic group that were diagnosed late, London residents, aged 15 years and over, 2021 to 2023 [note 4]

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD), HIV and AIDS Reporting System (HARS).

Note 4: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count less than 350 cells/mm³. Proportions are only shown for the White, Black African and Black Caribbean ethnic groups and are withheld for any of these ethnic group categories if they contain fewer than 5 late diagnoses. IPB means Indian/Pakistani/Bangladeshi.

Figure 12b is a column chart. It is structured in the same way as figure 12a and shows percentages of HIV diagnoses made late by ethnic group for London residents aged 15 years or older for the period 2021 to 2023. As with all late diagnosis charts, the calculation is restricted to new HIV diagnoses where there is an associated CD4 count within 91 days of diagnosis and no evidence of a prior diagnosis abroad.

When interpreting these percentages, it is important to note the association between having acquired HIV via heterosexual sex and a late diagnosis, as some ethnic groups have a higher proportion of diagnoses in people who are believed to have acquired HIV via this route.

The White ethnic group had the lowest percentage of diagnoses made late (33%), while the Indian/Pakistani/Bangladeshi (IPB) group had the highest (57%), followed by the Black African group (55%). It is important to note that the confidence intervals for ethnic groups with fewer diagnoses, for example, the Chinese ethnic group, are much wider than for those with more diagnoses.

Figure 13. Percentage of new HIV diagnoses that were diagnosed late by probable route of acquisition and year of first UK HIV diagnosis, London residents, aged 15 years and over, 2014 to 2023 [note 5]

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD), HIV and AIDS Reporting System (HARS).

Note 5: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count less than 350 cells/mm³.

Figure 13 is a line chart showing trends in late diagnoses in London residents aged 15 years or older between 2014 and 2023 by exposure group in 3 categories: sex between men, sex between men and women and all other acquisition routes. As with all late diagnosis charts, the calculation is restricted to new HIV diagnoses where there is an associated valid CD4 count and no evidence of a prior diagnosis abroad. Percentages in this chart are less robust as numbers in individual years are small and should be interpreted as indicative of broad trends only.

New HIV diagnoses are excluded from late diagnosis calculations if they do not have an associated CD4 count within 91 days of the diagnosis. For the period 2014 to 2023, this information was available for 87% of diagnoses where the route of acquisition was believed to be sex between men, 84% of diagnoses where it was believed to be sex between men and women and 74% of diagnoses where HIV was believed to have been acquired non-sexually.

The chart shows that late diagnoses in those probably acquiring HIV through sex between men were lowest but started to rise after 2018, reaching 32% in 2022 (double the percentage in 2014, 16%). The proportion in 2023, 28%, was slightly lower. This increase in the proportion of GBMSM Londoners diagnosed late over the 10-year period should be seen in the context of an 61% decrease in the number of late diagnoses in this group between 2014 and 2023, from 208 in 2014 to 81 in 2023.

For those probably acquiring HIV via heterosexual sex the percentage was above 50% for all years in the 10-year period other than 2019 when it was 47% and 2023, the most recent year, when it was 48%. The proportion diagnosed late was particularly high for this group during the 2 main pandemic years, 2020 and 2021, during both of which it was 59%. Although the proportion diagnosed late remained high, the number of late diagnoses declined by 53% from 327 in 2014 to 154 in 2023.

The trend for the other HIV acquisition routes group was more variable as this group is heterogenous the number of new HIV diagnoses is low. The lowest percentage recorded was for 2016 when it was 32% while the highest was 62% in 2021. For all years from 2016 onwards the number of late diagnoses in this group was less than 10.

The decrease in the number of late diagnoses, even as the proportion diagnosed late increased for the GBMSM group and remained high for other routes of acquisition suggests that effective treatment and more frequent testing may be preventing onward transmission but sub-populations within this group remain that are not being reached as effectively.

Figure 14. Percentage of new HIV diagnoses that were diagnosed late in GBMSM and heterosexuals by whether born abroad, London residents, aged 15 years and over, 2021 to 2023 [note 5]

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD), HIV and AIDS Reporting System (HARS).

Note 5: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count less than 350 cells/mm³.

Figure 14 is a column chart. For 2 exposure groups, GBMSM (those probably acquiring HIV through sex between men) and heterosexuals (those probably acquiring HIV through sex between men and women) 2 columns are displayed. The first shows the percentage of UK-born London residents in each group that were diagnosed late, the second the percentage of London residents born abroad in each group that were diagnosed late. The data spans 3 years: 2021 to 2023.

For GBMSM there was little difference between those born in the UK and those born abroad (around a third of each group were diagnosed late). However, for heterosexuals the percentage diagnosed late was higher for those born abroad: 46% of UK-born heterosexuals and 55% of heterosexuals born abroad were diagnosed late.

Figure 15a. Age distribution of new HIV diagnoses that were diagnosed late by year of first UK HIV diagnosis, London residents, aged 15 years and over, 2014 to 2023 [note 5]

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD), HIV and AIDS Reporting System (HARS).

Note 5: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count less than 350 cells/mm³.

Figure 15a is a column chart showing the age distribution of those diagnosed late between 2014 and 2023. Unlike the previous late diagnosis charts the percentages indicate the proportion of late diagnoses that occurred within each age group, rather than showing the proportion within each group that were diagnosed late. Percentages in this chart are less robust as they are by single year and numbers are small when broken down by age group. They should be interpreted as indicative of broad trends only.

The proportion of those diagnosed late in the youngest age groups has remained broadly stable over the 10-year trend period. People aged 15 to 24 years accounted for the smallest proportion of late diagnoses in every year. In 2014, they accounted for 5% of those diagnosed late. In 2023 it was 9%, the first year a value higher than 7% had been recorded during the period. A rising trend, broadly speaking, was seen for the oldest age group, those aged 55 years or older. This group accounted for 11% of late diagnoses in 2014, a high of 24% in 2021 and 20% in 2023.

The age groups with the largest proportions remained the 25 to 34 year, 35 to 44 year and 45 to 54 year age groups. The proportion for the first of those 3 groups, those aged 25 to 34 years, remained broadly stable over the 10-year period and was 25% in both 2014 and 2023. The other 2 groups tended to decrease in proportional size. The 35 to 44 year group accounted for 32% of late diagnoses in 2014 and 26% in 2023, while the 45 to 54 year age group accounted for 27% of late diagnoses in 2014 and 20% in 2023.

Median age at diagnosis was older for those diagnosed late compared to all new diagnoses eligible for inclusion in the calculation for both GBMSM and heterosexuals (see chart footnote). For 2021 to 2023, for GBMSM, the median age at diagnosis for those diagnosed late was 36 years, compared to 33 for all newly diagnosed GBMSM who met the inclusion criteria. For heterosexuals for the same period, the median age at diagnosis for those diagnosed late was 45 years, compared to 42 for all newly diagnosed heterosexuals who met the inclusion criteria.

Figure 15b. Percentage of all new diagnoses that were late by age by year of first UK HIV diagnosis, London residents, aged 15 years and over, 2014 to 2023 [note 5]

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD), HIV and AIDS Reporting System (HARS).

Note 5: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count less than 350 cells/mm³.

Figure 15b is a column chart showing the proportion of London residents in each age group who were diagnosed late between 2014 and 2023. The analysis is restricted to those aged 15 years or older with a CD4 count within 91 days of their diagnosis and no prior diagnosis abroad. As with the previous chart, percentages in this chart are less robust as they are by single year and numbers are small when broken down by age group. They should be interpreted as indicative of broad trends only.

The 55 years or older age group consistently has the highest proportion of late HIV diagnoses. In 2023 the proportion was 54%. This was a 6 percentage point increase compared to 2014, but a 9 percentage point decrease compared to 2022.

For most of the 10-year period the 15 to 24 year age group had the lowest proportion of late HIV diagnoses but this changed in 2021, from which point the age group with the lowest proportion of late diagnoses became those aged 25 to 34 years. This is largely due to a steep rise in the proportion of those aged 15 to 24 years diagnosed late after 2020. The proportion of late diagnoses in those aged 15 to 24 years had already risen by 6 percentage points from 13% in 2014 to 19% in 2020 but in 2021 this rose by a further 15 percentage points in a single year. The proportion decreased by 5 percentage points in 2022 to 29%, but this was still much higher than seen prior to 2021. In 2023 this decrease was reversed and a 6 percentage point increase brought the proportion of 15 to 24 year olds diagnosed late to 35%, the highest value recorded over the 10-year period and a 22 percentage point increase on the proportion in 2014.

The remaining age groups all saw rises of between 8 and 10 percentage points between 2014 and 2023.

Putting these proportions in the context of numbers of late diagnoses, only the 55 year and older age group saw a rise when 2023 is compared to 2014, from 65 to 67.

Figure 16. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by UKHSA region, 2023

Source: UKHSA, HIV and AIDS Reporting System (HARS).

Figure 16 is a column chart showing the prevalence of diagnosed HIV by English region for the year 2023. Rates are by 1,000 population and are restricted to those aged 15 to 59 years. The chart shows that London has a much higher rate (5.2) than any other English region. The region with the next highest rate is the North West, with a rate (2.1) less than half of London’s. As noted earlier, London has a population which is more diverse than other regions. It also has a younger age structure. In 2021, 46% of London’s population was aged 15 to 44 years compared to 37% for the rest of England.

Figure 17. Number of residents living with diagnosed HIV and accessing care, London, 2014 to 2023

Source: UKHSA, HIV and AIDS Reporting System (HARS).

Figure 17 is a line chart showing the number of Londoners living with diagnosed HIV who accessed HIV-related care in the years 2014 to 2023. As everyone living with diagnosed HIV in the UK can access care for free, this number acts as a proxy for the number of people living with diagnosed HIV. The line reflects changes in new HIV diagnoses, mortality in those living with diagnosed HIV and immigration patterns. It may also be affected by disruptions to care and changes in residence during the main pandemic year 2020. It shows that from 35,196 in 2013 the number reached a high of 37,169 in 2019, dropping down to 36,581 in 2020 before rising to a new peak of 38,477 in 2023. This represents a 9% increase on the number in 2014.

Figure 18. Number of residents living with diagnosed HIV and accessing care by probable route of acquisition (adjusted for missing route information), London, 2023

Source: UKHSA, HIV and AIDS Reporting System (HARS).

Figure 18 is a column chart which displays the number of London residents living with diagnosed HIV and accessing care in 2023 by probable route of acquisition. The columns are arranged in descending order of size. People with missing information about route of acquisition (7% of London residents living with diagnosed HIV in 2023) were allocated proportionately to the route of acquisition categories.

The chart shows that Londoners living with diagnosed HIV were overwhelmingly likely to have acquired HIV via sex, with 19,663 having probably acquired HIV through sex between men and 17,244 having probably acquired HIV through sex between men and women. By contrast, those who probably acquired HIV through vertical transmission, which was the next largest exposure group, numbered only 852 while those believed to have acquired HIV via injecting drug use numbered 521 and those who acquired HIV via blood products or as a healthcare worker numbered 197.

Figure 19. Percentage of residents with diagnosed HIV who are accessing care in each age group, London, 2014 and 2023

Source: UKHSA, HIV and AIDS Reporting System (HARS).

Figure 19 is a column chart which shows the percentage of Londoners living with diagnosed HIV and accessing care who belong to each age group. Two years are shown, 2014 and 2023.

The chart shows an ageing cohort effect as, due to decreased transmission, fewer people receive a new HIV diagnosis and, due to effective treatment, fewer die prematurely.

In 2014 the largest age group was the 35 to 49 year group, containing 50% of Londoners living with diagnosed HIV. Only 30% were aged 50 years or older. By 2023, the 50 years or older group was the largest group, accounting for 53% of those living with diagnosed HIV. In both years fewer than 1% of those living with diagnosed HIV were aged under 15 years. The value for 2023 was too low to register on the chart but was not zero.

By 2023, the median age for those living with diagnosed HIV was around 50 years for almost all transmission groups (from 48 years for those who acquired HIV via healthcare work to 53 years for heterosexuals and those who probably acquired HIV via injecting drugs). The exception was the group made up of those who probably acquired HIV via vertical transmission. This group had a median age of 27 years.

Figure 20. Diagnosed HIV prevalence per 1,000 residents by ethnic group (all ages), London, 2023

Source: UKHSA, HIV and AIDS Reporting System (HARS).

Figure 20 is a column chart which shows the prevalence of diagnosed HIV by ethnic group for Londoners in 2023. Rates are per 1,000 population. They are not age-restricted as age-restricted denominator data was not available which means they are sensitive to differences in age distribution.

The ethnic group with the highest rate was the Black African group (16.1). The White ethnic group had a rate of 3.4, but the White British population has an older age distribution than the other groups, which may cause the rate for the White group to be artificially depressed in relation to other groups. The lowest rate was seen for the Asian ethnic group (1.2).

As mentioned above, ethnic group is not a proxy for country or world region of birth. It is a complex concept, self-identified within the limitations of the options that are provided. Ethnic group specific rates should always be interpreted in the wider context of social determinants such as stigma and deprivation, and never in isolation.

Figure 21. Rate of HIV diagnoses per 1,000 population by Index of Multiple Deprivation decile, London, 2023

Source: UKHSA, HIV and AIDS Reporting System (HARS).

Figure 21 is a column chart. It shows rates of diagnosed HIV prevalence for London residents by decile of deprivation for 2023. Deciles run from most deprived (decile 1) to least deprived (decile 10). They are calculated for England as a whole and patients are assigned on the basis of their lower super output area (LSOA) of residence.

The chart shows that the diagnosed prevalence rate for areas of London that fell into the most deprived decile (6.5) was around 6 times the rate for areas that fell into the least deprived decile (1.1). While not everyone who lives in an area of higher deprivation may be deprived, the differences seen suggest that people living with diagnosed HIV are more likely living in poverty and at higher risk of additional stresses relating to financial pressures and the impact on wider determinants of health. This may negatively impact their ability to access health services.

One point that should be borne in mind when interpreting the chart gradient is that these rates are not age restricted. More affluent areas may be more likely to have older populations as people tend to accumulate wealth over their lifetime. Whilst this unlikely to account for the downward gradient seen in the chart, it may cause the gradient to decline more steeply.

Figure 22. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by local authority, London, 2023

Source: UKHSA, HIV and AIDS Reporting System (HARS).

Figure 22 is a column chart which displays the prevalence of diagnosed HIV by London local authority of residence in 2023. Rates are restricted to those aged 15 to 59 years and are by 1,000 population. As with the previous charts of this type, LAs are shown in descending order. The pattern is similar to that seen for new HIV diagnoses: inner London local authorities had higher rates while rates in outer London local authorities were lower. The highest rate was seen in Lambeth (12.5) and the lowest in Richmond (2.0). There were no boroughs where the rate was below the 2 per 1,000 threshold, above which expanded testing is advised. Fifteen of London’s 33 LAs had rates above the 5 per 1,000 threshold beyond which rates are considered to be very high and 2 had rates above 10 per 1,000.

Figure 23. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by local authority, London, 2023

Source: UKHSA, HIV and AIDS Reporting System (HARS).

Figure 23 is a map, that like figure 22, displays the prevalence of diagnosed HIV by London local authority of residence in 2023. Displaying this on a map shows more clearly the difference in diagnosed prevalence in inner London LAs compared to those in outer London. The map is shaded in relation to 6 rate bands, the highest of which is 10+ per 1,000 population aged 15 to 59 years. Two London LAs fell into this band: Lambeth and Southwark, both of which are in inner London, just south of the River Thames. The 7.5 to 10 rate band contained 3 inner London LAs: Westminster, Kensington and Chelsea and Lewisham. The lowest rate band represents rates that are lower than 1.25 per 1,000 population aged 15 to 59 years. No London LAs fell into this band.

Figure 24. Diagnosed HIV prevalence per 1,000 residents (all ages) by middle super outer area of residence London, 2023

Source: UKHSA, HIV and AIDS Reporting System (HARS).

Figure 24 is a map that displays the prevalence of diagnosed HIV by London middle super output area (MSOA) of residence in 6 rate bands for the year 2023. Unlike the local authority level map, rates are not age restricted. This reflects the smaller size of an MSOA which is a geographical unit with populations of around 7,500. It shows that there were areas of inner London that had higher rates even than inner London as a whole. There were also areas of raised prevalence outside of inner London. These included areas close to major transport links (including airports) and areas where less expensive housing is more readily available.

Figure 25. The continuum of HIV care, 2023

Source: UKHSA, HIV and AIDS Reporting System (HARS, MPES model).

Figure 25 shows the continuum of care for Londoners living with HIV in 2023. This provides evidence of the progress that London is making in relation to the UNAIDS 90-90-90 target and the higher 95-95-95 target (10). The chart consists of 4 columns with a y-axis which shows a percentage. A red line across each column shows the height that is needed for the column to meet the 90-90-90 UNAIDS target.

The first column represents all Londoners living with HIV, both diagnosed and undiagnosed and is therefore set to 100%. The second shows the percentage of those living with HIV who were diagnosed (97%), the third the percentage of those living with HIV who were diagnosed and on treatment (95%) and the fourth the percentage of those living with HIV who were diagnosed, on treatment and successfully virally suppressed (93%). If people are virally suppressed, they cannot transmit HIV to others.

The percentages and the column heights relate each group to the total number of those living with HIV. However, the UNAIDS target relates each group to the group that precedes it. In other words, 90% of those living with HIV should be diagnosed, 90% of those diagnosed should be on treatment and 90% of those on treatment should be virally suppressed. Therefore, between each column there is an arrow. This shows the relationship of each column to the one before it. The first arrow contains 97% as there is no difference: in both approaches the second column is looked at in relation to the first. The second arrow contains 98% as the 95% of those living with HIV who were on treatment represents 98% of those who were diagnosed. The third arrow contains 98% as this is the percentage of those on treatment who were virally suppressed. This means that in 2023 London achieved 97-98-98, exceeding both the standard and higher UNAIDS targets.

Figure 26. HIV testing rate per 100,000 by population group, London residents, 2019 to 2023

Source: UKHSA, GUMCAD.

The proportion of eligible attendees at specialist sexual health services (SHS) who accepted a HIV test. An eligible attendee is defined as a patient attending specialist SHS at least once during a calendar year. Patients known to be HIV positive, or for whom a HIV test was not appropriate, or for whom the attendance was related to Sexual and Reproductive Health (SRH) care only, are excluded.

Figure 26 is a line chart displaying HIV testing rates per 100,000 population for Londoners attending all sexual health services from 2019 to 2023. Numbers include people tested as a result of consultations via online services. The proportion of HIV tests via online services has increased rapidly since the pandemic. Three groups are shown:

• all residents
• all males
• all females

Throughout the 5-year period men had the highest HIV testing rate. This increased by 17% from 6,346 in 2019 to 7,422 in 2023. HIV testing rates for women also increased, from 5,538 in 2019 to 6,033 in 2023 (a rise of 9%). For all residents an increase of 14% was seen, from 5,984 in 2019 to 6,816 in 2023.

Table 2. People tested for HIV by population group, London residents attending all SHSs, 2019 to 2023

Gender/sexual orientation	2019	2020	2021	2022	2023	% change 2019 to 2023	% change 2022 to 2023
Heterosexual men	130,523	85,392	87,899	103,530	115,745	-11%	12%
GBMSM	68,969	64,176	71,294	89,719	96,929	41%	8%
Subtotal (men)	211,459	158,613	172,240	204,430	224,747	6%	10%
Hetero/bisexual women	199,969	155,082	166,452	183,881	196,591	-2%	7%
Lesbians (WOSW)	2,967	2,935	6,415	8,810	6,136	107%	-30%
Subtotal (women)	215,562	165,844	182,135	201,607	212,648	-1%	5%
Total (all genders)	430,853	326,752	358,558	413,755	445,655	3%	8%

Source: UKHSA, GUMCAD.

Note: GBMSM = Gay, bisexual, and other men who have sex with men; Lesbians (WOSW) = women who only have sex with women

Table 2 shows information about the number of Londoners attending sexual health services who tested for HIV from 2019 to 2023. Numbers include people tested as a result of consultations via online services. The proportion of HIV tests via online services has increased rapidly since the pandemic. The table shows numbers of people tested for each year and proportional change from 2019 to 2023 and from 2022 to 2023. In addition to the overall total, numbers are provided by gender and, within gender, by sexual orientation.

The table shows that, while the proportion of men tested has remained roughly stable over the 5-year period at around half of those with a known gender, this masks a decline in HIV tests in heterosexual men both in absolute numbers of men tested and compared to GBMSM. Absolute numbers of heterosexual men tested decreased from 130,523 in 2019 to 115,745 in 2023, a decline of 11%, but did increase by 12% from the 103,530 tests reported for 2022. The proportion of men with a known sexual orientation was slightly higher in 2023 (95%) compared to 2019 (94%). However, the number of heterosexual men tested as a percentage of men with known sexual orientation decreased from 65% in 2019 to 54% in 2023.

For GBMSM the number reported for 2023 was the highest over the period of comparison: 96,929 GBMSM tested, a 41% rise on the 68,969 reported for 2019.

The number of women tested for HIV in 2023 was 212,648, a slight decrease (1%) on the 215,562 recorded for 2019, the start of the comparison period. The proportion of women for whom sexual orientation was reported increases slightly from 94% in 2019 to 95% in 2023. Where sexual orientation was known, the percentage of lesbians tested for HIV increased from 1% (2,967) in 2019 to 3% (6,136) in 2023. This represented an increase of 107% in lesbians tested over the comparison period. Whilst the number of those in this group who were tested was small in relation to the heterosexual and bisexual women group, it nevertheless partially masked a slight drop (2%) in the number of those tested in the heterosexual and bisexual women group (from 199,969 to 196,591) over the 5 years.

Figure 27. HIV pre-exposure prophylaxis (PrEP) need and initiation/continuation in residents attending specialist sexual health services (SHSs), London, 2023

Source: UKHSA, GUMCAD.

Figure 27 is a column chart showing information about PrEP need and use by gender and sexual orientation in 2023. The first column represents the percentage of London residents attending specialist SHSs who were determined to be in need of PrEP based on clinical and other information. The second column shows the percentage of those in need of PrEP whose PrEP need was identified by the service, and the third column shows the percentage of those in need of PrEP for whom PrEP was initiated or continued. These 2 final columns for each group must be looked at in relation to the first column.

Figure 27 is a column chart showing information about PrEP need and use by gender and sexual orientation in 2023. The first column represents the percentage of London residents attending specialist SHSs who were determined to be in need of PrEP based on clinical and other information. The second column shows the percentage of those in need in PrEP whose PrEP need was identified by the service and the third shows the percentage of those in need of PrEP for whom PrEP was initiated or continued. These 2 final columns for each group must be looked at in relation to the first column.

GBMSM had by far the highest need for PrEP (74%). Of these, 85% had their need identified and PrEP was initiated or continued for 79%.

The group with the next highest level of PrEP need was lesbians (women who only have sex with women, WOSW), but the percentage was much lower (7%) and the absolute numbers for this group were also much lower than for any other group. Because of its small size this group is more sensitive to the effects of misclassification/miscoding. These caveats should be borne in mind when interpreting the 89% achieved for PrEP need identified and the 80% with a PrEP need identified for whom PrEP was initiated or continued.

Very low levels of PrEP need were reported for heterosexual men (2%) and heterosexual and bisexual women (1%). However, the proportions for whom PrEP need was identified were also much lower than for other groups (59% in both cases), as were the proportions with a PrEP need identified for whom PrEP was initiated or continued (44% for heterosexual men and 43% for heterosexual and bisexual women).

For all columns, other than the proportion of GBMSM with a PrEP need identified for whom PrEP was initiated or continued, which remained unchanged, the values reported represented an increase on those reported last year.

In response to unequal access to PrEP, the 2025 PrEP guidelines include new sections on equity and risk assessment, shifting away from clinical trial-based eligibility criteria. This aims to reduce barriers and expand access, including event-based dosing options for all PrEP users and use of new PrEP formulations, such as long-acting injectable cabotegravir (11).

Figure 28. Lower and upper-level estimates for the number of people living with HIV with transmissible levels of virus, London, 2023

Source: UKHSA, HARS.

Figure 28 shows a pair of data visualisations indicating the proportions of Londoners living with transmissible levels of HIV in 2023 by sub-category. Each chart, one of which shows lower-level estimates and the other upper-level estimates, is a stacked bar chart. Numbers are rounded to the nearest hundred.

The first chart shows that the lower-level estimate of Londoners living with transmissible levels of HIV in 2023 was 5,800.

Of those:

• 1,200 (21%) were undiagnosed (first section of bar)
• a further 140 (2%) people were first diagnosed in 2023 and not linked to HIV care by the end of the year (second section of bar)
• the third section of the bar shows there 1,900 people (33%) who had not been seen for care in the 15 months since their last HIV care appointment between October 2021 and September 2022
• 700 people (12%) attended HIV care in 2023 but were not receiving treatment (fourth section of bar)
• 1,800 people (31%) were on treatment in 2023 but were not virally suppressed or had no viral load reported that year but were not virally suppressed the year before (fifth section of bar)

The second chart shows that the upper-level estimate of Londoners living with transmissible levels of HIV in 2023 was 7,000. This number is 1,200 higher than the lower-level estimate. This higher number reflects 2 different approaches for estimating the number of people with transmissible levels of virus.

The lower-level estimate excludes:

• people who were on treatment and had no record of a viral load in the year of interest but did have suppressed viral loads in the previous year

and

• people who were on treatment and had no record of a viral load or treatment in the year of interest but did have suppressed viral loads at their first attendance the following year

The upper-level estimate assumes that all people with missing care, treatment or viral load records for a given year have transmissible levels of virus for that year.

Information on data sources

HIV and AIDS New Diagnoses and Deaths (HANDD) collects information on new HIV diagnoses, AIDS at diagnosis and deaths among people diagnosed with HIV. Information is received from laboratories, specialist SHSs, GPs and other services where HIV testing takes place in England, Wales and Northern Ireland. The Recent Infection Testing Algorithm (RITA) and CD4 surveillance scheme are linked to HANDD to assess trends in recent and late diagnoses. Data is deduplicated across regions and therefore figures may differ from country-specific data.

The Survey of Prevalent HIV Infections Diagnosed (SOPHID) began in 1995 and was a cross-sectional survey of all adults living with diagnosed HIV infection who attend for HIV care in England, Wales and Northern Ireland. SOPHID collected information about the individual’s place of residence along with epidemiological data including clinical stage and antiretroviral therapy (ART). In 2015, SOPHID reporting in England was replaced by the HIV and AIDS Reporting System (HARS) which captures information at every attendance for HIV care.

Date of data extract: October 2024. Updates to HANDD and SOPHID/HARS made after this date will not be reflected in this report.

Confidence intervals for rates in the figures have been calculated to the 95% level using the Byar’s method; confidence intervals for percentages have been calculated to the 95% level using the Wilson Score method. Confidence intervals presented in the text are produced by Bayesian analysis.

The most recent ONS mid-year estimates at the time of analysis were used as denominators for rates. For UTLAs 2023 estimates were used (published June 2024), for MSOAs 2022 estimates were used (published November 2024), for LTLAs 2021 estimates were used (published Nov-2022), and for LSOAs 2022 estimates were used (published November 2024).

The data behind charts showing absolute numbers may have been adjusted for missing information; however, unless stated otherwise, the numbers in the summary section are the numbers as reported, that is, unadjusted counts. Where charts are displaying adjusted data this is indicated in the chart title. Where figures have been ‘adjusted for missing information’, this means that when unknown values are present (for example, route of probable infection = ‘unknown’), they are proportionally distributed amongst other groups for the purposes of analysis (for example, if A = 12, B = 4, C = 2, and unknown = 6, the 6 ‘unknown’ values are distributed proportionally among groups A, B, and C to give A = 15, B = 6, C = 3).

The denominators for all percentages exclude records for which information was unknown, that is, the proportion of new diagnoses where probable route of acquisition was sex between men would be calculated using new diagnoses for which route of acquisition was known as the denominator.

All analyses in this report are residence-based and reflect the patient’s place of residence at diagnosis.

Numbers may change as more information becomes available to assign area of residence to cases and historical data is refreshed accordingly.

Further information

Access the online ‘Sexual and Reproductive Health Profiles’ for further information on a whole range of sexual health indicators.

For more information on local sexual health data sources please access the UKHSA guide.

See the annual epidemiological spotlight on STIs in London: 2023 data.

See the national HIV report: 2023 data.

Local authorities have access to additional HIV and STI intelligence via the Data Exchange and the HIV and STI web portal. They should also have received a set of tables containing HIV data specific to their authority. They should contact fes.seal@ukhsa.gov.uk if they do not have access to this information.

About the Field Service

The Field Service was established in 2018 as a national service comprising geographically dispersed multi-disciplinary teams integrating expertise in Field Epidemiology, Real-time Syndromic Surveillance and Public Health Microbiology to strengthen the surveillance, intelligence and response functions of UKHSA.

You can contact your local Field Service team at FES.SEaL@ukhsa.gov.uk

If you have any comments or feedback regarding this report, contact josh.forde@ukhsa.gov.uk

Acknowledgements

We would like to thank:

• local sexual health and HIV clinics for supplying the HIV data
• the Institute of Child Health
• UKHSA Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division (BSHSH) for collection, analysis and distribution of data

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