Annual epidemiological spotlight on HIV in London: 2024 data

Question 1

Summary

Accepted Answer

During 2024 and 2025, the UK Health Security Agency (UKHSA) engaged in a stakeholders’ review on language use for HIV. Consequently, a number of changes have been made to the language used in this report. These include reference to gender identity, sexual orientation and probable route of exposure:

for gay, bisexual and all men who have sex with men, the abbreviation is gay and bisexual men (instead of GBMSM or sex between men)
for heterosexual men or men who acquired HIV through sex with women, we abbreviate as heterosexual men (instead of men exposed through sex with women)
for heterosexual and bisexual women or women who acquired HIV through sex with men, we use heterosexual women (instead of women exposed through sex with men)

In previous HIV Spotlights reports, counts of new HIV diagnoses included people diagnosed with HIV before continuing care in England (referred to as ‘previously diagnosed abroad’). These cases do not reflect HIV acquired in England and most of these individuals are rapidly linked to care shortly after arrival, making the majority extremely unlikely to pass on HIV in England (1). For this report, reflecting changes in national HIV statistics, reference to new HIV diagnoses now only includes diagnoses first made in England.

HIV remains an important public health issue in London. Diagnoses have been declining over a long period but in recent years they have plateaued at around 1,000 new diagnoses per year. Interpreting trends over the period which includes 2020 and 2021 is challenging due to the disruptions in access to sexual health services and reduced social mixing during these years. Deaths are relatively stable too at around 250 per year so the number of people living with HIV in London is increasing year-on-year. In 2024, approximately 39,000 people were living with HIV in London and accessing care.

This report aims to provide key intelligence about HIV in London. For a broader context see UKHSA’s national HIV report (2).

New diagnoses

In 2024, 971 London residents were newly diagnosed with HIV, accounting for 35% of new diagnoses in England. This represents a fall of 5% from 2023.

The new diagnosis rate for London residents (11 per 100,000) was above that of England in 2024 (5 per 100,000).

In 2024, 46% of all new diagnoses in London residents were in gay and bisexual men (compared to 46% in 2023 and 65% in 2015). The number of gay and bisexual men resident in London newly diagnosed with HIV (445, adjusted for missing information) was 65% lower than in 2015. Of the gay and bisexual men newly diagnosed with HIV 49% were White and 34% were UK born.

Heterosexual contact was the largest route of exposure for new diagnoses in London residents in 2024 (51%). Infections in African-born persons accounted for 54% of all heterosexually acquired cases in 2024 (n=187), compared to 51% (n=260) in 2015. Infections in UK born persons accounted for 20% of all heterosexually acquired cases in 2024.

Injecting drug use accounted for 1% of new diagnoses in London residents. Black Africans represented 29% of all newly diagnosed London residents in 2024 (compared to 26% in 2023 and 19% in 2015). A small proportion of new diagnoses in 2024 were in Black Caribbeans (6%).

The number of new diagnoses was highest in the 25 to 34 year age group in males and the 35 to 44 year age group in females in 2024.

Late diagnoses

Reducing late HIV diagnoses is one of the indicators in the Public Health Outcomes Framework and HIV Action Plan Monitoring and Evaluation Framework. 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 (39% from 2022 to 2024, compared to 43% in England), defined by a CD4 count of less than 350 cells/mm³ at diagnosis.

In London, heterosexual men (51%) and heterosexual women (48%) were more likely to be diagnosed late than gay and bisexual men (28%). By ethnic group, Black Africans were more likely to be diagnosed late than the White population (49% and 31% respectively).

People living with diagnosed HIV

The 38,933 people living with diagnosed HIV in London in 2024 was 2% higher than in 2023 and 7% higher than in 2015. 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 2024 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. Almost all local authorities in London had a diagnosed HIV prevalence in excess of 2 per 1,000 population aged 15 to 59 in 2024, which is the threshold for expanded HIV testing. The only local authorities in London with a diagnosed prevalence below this level were Kingston-upon-Thames (2) and Richmond-upon-Thames (2).

The 2 most common probable exposure groups for London residents living with diagnosed HIV in 2024 were gay and bisexual men (51%) and heterosexual sex (45%). In 2024, 34% of those living with diagnosed HIV in London were aged between 35 and 49 years, and 54% were aged 50 years and over (up from 32% in 2015). Males represented 70% of London residents living with diagnosed HIV in 2024 and females represented 30%.

In 2024, 43% of London residents living with diagnosed HIV were White and 30% 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).

HIV testing

A total of 218,535 people were tested in specialist sexual health services (SHSs) in London in 2024, an increase of 67% since 2020 and an increase of 13% since 2023. The HIV testing rate (per 100,000 population) at all SHSs in London was 6,980, which compares to 2,843 across England. HIV testing rates in all SHSs (specialist and non-specialist sexual health services) in London is higher in men (7,768) than women (5,965).

PrEP

In 2024, 18% of HIV-negative London residents accessing SHSs in England were defined as having a pre-exposure prophylaxis (PrEP) need, among whom 82% initiated or continued PrEP. Of those with PrEP need, 87% had this need identified at a clinical consultation. Among gay and bisexual men, the group with greatest need, these proportions were: 79% need, 84% initiated/continued and 88% identified at consultation. 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.

HIV in England

The HIV Action Plan for England, 2025 to 2030 was published on 1 December 2025. It sets UNAIDS 2025 ambitions to reduce HIV transmission (measured by new HIV diagnoses) and AIDS-related deaths by 90% between 2010 and 2030. New diagnoses among White gay and bisexual men are on track to reach the ambition, however further work is needed over the next 5 years for other population groups such as ethnic minority gay and bisexual men, Black African and Other ethnic minority heterosexual populations. This is why HIV Official Statistics this year highlight progress along the HIV pathway for 5 population groups.

The number of people first diagnosed with HIV in England decreased by 2% in 2024 (2,838 in 2023 to 2,773) (2). Gay and bisexual men accounted for almost 30% of new HIV diagnoses (810 of 2,773), with heterosexual men 23% (634) and heterosexual women 27% (749). Within and between these population groups, there remains evidence of considerable inequalities (2). Further provision of services that are culturally competent and accessible to diverse populations is needed.

The number of new HIV diagnoses in England decreased by 6% (859 to 810) in 2024 for gay and bisexual men (2). However, this reduction was not seen consistently among all ethnic groups. While a reduction of 6% was observed among White gay and bisexual men (488 to 461), new HIV diagnoses increased among Black (15%, 80 to 92) and Asian (6%, 101 to 107) gay and bisexual men. Nearly half (48%, 386 of 810) of the gay and bisexual men newly diagnosed in England in 2024 were born abroad.

For heterosexual men and women, the number of new HIV diagnoses were similar in 2024 compared to 2023 (1,371 to 1,383), although numbers increased for heterosexual men (by 3%, 615 to 634) and decreased marginally for heterosexual women (by 1%, 755 to 749) (2). As with gay and bisexual men, for heterosexual men and women, there was considerable variation between ethnic groups. Notably, new HIV diagnoses among Black African heterosexual men increased by 15% (231 to 265) but decreased by 5% among Black African heterosexual women (441 to 418). Of the heterosexual men newly diagnosed in 2024, 27% (170 of 634) were known to be born in the UK and 68% (431 of 634) abroad. Among women, 15% (116 of 749) were known to be born in the UK and 77% (580 of 749) abroad.

Overall, the number of people tested for HIV in sexual health services in England was 3% higher in 2024 than 2023 but has not fully recovered to pre-pandemic (2019) levels for all groups. Whereas testing increased markedly within specialist SHSs (9%), non-specialist online testing declined by 4% in 2024. The proportion of people tested through online consultations at all SHSs (compared to face-to-face) fell by 3%, continuing a year-on-year reduction in this proportion since a peak in 2021. There was a 7% decrease in the HIV testing rate in all SHSs in people aged 15 to 24 years. This compares to a continued increase in the HIV testing rate in all other age groups. Testing increases were observed across gender and sexual orientation groups (gay and bisexual men, 2% increase; heterosexual men, 5%; heterosexual woman, 2%).

Consistently increased testing for gay and bisexual men, coupled with an overall decline in HIV test positivity (0.3% in 2020 to 0.2% in 2024) suggests that there may be a reduction in transmission in this community. HIV test positivity in heterosexual men and women has remained similar in 2023 and 2024 (0.05% to 0.06%, and 0.08% to 0.08%, respectively).

The programme of emergency departments (ED) opt-out testing for bloodborne viruses continues to be a successful approach for HIV diagnoses, contributing to 8% of all new HIV diagnoses in 2024.

The number of people diagnosed with HIV before continuing care in England fell markedly in 2024 (3,363 to 2,525) with a corresponding 15% drop in all HIV diagnoses (6,201 to 5,298). The reduction in the number of people diagnosed before continuing care in England was most pronounced in heterosexual women (33%), compared to reductions in heterosexual men (11%) and gay and bisexual men (21%). The decline in the number of people diagnosed before continuing care in England in 2024 varied by ethnic group. The largest proportionate reductions in numbers (compared to 2023) were seen in people of Black Other (30%; 79 to 55), Black African (28%; 2,196 to 1,587), Asian (25%; 228 to 172), Other or Mixed (25%; 288 to 216) and White (22%; 326 to 253) ethnicities.

The number of people receiving HIV pre-exposure prophylaxis via SHSs has been increasing on an annual basis since 2020, increasing by 7.7% between 2023 and 2024 (111,123 in 2024 versus 103,138 in 2023). However, inequalities in access remain. While the overall number of gay and bisexual men with unmet HIV PrEP need was highest, there is proportionally greater unidentified and unmet PrEP need among heterosexual men and women.

Despite a 2% decrease in the number of adults being diagnosed late between 2023 and 2024 (950 to 928), 42% (928 of 2,196) of the new HIV diagnoses were made at a late stage in England in 2024. Reductions in the number of late HIV diagnoses fell most among gay and bisexual men (11%) compared with heterosexual women (4%) and heterosexual men (1%). The percentage of new diagnoses that were late for all 3 groups remained similar to 2023 (45% to 46%, 53% to 52%, 31% to 30% for heterosexual women, heterosexual men, and gay and bisexual men, respectively). In 2024, half of adult Black African heterosexual men and women newly diagnosed with HIV were diagnosed late (285 of 572; 50%). People diagnosed late with HIV in England in 2024 were 10 times more likely to die within a year of their diagnosis, compared to those diagnosed promptly.

Provisional estimates are that 95% of all adults living with HIV in England are diagnosed, with 99% of diagnosed adults receiving treatment, and 98% of adults on treatment having suppressed viral loads.

HIV prevention messages

Combined prevention methods prevent HIV; these include HIV testing and treatment, PrEP and condom use. Using condoms consistently and correctly protects against HIV and other STIs such as chlamydia, gonorrhoea and syphilis.

HIV testing is central to HIV prevention since it provides access to PrEP and health advice for those who don’t have HIV, while an HIV result leads to essential HIV care and treatment, keeping a person healthy and preventing onward transmission. Anyone having sex without a condom with new or casual partners needs an STI screen, including an HIV test, on at least an annual basis. Gay and bisexual men should have tests 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 SHSs 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 SHSs, awareness, accessibility and uptake of this primary prevention initiative remain low in many population groups (3).

HIV post-exposure prophylaxis (PEP) can be used to reduce the risk of acquiring HIV following exposure. PEP is available for free from specialist SHSs 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 (4).

Stigma, anxiety and depression experienced by people living with HIV may stop them seeking healthcare, engaging in treatment and remaining in care (5). 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 at 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 all actions published recently in the HIV Action Plan for England (HIVAP). Below are some examples of how this could be done, focusing on each of the f5 HIVAP priorities:

Prevent

Drive forward HIV service improvements and innovation with a focus on reducing inequalities in HIV testing, access to HIV PrEP and PEP.
Collate evidence and best practice of HIV PrEP provision pilot studies.
Ensure localities are aware that there is central funding for formula milk (and related sterilised equipment) for the infants of women living with HIV.

Test

Implement and monitor British HIV Association (BHIVA), British Association for Sexual Health and HIV (BASHH) and British Infection Association (BIA) Adult HIV testing guidelines 2020, including opt-out in SHSs and reduce inequalities in HIV testing.
Continue ED opt-out testing in very high and high prevalence HIV areas.
Work with GP practices to promote HIV testing into routine primary care pathways.
Scale up partner notification activities.
Understand the drivers of late diagnosis in order to better focus interventions.

Treat

Share learnings from UKHSA audits with local networks and encourage provision of peer support and psychological support within HIV treatment services.
Ensure commissioning arrangements are in place with local providers for HIV peer support provision.
Ensure local SHSs and HIV services engage with and learn from retention in care reviews to strengthen pathways.

Thrive

Ensure services provide a holistic approach to HIV care for women, signposting to other services, such as partner violence services and menopause clinics, when needed.
Improve the quality of life for people living with HIV, including promotion of U=U, particularly for older adults and people with complex health and care needs, by commissioning integrated, person-centred support services that address physical, mental and social wellbeing.

Collaborate

Share culturally competent education and awareness of new technologies as they become available to enhance national messaging.
Apply and promote the HIV Low Prevalence Toolkit to guide local planning, commissioning and evaluation and strengthen outreach, primary care partnerships and service visibility to ensure equitable access to prevention, treatment and care in low prevalence areas.

Question 2

Charts, tables and maps

Accepted Answer

Figure 1. Rate of new HIV diagnoses per 100,000 population (all ages) by UKHSA region of residence, 2024

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. Due to a change in the definition of new HIV diagnoses, this figure no longer includes data for persons previously diagnosed abroad and differs from that included in previous reports.

Figure 1 is a column chart showing new HIV diagnosis rates by English region for the year 2024. Rates are per 100,000 population and are not age-restricted. The overall England rate (4.7) 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 (10.7) but that its rate is more than double that of the region with the next highest rate (the West Midlands with 4.2).

London’s rate was slightly lower in 2024 than in 2023 when it was 11.5 (note the change in definition of new HIV diagnoses if comparing with previous HIV Spotlight reports). London’s population is younger and more ethnically and socio-economically diverse than other regions.

Figure 2. Rate of new HIV diagnoses per 100,000 population (all ages) by local authority of residence, London residents, 2024

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. 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. Due to a change in the definition of new HIV diagnoses, this figure no longer includes data for persons previously diagnosed abroad and differs from that included in previous reports.

Colour coding of bars 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 2024. Local authorities 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 (10.7) 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. Barking and Dagenham 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, Tower Hamlets).

The chart shows that new HIV diagnosis rates tend to be higher in inner London local authorities such as Lambeth and Westminster, which have the highest rates (22), Haringey (21) and Southwark (18). The lowest rates are found in local authorities in outer London: Kingston-upon-Thames (3) and Richmond-upon-Thames (4). 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, 2015 to 2024 [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. Due to a change in the definition of new HIV diagnoses, this figure no longer includes data for persons previously diagnosed abroad and differs from that included in previous reports.

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 2024.

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 2015 (1,979 new HIV diagnoses) and 2024 (971).

The new HIV diagnosis line shows the number of diagnoses falling after 2015. The decline slowed from 2017 onwards. Diagnoses continued to decline until the end of the COVID-19 pandemic, but rose steeply in 2022, the first post-pandemic year. In the 2 years since then, a slight decline has been seen.

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 be 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 diagnosed with HIV before continuing care in England, London, 2020 to 2024 [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 2024.

Figure 4 is a column chart. It displays the trend in new HIV diagnoses in London residents between 2020 and 2024 by whether the person had been previously diagnosed abroad or not. The lower darker blue section of each column represents diagnoses first made in England. These are the diagnoses included in all other new and late diagnosis charts and tables in the report. The upper lighter blue section of each column represents diagnoses in people who are continuing care in England, having previously been diagnosed elsewhere.

Distinguishing between these 2 groups is important to identify transmissions and diagnosis within England. This avoids distortions in our understanding of which groups remain vulnerable to a greater risk of transmission within England.

The chart shows that the proportion of London residents newly diagnosed with HIV who were continuing care in England was 35% in 2024, a slight decrease from 36% in 2023. 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 5. New HIV diagnoses by probable route of exposure (adjusted for missing route information), London residents, 2015 to 2024 [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. Due to a change in the definition of new HIV diagnoses, this figure no longer includes data for persons previously diagnosed abroad and differs from that included in previous reports.

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 2024.

Figure 5 is a line chart showing the trend in new HIV diagnoses in London residents by probable route of exposure, grouped as gay and bisexual men, heterosexual men and women, including bisexual women, (as a single group) and other exposure routes from 2015 to 2024. New HIV diagnoses with missing information about probable route of exposure (22% of new HIV diagnoses in this period) were allocated proportionately to the 3 categories. The lines on this chart are equivalent to the dashed lines in the previous year’s report which also showed diagnoses without the exclusion of those continuing care in England.

HIV surveillance systems collect information on exposure to HIV, including sexual behaviours, rather than sexual identity. 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. Based on existing evidence, sex between men and women is associated with a higher risk of exposure to HIV than sex between women. Because of this, for the purposes of HIV epidemiology, bisexual women are grouped with heterosexual men and women, while bisexual men are grouped with gay men. Similarly, a man who reported sex between men and injecting drug use would be allocated to the gay and bisexual men group. Whenever we refer to gay and bisexual men in this report we mean men who probably acquired HIV through sex between men. Whenever we refer to heterosexual men or to heterosexual women we mean men and women who probably acquired HIV through sex between men and women, also referred to here as heterosexual sex.

New HIV diagnoses declined in all groups in 2024 compared to both 2015, the first year in the 10-year period, and 2023, the previous year. Much steeper declines were seen for gay and bisexual men (65% compared to 2015, 7% compared to 2023) in comparison with heterosexual men and women (21% compared to 2015, 3% compared to 2023). A more complex picture is seen when we compare the numbers with 2019, the last pre-pandemic year: for gay and bisexual men they were 31% lower, but for heterosexual men and women 21% higher.

Decreases were more pronounced among heterosexual men than among heterosexual women, although the trends for each gender were extremely similar.

Numbers of diagnoses via other, non-sexual, exposure routes remained low and decreased by 60% over the 10-year period from 66 to 26, with a 20% decrease compared to 2023 (32 diagnoses). These exposures are explored in more detail in Figure 6.

Figure 6. New HIV diagnoses detailed ‘other’ route of exposure (not adjusted for missing information), London residents, 2015 to 2024 [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. Due to a change in the definition of new HIV diagnoses, this figure no longer includes data for persons previously diagnosed abroad and differs from that included in previous reports.

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 2024.

Figure 6 is a line chart which provides more detail about the HIV transmission routes grouped into ‘other exposure route’ in Figure 5. The group is broken down into subcategories: injecting drug use, vertical transmission and other exposure routes which include transmission via blood or tissue. The chart displays data for 2015 to 2024. As numbers of diagnoses via these routes of exposure are low, trends are subject to ‘noise’ with small changes in numbers capable of causing large changes in the shape of the lines. Trends can only be interpreted broadly.

The chart shows that the number of new HIV diagnoses in London residents where the probable route of exposure was injecting drug use fell substantially over the 10-year period, while the trends for vertical transmission and other exposure routes were more variable.

Figure 7. Number of new HIV diagnoses by age group and gender, London residents, 2024

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD). The number of new diagnoses will depend on accessibility of testing as well as infections and transmission. Due to a change in the definition of new HIV diagnoses, this figure no longer includes data for persons previously diagnosed abroad and differs from that included in previous reports.

Figure 7 is a pyramid bar chart showing the number of new HIV diagnoses by age group and gender in London residents in 2024. 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 (219). For females, the 35 to 44 year age group was largest (78). Diagnoses for male Londoners were strongly skewed towards younger age groups with 43% of new HIV diagnoses in men and boys aged less than 35 years. For female Londoners, the equivalent proportion was 35%. Although HIV is predominately sexually transmitted, this differs from the picture we see for chlamydia, the most common STI, where affected women are more likely than men to be in younger age groups.

For those aged 15 or more years, new HIV diagnoses in men and boys outnumbered those in women and girls for every age group. The difference was highest for the 25 to 34 year age group. In this age group 3.4 men were diagnosed for every 1 woman. Men in London diagnosed with HIV had a median age at diagnosis of 36 years (interquartile range (IQR): 29 to 47 years), while women had a median age of median age of 39 years (interquartile range (IQR): 30 to 51.5 years).

Figure 8. Number of new HIV diagnoses by age group and gender, split by whether first diagnosed in the UK or abroad, London residents, 2024

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

Figure 8 is a pair of pyramid bar charts. The chart from Figure 7, showing the number of new HIV diagnoses in Londoners by age group and gender in 2024, is paired with one showing the same information for people diagnosed and continuing care in England after being previously diagnosed elsewhere, the group now excluded from counts of new HIV diagnoses. As with Figure 7, diagnoses for males are on the left in both these charts.

The age and gender distributions in the chart for those diagnosed before continuing care in England (chart on the left) are similar to those first diagnosed in England but the oldest age group (55 years or older) is smaller in those diagnosed before continuing care in England: 6% of those continuing care in England compared to 16% of those first diagnosed in England. No significant differences were seen between the 2 groups in the proportion aged under 35 years.

The largest age groups for each gender are the same in both charts. Numbers are lower for those continuing care in England however, with 145 new HIV diagnoses in male Londoners aged 25 to 34 years (the largest age group for men) and 62 diagnoses in female Londoners aged 35 to 44 years (the largest age group for women).

Among Londoners diagnosed before continuing care in England, men had a median age at diagnosis of 35 years (IQR: 29 to 42 years) and women had a median age of 37 years (IQR: 31 to 44 years).

Figure 9. Number of new HIV diagnoses by age group and probable route of exposure, male London residents aged 15 to 64 years, 2024

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. Due to a change in the definition of new HIV diagnoses, this figure no longer includes data for persons previously diagnosed abroad and differs from that included in previous reports.

Figure 9 is a pyramid bar chart showing the number of new HIV diagnoses by age group and probable route of exposure for male London residents aged 15 to 64 years in 2024. Men who were exposed to HIV through routes other than sex between men tended to be older at diagnosis than those exposed to HIV through sex between men. They also tended to be slightly older at diagnosis compared to women.

For gay and bisexual men, the 25 to 34 year group accounted for the highest number of new HIV diagnoses (132), while for those whose HIV exposure was by any other route it was the 35 to 44 year group (56).

Median age at diagnosis was 33 years (IQR: 28 to 42 years) for gay and bisexual men and 41 years (IQR: 33 to 53 years) for men exposed via other routes.

Figure 10. Number of new HIV diagnoses in gay and bisexual men by age group and year of first UK HIV diagnosis, London residents aged 15 to 64 years, 2015 to 2024 [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. Due to a change in the definition of new HIV diagnoses, this figure no longer includes data for persons previously diagnosed abroad and differs from that included in previous reports.

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 2024.

Figure 10 is a line chart showing the number of new HIV diagnoses by age group for gay and bisexual male London residents aged 15 to 64 years from 2015 to 2024. Diagnoses in those aged between 15 and 64 years accounted for an average of 99% of diagnoses in gay and bisexual male Londoners over the 10-year period. The final points on the lines correspond to the bars on the left hand side of Figure 9.

Prior to 2022 diagnoses had been declining across all age groups, with occasional minor fluctuations, but in 2022 a 33% rise was seen in gay and bisexual male Londoners aged between 15 and 24 years compared to the previous year. 2022 was the first year following the COVID-19 pandemic that was unaffected by lockdowns and other social mixing restrictions. The following year, 2023, a further rise of 18% was seen in this age group and rises were also seen in all other age groups, including a 67% rise in gay and bisexual male Londoners aged between 55 and 64 years (although this remained by far the smallest age group).

In 2024, by contrast, new HIV diagnoses fell for gay and bisexual male Londoners across most age groups. They remained unchanged in those aged between 45 and 54 years and rose by 4% in those aged between 35 and 44 years.

Figure 11. Number of new HIV diagnoses with a probable route of exposure through heterosexual sex by age group (in years) and year of first HIV diagnosis, London residents aged 15 to 64 years, 2015 to 2024 [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. Due to a change in the definition of new HIV diagnoses, this figure no longer includes data for persons previously diagnosed abroad and differs from that included in previous reports.

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 2024.

Figure 11 is a line chart showing the number of new HIV diagnoses by age group for London residents exposed to HIV via heterosexual sex aged 15 to 64 years from 2015 to 2024. Bisexual women are included. Diagnoses in those aged between 15 and 64 years accounted for an average of 95% of diagnoses in heterosexual London residents over the 10-year period.

Up until 2021 diagnoses among London residents exposed to HIV via heterosexual sex had been broadly declining across all age groups, albeit with fluctuations. However, in 2021 year-on-year rises were seen in most age groups. This was in the context of 2020 having been the main COVID-19 pandemic year and heterosexual men and women having been more impacted by service access restrictions. The largest increase in 2021 was a 53% rise among those aged 15 to 24 years, although it should be noted that this is an age group in which numbers of new HIV diagnoses are low. The following year diagnoses fell for this age group but rose for all others. In 2023 rises were only seen among those aged 26 to 34 years (a rise of 16%) and those aged 35 to 44 years (a rise of 32%). In 2024, the most recent year, falls were seen for all age groups other than the 15 to 24 year age group, which rose by 150% (from 10 to 25 diagnoses).

Figure 12. Number of new HIV diagnoses by ethnic group (adjusted for missing ethnic group information), London residents, 2015 to 2024 [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. Due to a change in the definition of new HIV diagnoses, this figure no longer includes data for persons previously diagnosed abroad and differs from that included in previous reports.

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 2024.

Figure 12 is a line chart showing the number of new HIV diagnoses in London residents by ethnic group from 2015 to 2024. The White and Black African ethnic groups are represented as distinct categories. All other ethnic groups are grouped into a single category (because of smaller numbers of diagnoses). New HIV diagnoses with missing information about ethnic group (14% of new HIV diagnoses between 2015 and 2024) were allocated proportionately to the 3 categories.

All 3 ethnic group categories were on a declining trend until 2021 when a 24% year-on-year rise was seen in new HIV diagnoses in Black African Londoners. Diagnoses in this group fell slightly the following year but rose again in 2023 (by 27%) and rose again in 2024 but only by 3%. In the White category decreases were seen in every year other than 2022 when a 31% increase was seen. This last category is very heterogenous. Probable route of HIV exposure and ethnic group correlate to some extent. Almost half of Londoners diagnosed in 2024, who were exposed to HIV via heterosexual sex, identified themselves as Black African, while almost half of male Londoners exposed to HIV via sex between men identified themselves as White. This should be considered when interpreting trends for either variable.

Over 90% of Black African Londoners newly diagnosed with HIV in 2024 had been born abroad. Year of arrival was recorded for 84% of this group. For those with year of arrival recorded, almost half had been in the UK for more than 4 calendar years before their diagnosis with HIV.

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 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 13. Number of new HIV diagnoses by world region of birth (adjusted for missing world region of birth information), London residents, 2015 to 2024 [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. Due to a change in the definition of new HIV diagnoses, this figure no longer includes data for persons previously diagnosed abroad and differs from that included in previous reports.

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 2024.

Figure 13 is a line chart showing the number of new HIV diagnoses in London residents by world region of birth from 2015 to 2024. The UK and Africa are represented as distinct categories. All other world regions of birth are grouped into a single category (because of smaller number of diagnoses). New HIV diagnoses with missing information about world region of birth (23%) were allocated proportionately to the 3 categories.

Prior to the COVID-19 pandemic in 2020, new HIV diagnoses were declining for all 3 world region of birth categories. In 2020, however, despite restrictions on access to services, the number of new HIV diagnoses rose by 3% year-on-year among Londoners born in Africa, while declining for the other 2 categories. The following year diagnoses rose by 9% in this group but continued to decline for the other 2 categories. In 2022, the first year with no COVID-19 related restrictions on service access or social mixing, diagnoses rose across all 3 world region of birth categories, before falling the next year for all categories other than the heterogenous ‘All other countries’ category.

In 2024, the most recent year, new HIV diagnoses rose by 5% for Londoners born in Africa and by 6% for Londoners born in the UK. They fell by 18% for those grouped into the ‘All other countries’ category. In short, since the COVID-19 pandemic, there has been no consistent trend in new HIV diagnoses by world region of birth.

Calendar year of arrival in the UK was reported for 74% of Londoners born outside the UK who were diagnosed with HIV between 2015 and 2024. Where this information was known, 56% had been in the UK for 4 or more calendar years following their year of arrival before being diagnosed. This category will include people exposed to HIV in the UK as well as people exposed abroad. Conversely, 32% were diagnosed either within the calendar year of arrival or during the following calendar year.

Gay and bisexual male Londoners born outside the UK were less likely than heterosexual men and women to have been in the UK for 4 or more calendar years following their year of arrival before diagnosis, but even for this group the proportion in this category was nearly 50%.

London is a global city (6) 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 (7). 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, 2020 to 2024 [note 1]

Ethnic group	UK-born	Born abroad	Unknown country of birth
White	457	657	535
Black African	61	791	101
Black Caribbean	91	70	36
Other Black	42	98	52
Indian / Pakistani / Bangladeshi	38	168	40
Other Asian (including Chinese)	12	120	97
Mixed / Other	82	340	189
Unknown	66	229	559

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 2024.

Table 1 shows the relationship between ethnic group and whether a person newly diagnosed with HIV was born abroad (those with a prior diagnosis abroad are excluded). Data is for the 5-year period 2020 to 2024. 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, 93% of Black Africans newly diagnosed with HIV were born abroad (791 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 (59% or 657 new HIV diagnoses).

For Black Caribbeans, 82% had a known country of birth. This was the only ethnic group in which the proportion born abroad was below half: 43%, equating to 70 new HIV diagnoses.

The Other Black group sat between the Black Caribbean and Black African groups in terms of proportion born abroad: 73% had a known country of birth and of these 70% (98) were born abroad (78% in Africa, 15% in Latin America or the Caribbean and the remaining 7% in other countries).

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 84% of the IPB group and of those 82% (168) had been born abroad. The Other Asian group had the lowest proportion with a reported country of birth (58%) but where we did have this information 91% (120) were born abroad.

The remaining mixed/other group is extremely heterogenous. Country of birth was known for 69% of people in this category and of these 81% (340) had been born abroad (42% in Latin America or the Caribbean, 26% in Africa, 17% in Asia and the remaining 16% in other countries).

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 14. New HIV diagnoses in gay and bisexual men by whether born abroad, London residents, 2015 to 2024 [note 1]

Source: UKHSA, HANDD. The number of new diagnoses will depend on accessibility of testing as well as infection and transmission. Those with a prior diagnosis abroad are excluded.

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 2024.

Figure 14 is a line chart which displays new HIV diagnoses in gay and bisexual male Londoners over the period 2015 to 2024 subdivided by whether born in the UK or abroad. Country of birth was reported for 98% of diagnoses in this group in 2024 and 87% over the 10-year period.

It shows that, when gay and bisexual men newly diagnosed with HIV who had been previously diagnosed abroad are excluded, those born abroad were the largest sub-group in 2024 (208 diagnoses or 66% of those with a known country of birth).

This proportion was a decrease of 6 percentage points from 72% the previous year. Absolute numbers of new diagnoses decreased in gay and bisexual men born outside the UK decreased by 15% from 2023 to 2024 (from 246 to 208), while those in gay and bisexual men born in the UK increased by 10% (from 98 to 108).

Figure 15. New HIV diagnoses in heterosexual men and women by whether born abroad, London residents, 2015 to 2024 [note 1]

Source: UKHSA, HANDD. The number of new diagnoses will depend on accessibility of testing as well as infection and transmission. Those with a prior diagnosis abroad are excluded.

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 2024.

Figure 15 is a line chart which displays new HIV diagnoses in heterosexual Londoners over the period 2015 to 2024 subdivided by whether born in the UK or abroad. Country of birth was reported for 96% of diagnoses in this group in 2024 and 92% over the 10-year period.

The chart shows that, when heterosexual men and women newly diagnosed with HIV who had been previously diagnosed abroad are excluded, people born abroad are still by far the largest group (278 diagnoses or 80% of those with a known country of birth). This proportion represented a percentage point decrease of 1% compared to 2023, when it was 81%.

Absolute numbers of new diagnoses remained the same compared to the previous year for heterosexual men and women born in the UK (70) but decreased for those in this group born abroad (down from 295 in 2023).

Figure 16. People diagnosed with HIV before continuing care in England by probable route of exposure (adjusted for missing route information), London residents, 2015 to 2024 [note 1]

Source: UKHSA, 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 2024.

Figure 16 is a line chart which displays HIV diagnoses in London residents who were continuing care in England, after being previously diagnosed elsewhere, by probable route of exposure over the period 2015 to 2024. These diagnoses are now excluded from new HIV diagnosis counts, unless stated otherwise, as they are not true new diagnoses and most of the patients will already be receiving treatment. HIV diagnoses with missing information about probable route of exposure (7% of HIV diagnoses among those continuing care in this period) were allocated proportionately to the 3 categories.

The chart shows that a decline was seen in the number of gay and bisexual men resident in London who were diagnosed with HIV before continuing care in England whereas increases were seen for heterosexual men and women and for those with other exposure routes. HIV diagnoses in gay and bisexual men decreased by 36% from 377 diagnoses in 2015 to 241 in 2024 and by 9% compared to 2023 (from 266 diagnoses). In heterosexual men and women, on the other hand, diagnoses rose by 38% from 175 in 2015 to 242 in 2024 but fell by 16% compared to 2023 (from 287 diagnoses). Within the heterosexual men and women grouping, little difference was seen by gender until 2023, although numbers were always a little higher for women than for men. In 2023 a much larger rise was seen in women and in 2024 a larger decrease.

Numbers of HIV diagnoses in those continuing care via other, non-sexual, exposure routes remained low throughout the 10-year period but rose by 58% from 19 to 30.

Figure 17. Percentage of new HIV diagnoses, by local authority of residence, that were diagnosed late, London, aged 15 years and over, 2022 to 2024 [note 2]

Source: UKHSA, HIV and AIDS New Diagnoses and Deaths (HANDD), HIV and AIDS Reporting System (HARS). The number contained within each bar indicates the number of cases.

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 a CD4 count of less than 350 cells/mm³. The underlying population will impact on the proportion diagnosed late, for example, gay and bisexual men are less likely to be diagnosed late.

Figure 17 is a column chart showing the percentage of HIV diagnoses for the period 2022 to 2024 that are estimated to have been made ‘late’ in relation to the time of acquisition by London local authority of residence. Late diagnosis calculations are restricted to residents aged 15 years or older for whom there is an associated CD4 count within 91 days of diagnosis (80% of eligible diagnoses in London residents during this period). As with new HIV diagnoses, those continuing care in England after being diagnosed elsewhere are excluded. 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 Kingston-upon-Thames (68% and 17 late HIV diagnoses) and Hounslow (58% and 31 late HIV diagnoses) 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 LA, Richmond (20% and less than 5 late HIV diagnoses) but an inner London local authority, Westminster, with a late diagnosis percentage of 21% (33 late HIV diagnoses).

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 gay and bisexual men diagnosed with HIV tend to have lower late diagnosis percentages. This reflects greater awareness of HIV and higher testing rates for this group, compared to heterosexual men and heterosexual women.

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 18. Percentage and number of new HIV diagnoses by probable route of exposure that were diagnosed late, London residents, aged 15 years and over, 2022 to 2024 [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 a CD4 count of less than 350 cells/mm³. Proportions are only shown for the gay and bisexual men, heterosexual men, heterosexual women, and injecting drug use exposure groups and are withheld for any of these categories if they contain fewer than 5 late diagnoses.

Figure 18 is a column chart. For each major exposure category, it shows the percentage of HIV diagnoses for the period 2022 to 2024 among London residents aged 15 years or older that are estimated to have been made late. The calculation is restricted to new HIV diagnoses where there is an associated CD4 count within 91 days of diagnosis. This information was available for 88% of gay and bisexual men, 88% of heterosexual men and 84% of heterosexual women among London residents aged 15 years or older newly diagnosed during this period. For all 3 exposure categories this proportion is higher than for late diagnoses in London residents as a whole. This is because the proportion for London residents as a whole includes those with unknown exposure and CD4 count at diagnosis is much less likely to be reported for those with an unknown exposure.

Gay and bisexual men were least likely to be diagnosed late (28% and 234 late HIV diagnoses). This reflects the higher testing rates and greater engagement with sexual health services generally seen in this group. Gay and bisexual men resident in London were less likely to be diagnosed late compared to those resident in England as a whole (33%).

A late diagnosis was much more common for heterosexual men (51% and 237 late HIV diagnoses) and heterosexual women (48% and 239 late HIV diagnoses). Some women may have additional opportunities to be diagnosed via antenatal services and this may partly explain the lower proportion of late diagnoses seen among heterosexual women compared to heterosexual men. Heterosexual male Londoners were less likely to be diagnosed late compared to those resident in England as a whole (54%). Heterosexual female Londoners were slightly more likely to be diagnosed late (47% for England as a whole).

For those who probably acquired HIV via injecting drug use the percentage diagnosed late was 47%. The confidence interval for this group is much larger however as the number of new HIV diagnoses in this group was much smaller (only 7 over the 3-year period).

Figure 19. Percentage and number of new HIV diagnoses by ethnic group that were diagnosed late, London residents, aged 15 years and over, 2022 to 2024 [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 a CD4 count of 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 19 is a column chart. It is structured in the same way as Figure 18 and shows percentages of HIV diagnoses made late by ethnic group for London residents aged 15 years or older for the period 2022 to 2024. The proportion of new HIV diagnoses with an associated CD4 count within 91 days of diagnosis ranged from 75% for the Mixed ethnic group to 92% for the Indian/Pakistani/Bangladeshi (IPB) ethnic group.

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 Mixed ethnic group had the lowest percentage of diagnoses made late (27% and 31 late HIV diagnoses), while the IPB group had the highest (50% and 78 late HIV diagnoses), followed by the Black African group (49% and 258 late HIV diagnoses). 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 20. Percentage of new HIV diagnoses that were diagnosed late by probable route of exposure and year of first UK HIV diagnosis, London residents, aged 15 years and over, 2015 to 2024 [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 a CD4 count of less than 350 cells/mm³.

Figure 20 is a line chart showing trends in late diagnoses in London residents aged 15 years or older between 2015 and 2024 by exposure group in 3 categories: gay and bisexual men; heterosexual men and women; and all other exposure routes. 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 2015 to 2024, this information was available for 82% of diagnoses gay and bisexual men, 80% of diagnoses in heterosexual men and women and 68% of diagnoses where HIV was believed to have been acquired non-sexually.

The chart shows that the proportion of new HIV diagnoses made late was lowest in gay and bisexual men but tended to rise over the 10-year period until 2022 when it reached 33% (more than double the percentage in 2015, 14%). In 2023 a decrease was seen to 28% and in 2024 a further decrease to 22%, suggesting that for gay and bisexual men late HIV diagnoses may be returning to pre-pandemic levels. The number of late diagnoses decreased by 51% for gay and bisexual men over the 10-year period (from 134 late diagnoses to 65) and by 26% compared to 2023 (88 late diagnoses).

For heterosexual men and women the percentage was above 50% for almost all years in the 10-year period until 2023 when it dropped to 48%. In 2024 the proportion late fell even further to 44%. This was the lowest proportion seen for this group over the 10-year period but was still twice that seen for gay and bisexual men in 2024.The number of late HIV diagnoses for heterosexual men and women fell by 40% over the 10-year period (from 225 late diagnoses in 2015 to 134 in 2024) and by 17% compared to 2023 (161 late diagnoses).

The trend for the other exposure routes group was more variable as this group is heterogenous and the number of new HIV diagnoses is low. The lowest percentage recorded was for 2015 when it was 32% (12 late diagnoses) while the highest was 73% in 2021 (8 late diagnoses). For all years from 2016 onwards the number of late diagnoses in this group was less than 10.

The decrease in the numbers of late diagnoses, but more variable trend in the proportion that these made up of new HIV diagnoses, 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 21. Percentage of new HIV diagnoses that were diagnosed late in gay and bisexual men and in those whose exposure was heterosexual sex by whether born abroad, London residents, aged 15 years and over, 2022 to 2024 [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 a CD4 count of less than 350 cells/mm³.

Figure 21 is a column chart. For 2 exposure groups, gay and bisexual men (those probably acquiring HIV through sex between men) and heterosexual men and women (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: 2022 to 2024. Country of birth was reported for 90% of gay and bisexual men and 92% of heterosexual men and women aged 15 years or older, resident in London, and diagnosed late during this period.

For gay and bisexual men 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 heterosexual men and women the percentage diagnosed late was higher for those born abroad: 39% of those who were born in the UK and 52% of those who were born in other countries were diagnosed late.

Figure 22. Age distribution of new HIV diagnoses that were diagnosed late by year of first HIV diagnosis, London residents, aged 15 years and over, 2015 to 2024 [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 a CD4 count of less than 350 cells/mm³.

Figure 22 is a column chart showing the age distribution of those diagnosed late between 2015 and 2024. 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. Age groups begin at 15 to 24 years as those diagnosed must be at least 15 years old to be included in the late diagnosis calculation. 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 2015, they accounted for 7% of those diagnosed late. In 2024 it was 5%. This was down from 8% the previous year, the highest value recorded for this age group over the 10-year period. A rising trend, broadly speaking, was seen for the oldest age group, those aged 55 years or older. This group accounted for 13% of late diagnoses in 2015 and 23% in 2024, the highest value recorded for this age group over the 10-year period. The 55 years and older age group was the only one in which the number of late HIV diagnoses increased over this period: from 52 in 2015 to 63 in 2024, a rise of 21%.

The age groups with the largest proportions remained the 25 to 34 year and 35 to 44 year age groups. The proportion for those aged 25 to 34 years, remained broadly stable over the 10-year period and was 23% in 2015 and 25% in 2024. The relative size of the 35 to 44 year group tended to decrease over the 10-year period. It accounted for 31% of late diagnoses in 2015 and 26% in 2024.

Median age at diagnosis was older for those diagnosed late compared to all new diagnoses eligible for inclusion in the calculation for both gay and bisexual men and heterosexual men and women (see chart footnote). For 2015 to 2024, for gay and bisexual men, the median age at diagnosis for those diagnosed late was 36 years, compared to 33 for all newly diagnosed gay and bisexual men who met the inclusion criteria. For heterosexual men and women diagnosed over the same period, the median age at diagnosis for those diagnosed late was 45 years, compared to 43 for all newly diagnosed heterosexual men and women who met the inclusion criteria. Little change was seen over the 10-year period for either group.

Figure 23. Percentage of all new diagnoses that were late by age by year of first HIV diagnosis, London residents, aged 15 years and over, 2015 to 2024 [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 a CD4 count of less than 350 cells/mm³.

Figure 23 is a column chart showing the proportion of London residents in each age group who were diagnosed late between 2015 and 2024. Whereas the previous chart showed, for any given year, the proportion of late diagnoses in each age group, this chart shows the proportion of diagnoses that were late in a given year for each age group. 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 2024 the proportion was 50%. This was a 3 percentage point increase compared to 2015, but a 3 percentage point decrease compared to 2023.

For most of the 10-year period the 15 to 24 year age group had the lowest proportion of late HIV diagnoses. For 2 years, 2022 and 2023, a change was seen, with the 25 to 34 year age group having the lowest proportion of late diagnoses. However, in 2024, the proportion of late diagnoses fell by 45% for the 15 to 24 year age group and this returned to being the group with the lowest proportion. The 25 to 34 year age group remains the group with the largest proportional rise over the 10-year period however: an increase of 65% between 2015 and 2024 in the proportion of diagnoses that were late.

Figure 24. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by UKHSA region, 2024

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

Figure 24 is a column chart showing the prevalence of diagnosed HIV by English region for the year 2024. 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 (5.0) 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. 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 25. Number of residents living with diagnosed HIV (all ages) and accessing care, London, 2015 to 2024

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

Figure 25 is a line chart showing the number of Londoners living with diagnosed HIV who accessed HIV-related care in the years 2015 to 2024. 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 36,283 in 2015 the number reached a high of 37,161 in 2019, dropping down to 36,593 in 2020 before rising to a new peak of 38,933 in 2024. This represents a 7% increase on the number in 2015.

Figure 26. Number of residents living with diagnosed HIV and accessing care by probable route of exposure (adjusted for missing route information), London, 2024

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

Note 6: HCW means health care worker

Figure 26 is a column chart which displays the number of London residents living with diagnosed HIV and accessing care in 2024 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 2024) were allocated proportionately to the route of acquisition categories.

The chart shows that Londoners living with diagnosed HIV were overwhelmingly likely to have been exposed to HIV via sex, with 19,772 (51%) having been exposed to HIV through sex between men (gay and bisexual men) and 17,590 (45%) having been exposed to HIV through sex between men and women (heterosexual men and women). By contrast, those who were exposed to HIV through vertical transmission, which was the next largest exposure group, numbered only 879 (2%) while those exposed to HIV via injecting drug use numbered 491 (1%) and those exposed to HIV via blood products or as a healthcare worker (HCW) numbered 201 (1%).

Figure 27. Percentage of all residents with diagnosed HIV who are accessing care, by age group contribution, London, 2015 and 2024

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

Figure 27 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, 2015 and 2024.

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 2015 the largest age group was the 35 to 49 year group, containing 48% of Londoners living with diagnosed HIV. Only 32% were aged 50 years or older. By 2024, the 50 years or older group was the largest group, accounting for 54% 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 2024 was too low to register on the chart but was not zero.

By 2024, the median age for those living with diagnosed HIV was 47 years or above for all transmission groups other than those who were exposed via vertical transmission. Median age for this group was 28 years (IQR: 24 to 31). Gay and bisexual men had a median age of 50 years (IQR: 40 to 58), heterosexual men a median age of 56 years (IQR: 48 to 62) and heterosexual women a median age of 52 years (IQR: 45 to 59).

Figure 28. Diagnosed HIV prevalence per 1,000 residents by ethnic group (all ages), London, 2024

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

Figure 28 is a column chart which shows the prevalence of diagnosed HIV by ethnic group for Londoners in 2024. Rates are per 1,000 population. They are not age-restricted which means they are sensitive to differences in age distribution.

The ethnic group with the highest rate was the Black African group (15.9). 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 (1.3).

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 29. Diagnosed HIV prevalence per 1,000 population by Index of Multiple Deprivation decile, London, 2024

Figure 29 is a column chart. It shows rates of diagnosed HIV prevalence for London residents by decile of deprivation for 2024. 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 (6.8) was around 6 times the rate for areas that fell into the least deprived decile (1.2). 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.

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 is unlikely to account for the downward gradient seen in the chart, it may cause the gradient to decline more steeply.

Figure 30. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by local authority, London, 2024

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

Figure 30 is a column chart which displays the prevalence of diagnosed HIV by London local authority of residence in 2024. Rates are restricted to those aged 15 to 59 years and are by 1,000 population. Local authorities 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 (11.9) and the lowest in Kingston-upon-Thames (2.0). Although hidden by rounding, there were 2 boroughs where the rate was just below the 2 per 1,000 threshold, above which expanded testing is advised: Kingston-upon-Thames and Richmond-upon-Thames. Fourteen of London’s 33 local authorities 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 31. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by local authority, London, 2024

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

Figure 31 is a map, that like Figure 30, displays the prevalence of diagnosed HIV by London local authority of residence in 2024. Displaying this on a map shows more clearly the difference in diagnosed prevalence in inner London local authorities compared to those in outer London. The map is shaded in relation to 6 rate bands, the highest of which is at least 10 per 1,000 population aged 15 to 59 years. Two London local authorities 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 local authorities: 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 local authorities fell into this band.

Figure 32. Diagnosed HIV prevalence per 1,000 residents (all ages) by middle super outer area of residence London, 2024

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

Figure 32 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 2024. 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 33. HIV testing rate per 100,000 by population group, London residents, 2020 to 2024 [note 6]

Source: UKHSA, GUMCAD.

The proportion of eligible attendees at specialist sexual health services (SHS) who accepted an 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 an HIV test was not appropriate, or for whom the attendance was related to Sexual and Reproductive Health (SRH) care only, are excluded.

Note 7: ONS mid-2023 population estimates have been used to calculate HIV testing rates.

Figure 33 is a line chart displaying HIV testing rates per 100,000 population for Londoners attending all sexual health services from 2020 to 2024. 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 and all females.

Throughout the 5-year period men had the highest HIV testing rate. This increased by 6% from 7,331 tests per 100,000 male population in 2023 to 7,768 in 2024. HIV testing rates for women remained almost unchanged with 5,967 tests per female population in 2023 and 5,965 in 2024. For all residents an increase of 4% was seen from 6,740 tests per 100,000 population in 2023 to 6,980 in 2024.

Table 2. People tested for HIV by population group, London residents attending all SHSs, 2019 to 2024

Gender or sexual orientation	2019	2020	2021	2022	2023	2024	% change 2019 to 2024	% change 2023 to 2024
Heterosexual men	130,488	85,376	87,871	103,606	115,978	125,948	-3%	9%
Gay and bisexual men	68,956	64,155	71,279	89,706	96,750	97,237	41%	1%
All men	211,419	158,585	172,213	204,506	223,786	234,666	11%	5%
Heterosexual women	199,944	155,067	166,442	183,968	196,823	203,108	2%	3%
All women	215,534	165,829	182,126	201,728	211,961	212,729	1%	0%
Total	430,853	326,752	358,558	413,753	444,211	458,037	6%	3%

The totals for ‘All men’ and ‘All women’ include people tested from sexual orientation categories not shown in the table above.

Table 2 shows information about the number of Londoners attending sexual health services who tested for HIV from 2019 to 2024. 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 2024 and from 2023 to 2024. 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 constant over the 6-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 gay and bisexual men. Absolute numbers of heterosexual men tested decreased from 130,488 in 2019 to 125,948 in 2024, a decline of 3%, but did increase by 9% from the 115,978 men tested in 2023. The proportion of men with a known sexual orientation was slightly higher in 2024 (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 56% in 2024.

For gay and bisexual men the number reported for 2024 was the highest over the period of comparison: 97,237 gay and bisexual men tested, a 41% rise on the 68,956 reported for 2019.

The number of women tested for HIV in 2024 was 212,729, a slight decrease (1%) on the 215,534 recorded for 2019, the start of the comparison period.

Figure 34. HIV pre-exposure prophylaxis (PrEP) need and initiation/continuation in residents attending specialist sexual health services (SHSs), London, 2024

Source: UKHSA, GUMCAD.

Figure 34 is a column chart showing information about PrEP need and use by gender and sexual orientation in 2024. 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 34 is a column chart showing information about PrEP need and use by gender and sexual orientation in 2024. 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.

Gay and bisexual men had by far the highest need for PrEP (79%). Of these, 88% had their need identified and PrEP was initiated or continued for 84%.

Very low levels of PrEP need were reported for heterosexual men (3%) and heterosexual women (1%). However, the proportions for whom PrEP need was identified were also much lower than for other groups (67% for heterosexual men and 63% for heterosexual women), as were the proportions with a PrEP need identified for whom PrEP was initiated or continued (54% for heterosexual men and 52% for heterosexual women).

For all columns, other than the proportion of heterosexual men with a PrEP need identified for whom PrEP was initiated or continued, which decreased very slightly (by less than 1%), the values reported represented an increase on those reported last year, although in most cases the increase was very small.

In response to unequal access to PrEP, the 2025 PrEP guidelines included new sections on equity and risk assessment, shifting away from clinical trial-based eligibility criteria. The guidance aims to help 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.

Figure 35. The continuum of HIV care, 2024

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

Figure 35 shows the continuum of care for Londoners living with HIV in 2024. 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. 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 (96%), the third the percentage of those living with HIV who were diagnosed and on treatment (91%) and the fourth the percentage of those living with HIV who were diagnosed, on treatment and successfully virally suppressed (88%). 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 96% as there is no difference: in both approaches the second column is looked at in relation to the first. The second arrow contains 95% as the 91% of those living with HIV who were on treatment represents 95% of those who were diagnosed. The third arrow contains 97% as this is the percentage of those on treatment who were virally suppressed. This means that in 2024 London achieved 96-95-97, exceeding both the standard and higher UNAIDS targets.

Figure 36. Lower and upper level estimates for the number of people living with HIV with transmissible levels of virus, London, 2024

Source: UKHSA, HARS.

Figure 36 shows a pair of data visualisations indicating the proportions of Londoners living with transmissible levels of HIV in 2024 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 2024 was 6,700.

Of those:

1,800 (27%) were undiagnosed (first section of bar)
a further 100 (1%) people were first diagnosed in 2024 and not linked to HIV care by the end of the year (second section of bar)
the third section of the bar shows there were 1,700 people (25%) who had not been seen for care in the 15 months since their last HIV care appointment between October 2022 and September 2023
600 people (9%) attended HIV care in 2024 but were not receiving treatment (fourth section of bar)
2,400 people (36%) were on treatment in 2024 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 2024 was 9,700. This number is 3,000 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
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.

Question 3

Information on data sources

Accepted Answer

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. Unless otherwise stated, for UTLAs 2024 estimates were used (published Jun-2024), for MSOAs 2022 estimates were used (published November 2024), for LTLAs 2021 estimates were used (published November 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 exposure = ‘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 exposure was gay and bisexual men would be calculated using new diagnoses for which route of exposure 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.

Question 4

Further information

Accepted Answer

For more information on a range of sexual health indicators, see:

Sexual and Reproductive Health Profiles

For more information on local sexual health data sources, see:

https://www.gov.uk/government/publications/sexual-and-reproductive-health-in-england-local-and-national-data/sexual-health-reproductive-health-and-hiv-in-england-a-guide-to-local-and-national-data

For the annual epidemiological spotlight on STIs in London 2024 data, see:

https://www.gov.uk/government/publications/sexually-transmitted-infections-london-data

For the national HIV report: 2024 data, see:

https://www.gov.uk/government/statistics/hiv-annual-data-tables

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.

If they do not have access to this information, they should contact fes.seal@ukhsa.gov.uk

Question 5

About the Field Service

Accepted Answer

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 FS team at FES.SEaL@ukhsa.go.uk

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

Question 6

Acknowledgements

Accepted Answer

We would like to thank the following:

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

Question 7

References

Accepted Answer

1. Brown Alison E, Shah Ammi, Martin Veronique, Chau Cuong, Djuretic Tamara. ‘People diagnosed with HIV before continuing care in England are extremely unlikely to pass on HIV in England’ HIV Medicine 2025: volume 26, issue 10, pages 1,626 to 1,627

2. Shah Ammi, Mackay Neil, Kitt Hannah, Harrison Catriona, Okumu-Camerra Kadeen, Ratna Natasha and others. ‘HIV testing, PrEP, new HIV diagnoses and care outcomes for people accessing HIV services: 2025 report’ The annual official statistics data release (data to end of December 2024). London; 2025 (accessed 21 July 2026)

3. Department of Health and Social Care. ‘Towards zero: an action plan towards ending HIV transmission, AIDS and HIV-related deaths in England 2022 to 2025’ UK Government White Paper. 2022 (accessed 21 July 2026)

4. Aghaizu A, Martin V, Kelly C, Kitt H, Farah A, Latham V, Brown AE, Humphreys C. ‘Positive Voices: the national survey of people living with HIV – findings from 2022’ December 2023, UK Health Security Agency, London (accessed 21 July 2026)

5. Schoemig V, Martin V, Shah A, Okumu-Camerra K, Mackay N, Bera S, Kitt H, Kelly C, Kolawole T, Ratna N, Chau C, Đjuretić T, Brown A and others. ‘HIV Action Plan monitoring and evaluation framework 2024 report: report summarising progress from 2019 to 2023’ November 2024, UK Health Security Agency (accessed 21 July 2026)

6. Britannica. ‘Global city’ definition (accessed 21 July 2026)

7. Office of National Statistics. Population of the UK by country of birth and nationality: year ending June 2021 (accessed 21 July 2026)

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Summary

New diagnoses

Late diagnoses

People living with diagnosed HIV

HIV testing

PrEP

HIV in England

HIV prevention messages

Local and regional prevention strategies

Prevent

Test

Treat

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Charts, tables and maps

Figure 1. Rate of new HIV diagnoses per 100,000 population (all ages) by UKHSA region of residence, 2024

Figure 2. Rate of new HIV diagnoses per 100,000 population (all ages) by local authority of residence, London residents, 2024

Figure 3. New HIV diagnoses and deaths, London, 2015 to 2024 [note 1]

Figure 4. New HIV diagnoses by whether a person had been diagnosed with HIV before continuing care in England, London, 2020 to 2024 [note 1]

Figure 5. New HIV diagnoses by probable route of exposure (adjusted for missing route information), London residents, 2015 to 2024 [note 1]

Figure 6. New HIV diagnoses detailed ‘other’ route of exposure (not adjusted for missing information), London residents, 2015 to 2024 [note 1]

Figure 7. Number of new HIV diagnoses by age group and gender, London residents, 2024

Figure 8. Number of new HIV diagnoses by age group and gender, split by whether first diagnosed in the UK or abroad, London residents, 2024

Figure 9. Number of new HIV diagnoses by age group and probable route of exposure, male London residents aged 15 to 64 years, 2024

Figure 10. Number of new HIV diagnoses in gay and bisexual men by age group and year of first UK HIV diagnosis, London residents aged 15 to 64 years, 2015 to 2024 [note 1]

Figure 11. Number of new HIV diagnoses with a probable route of exposure through heterosexual sex by age group (in years) and year of first HIV diagnosis, London residents aged 15 to 64 years, 2015 to 2024 [note 1]

Figure 12. Number of new HIV diagnoses by ethnic group (adjusted for missing ethnic group information), London residents, 2015 to 2024 [note 1]

Figure 13. Number of new HIV diagnoses by world region of birth (adjusted for missing world region of birth information), London residents, 2015 to 2024 [note 1]

Table 1. Number of new HIV diagnoses by ethnic group and whether born abroad, London residents, 2020 to 2024 [note 1]

Figure 14. New HIV diagnoses in gay and bisexual men by whether born abroad, London residents, 2015 to 2024 [note 1]

Figure 15. New HIV diagnoses in heterosexual men and women by whether born abroad, London residents, 2015 to 2024 [note 1]

Figure 16. People diagnosed with HIV before continuing care in England by probable route of exposure (adjusted for missing route information), London residents, 2015 to 2024 [note 1]

Figure 17. Percentage of new HIV diagnoses, by local authority of residence, that were diagnosed late, London, aged 15 years and over, 2022 to 2024 [note 2]

Figure 18. Percentage and number of new HIV diagnoses by probable route of exposure that were diagnosed late, London residents, aged 15 years and over, 2022 to 2024 [note 3]

Figure 19. Percentage and number of new HIV diagnoses by ethnic group that were diagnosed late, London residents, aged 15 years and over, 2022 to 2024 [note 4]

Figure 20. Percentage of new HIV diagnoses that were diagnosed late by probable route of exposure and year of first UK HIV diagnosis, London residents, aged 15 years and over, 2015 to 2024 [note 5]

Figure 21. Percentage of new HIV diagnoses that were diagnosed late in gay and bisexual men and in those whose exposure was heterosexual sex by whether born abroad, London residents, aged 15 years and over, 2022 to 2024 [note 5]

Figure 22. Age distribution of new HIV diagnoses that were diagnosed late by year of first HIV diagnosis, London residents, aged 15 years and over, 2015 to 2024 [note 5]

Figure 23. Percentage of all new diagnoses that were late by age by year of first HIV diagnosis, London residents, aged 15 years and over, 2015 to 2024 [note 5]

Figure 24. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by UKHSA region, 2024

Figure 25. Number of residents living with diagnosed HIV (all ages) and accessing care, London, 2015 to 2024

Figure 26. Number of residents living with diagnosed HIV and accessing care by probable route of exposure (adjusted for missing route information), London, 2024

Figure 27. Percentage of all residents with diagnosed HIV who are accessing care, by age group contribution, London, 2015 and 2024

Figure 28. Diagnosed HIV prevalence per 1,000 residents by ethnic group (all ages), London, 2024

Figure 29. Diagnosed HIV prevalence per 1,000 population by Index of Multiple Deprivation decile, London, 2024

Figure 30. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by local authority, London, 2024

Figure 31. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by local authority, London, 2024

Figure 32. Diagnosed HIV prevalence per 1,000 residents (all ages) by middle super outer area of residence London, 2024

Figure 33. HIV testing rate per 100,000 by population group, London residents, 2020 to 2024 [note 6]

Table 2. People tested for HIV by population group, London residents attending all SHSs, 2019 to 2024

Figure 34. HIV pre-exposure prophylaxis (PrEP) need and initiation/continuation in residents attending specialist sexual health services (SHSs), London, 2024

Figure 35. The continuum of HIV care, 2024

Figure 36. Lower and upper level estimates for the number of people living with HIV with transmissible levels of virus, London, 2024

Information on data sources

Further information

About the Field Service

Acknowledgements

References

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