Research and analysis

Annual epidemiological spotlight on HIV in the North East: 2023

Updated 13 October 2025

Applies to England

Summary

This report aims to provide important intelligence about HIV in the North East of England. It presents data on:

• new and late HIV diagnoses
• people living with diagnosed HIV and continuum of care
• HIV testing and HIV pre-exposure prophylaxis (PrEP)

Data is mostly focused on activity in the North East in 2023. Where appropriate, data for the past 10 years is provided to understand trends. For a broader context see UKHSA’s National HIV report: 2023 data (1).

Whilst the data show that access to services have improved following the impact of the COVID-19 pandemic, it is important to note that trends in HIV testing and patterns of sexual behaviour remain difficult to interpret between 2019 and 2022. Information on data sources and analytical methods applied for this epidemiological report can be found in Section 6. Note that different methods may have been applied across the summary and the charts. 

Although the North East region continues to have the lowest prevalence of HIV compared to other England regions, HIV remains an important public health issue in the area with continuing challenges in both prevention and control. In November 2023, the North East and North Cumbria Regional HIV Steering Group was formed to provide system-wide support and accountability to ensure progress towards the national HIV Action Plan targets (2). To date, set priorities include:

• develop and implement a regional communication and awareness plan focused on HIV
• increase testing in services other than sexual health, including opt-out emergency department (ED) bloodborne virus (BBV) Testing
• strengthen partner notification across services
• optimise access and retention in care, including strengthening links between primary and secondary care, ensuring equitable access to support services for people living with HIV
• tackle HIV stigma, including implementing the HIV Confidence Charter in a number of organisations, developing regional training plan for health and social care staff and developing an empowerment programme for people living with HIV

Findings

New diagnoses

In 2023, 148 North East residents were newly diagnosed with HIV, accounting for 2% of new diagnoses in England. This represents a rise of 40% from 2022. Nationally, there has been a long-term trend for a decline in the overall number of new diagnoses, although there was a substantial upturn in 2023. This is mirrored in the North East.

The new diagnosis rate for North East residents (5.5 per 100,000) was substantially below that of England in 2023 (10.4 per 100,000). Rates within local authorities in the North East ranged from 1.4 per 100,000 in North Tyneside to 15.1 per 100,000 in Middlesbrough.

In 2023, 62% of the new diagnoses in North East residents were among people newly diagnosed with HIV in the North East (that is, not previously diagnosed abroad) and 38% were among people who had been previously diagnosed abroad.

Differences in the underlying population demographics of those individuals previously diagnosed abroad versus those first diagnosed in the North East need to be considered when reviewing the data on new diagnoses. For some analyses data are presented on just those first diagnosed in the North East as this enables better understanding of which groups remain exposed to the greatest risk and will help inform our actions to reduce transmission in the North East.

In 2023, when considering all new diagnoses of HIV in North East residents (including those previously diagnosed abroad), 65% were male, and heterosexual contact was the largest infection route (53%), followed by sex between men (43%). This is in contrast to 2014 and 2022 when 51% and 48% of new diagnoses, respectively, were attributed to sex between men. The highest number of all new diagnoses among North East male residents was in those aged 25 to 34 years, regardless of probable route of exposure. Across females the highest number of new diagnoses was among those aged 35 to 44 years.

When looking at just new diagnoses first made in the North East: 74% were male, sex between men accounted for 52%, and heterosexual contact accounted for 43%. The most common age group:

• amongst gay, bisexual and men who have sex with men (GBMSM) was 15 to 24 years
• in men who have sex with women was 25 to 34 years
• in women was 35 to 44 years

Males with new diagnoses first made in the North East accounted for 90% of all new diagnoses in those less than 25 years of age in 2023.

The highest number of new HIV diagnoses remained in the white ethnic group in North East residents in 2023 (43%). The number of new HIV diagnoses in the black African ethnic group has increased by 2.7 fold to 38% of new diagnoses in 2023 compared to 16% in 2014. This is largely driven by the increase in the number of individuals with new HIV diagnoses previously diagnosed abroad.

North East residents with HIV previously diagnosed abroad were of working age (25 to 54 years) in 2023. Among these cases: 50% were female, heterosexual contact accounted for 67% while sex between men accounted for 29%. Of those with available information, 65% reported Africa as their region of birth.

The proportion of North East residents with HIV previously diagnosed abroad has been increasing steadily over recent years. This pattern is consistent with that seen in England as a whole (1). Identifying patients who have been previously diagnosed abroad has become an issue of increasing importance as access to testing and treatment improves worldwide. Diagnoses previously made abroad are unlikely to reflect HIV acquired in the North East. Nonetheless, it is important to increase our understanding of individuals previously diagnosed and undergoing treatment before arriving in the UK to inform work on provision and retention in care, ensuring good health outcomes and preventing onward HIV transmission.

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 (3). People who are diagnosed late have a tenfold risk of mortality within one year of diagnosis compared to those diagnosed promptly and they have increased healthcare costs.

It is of particular concern that a large proportion of North East residents with a new HIV diagnosis not previously diagnosed abroad were diagnosed late (40% from 2021 to 2023, compared to 43% in England), as defined by a CD4 count of less than 350 cells/mm³ at diagnosis.

There are differences in the proportion of late diagnoses by risk groups: heterosexuals were more likely to be diagnosed late (52% of males, 38% of females) compared to GBMSM (35%).

By ethnic group, Black Africans were more likely to be diagnosed late than the White population (44% and 39% respectively).

People living with diagnosed HIV

The 2,437 people living with diagnosed HIV in the North East in 2023 was 13% higher than in 2022 and 52% higher than in 2014. This increase is mainly due to the effectiveness of HIV treatment upon which people who are diagnosed and started early can have a normal life expectancy but also due to increased number of new diagnoses.

The diagnosed prevalence rate of HIV in the North East in 2023 was 1.3 per 1,000 residents aged 15 to 59 years. This was below that of the 2 per 1,000 observed in England as a whole (small differences may be hidden by rounding). One local authority in the North East had a diagnosed HIV prevalence in excess of 2 per 1,000 population aged 15 to 59 in 2023, which is the threshold for expanded HIV testing or definition of ‘high prevalence’ area. This was Newcastle upon Tyne (2.5 1,000 population aged 15 to 59).

The 2 most common probable routes of transmission for North East residents living with diagnosed HIV in 2023 were sex between men (51%) and sex between men and women (46%).

In 2023, 37% of those living with diagnosed HIV in the North East were aged between 35 and 49 years, and 47% were aged 50 years and over (up from 30% in 2014). Males represented 72% of North East residents living with diagnosed HIV in 2023 and females represented 28%.

In 2023, 67% of North East residents living with diagnosed HIV were White and 23% 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 (24.2 per 1,000) than in the White population (0.6 per 1,000).

Continuum of HIV care

The continuum of care is a model that outlines the pathway and steps of HIV treatment and care. The steps are:

1. Diagnosis of HIV infection.
2. Linkage to medical care.
3. Receipt of medical care.
4. Retention to care.
5. Achievement and maintenance of viral suppression.

It is useful both as an individual-level tool to assess care as well as a public health outcomes framework, consisting of the 3 measures (HIV testing, treatment and viral suppression) included in the UNAIDS 95-95-95 targets designed to help end HIV transmission by 2030 (2,3).

In England, excluding London in 2023, 99% of HIV diagnosed residents were receiving anti-retroviral treatment. Of these, 98% were virally suppressed (viral load under 200) and were very unlikely to pass on HIV, even if having sex without condoms (untransmissible virus). This compares to 98% in England as a whole receiving ART and 98% of these virally suppressed.

For North East residents diagnosed with HIV, 94% were receiving ART and, of those with available information, 97% were virally suppressed (viral load under 200). Furthermore, the proportion starting treatment within 91 days of diagnosis for the period 2021 to 2023 was 87%. This compares to 84% for England.

People living with undiagnosed HIV

In 2023, it is estimated that 5% (credible interval (CrI) 4% to 7%) of people living with HIV in England, excluding London were undiagnosed. This equates to an estimated 3,407 (CrI 2,627 to 4,787) undiagnosed people.

It is estimated that 1,100 GBMSM in England, outside London, are undiagnosed (CrI 600 to 2,100) and 2,200 heterosexuals (CrI 1,700 to 3,200), including 1,200 Black Africans. In England, outside London, the proportion undiagnosed varied by exposure group with the highest proportion undiagnosed among people living with HIV who inject drugs (9%, CrI 2% to 20%), non-Black African heterosexual women (7%, 5% to 11%), and Black African heterosexual men (7%, 5% to 11%).

It is currently not possible to extrapolate numbers at regional level.

HIV testing

A total of 34,353 people were tested in specialist sexual health services (SHSs) in the North East in 2023, a decrease of 12% since 2019 and an increase of 13% since 2022.

The HIV testing rate (per 100,000 population) at all SHSs in the North East was 1,945, which compares to 2,771 across England. HIV testing rates in all SHSs (specialist and non-specialist services) in the North East is lower in men (1,831) than women (1,935).

Pre-exposure prophylaxis (PrEP)

HIV pre-exposure prophylaxis (PrEP) involves the use of antiretroviral medicines in individuals who are HIV negative to reduce the risk of acquiring HIV in those at high risk. It has become an important component of prevention strategies and a key public health indicator since the roll out of routine PrEP commissioning in England in the autumn of 2020. Further guidance on the evaluation of these public health indicators in addition to how individuals are identified as having a PrEP need can be found in the Routine commissioning of HIV PrEP in England: Monitoring and evaluation framework 2022 (4).

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 vital to HIV prevention.

In 2023, 7% of HIV-negative North East residents accessing SHSs in England were defined as having a PrEP need, among whom 58% initiated or continued PrEP. Of those defined as having a PrEP need, 76% had this need identified at a clinical consultation. Among GBMSM, the group with greatest need, these proportions were 59%, 63% and 79%.

HIV in England

The 2021 HIV Action Plan for England (2) sets an ambition to reduce HIV transmission by 80% between 2019 and 2025. The HIV Action Plan monitoring and evaluation framework report published in November 2024 further summarises progress made towards the ambitions of the HIV Action Plan (3). Although considerable progress has been made, it is unlikely that the 2025 interim ambitions will be met.

The number of people first diagnosed with HIV in England has risen by 15% in 2023 and there is further evidence of widening inequalities (1). Most of the increase in HIV diagnoses between 2022 and 2023 in England was among adults exposed through sex between men and women living outside London (increase of 51% among men exposed through sex with women and 44% among women exposed through sex with men). For both GBMSM and heterosexual adults, the 2023 rise has disproportionately affected ethnic minority groups. Further provision of services that are culturally competent and accessible to diverse populations is needed.

Overall testing rates increased substantially since 2022 in England but have not fully recovered to those observed in 2019 for some demographic groups (1). The increasing levels of testing and fall in positivity over the past 5 years may be suggestive of an overall fall in HIV transmission in GBMSM, but not a continued reduction. The rise in HIV testing together with a higher and sustained positivity in Black African heterosexuals may be suggestive of ongoing transmission. However, this number is likely affected by changing patterns of migration with a recent rise in people diagnosed with HIV abroad arriving in England.

In England in 2023, for the first time, over half of all HIV diagnoses were among those previously diagnosed abroad (1). Most of those previously diagnosed with HIV abroad have evidence of existing treatment in the form of viral suppression within a month of their England presentation and are rapidly linked to care following presentation in England, ensuring good clinical outcomes and prevention of onward transmission. Services need resilience to ensure appropriate and accessible capacity for recently-arrived populations.

Migration patterns for the UK support this observed shift in the HIV burden in England. However, although immigration into the UK increased sharply following the COVID-19 pandemic, provisional estimates for July 2022 to June 2023 show a slowing of immigration during this period (5). Most people arriving in the UK for the period July 2022 to June 2023 were non-EU nationals, mainly migrants coming for work, largely using health and care visas (5). 

The implementation of an NHS England funded programme of emergency departments (ED) opt-out testing for bloodborne viruses in April 2022 has contributed to the increase in HIV diagnoses in 2023 (1,3). The increase in HIV diagnoses seen in 2023 is only partially due to the increase in testing effort due to ED opt-out testing. This is particularly apparent outside of London, where there was a 21% increase in diagnoses after adjustment for ED opt-out testing (1,3).

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

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

For those diagnosed and linked to services, HIV care remains excellent with 98% of people with diagnosed HIV being treated and 98% of people on treatment virally suppressed (1). People seen for HIV care are ageing, with over half aged 50 years and over in 2023 compared to a quarter ten years ago. This highlights the need for joined up health and social care services to meet the needs of the ageing population.

HIV prevention messages

Using condoms consistently and correctly protects against HIV and other sexually transmitted infections (STIs) such as chlamydia, gonorrhoea and syphilis. They can also be used to prevent unplanned pregnancy.

HIV testing is central to HIV prevention since it provides access to PrEP and health advice for those testing HIV negative, while a positive result leads to essential HIV care and treatment, preventing onwards transmission. Everyone having condomless sex with new or casual partners should have an STI screen, including an HIV test, on at least an annual basis. GBMSM should have tests for HIV and STIs annually, or every 3 months if having condomless sex with new or casual partners.

HIV pre-exposure prophylaxis (PrEP) is available for free from specialist SHS and can be used to reduce an individual’s risk of acquiring HIV. Consistent use of PrEP can be an efficacious and effective intervention to prevent HIV acquisition. Despite PrEP being routinely available through specialist SHS, awareness, accessibility and uptake of primary prevention initiatives is variable for different population groups (1).

HIV post-exposure prophylaxis (PEP) can be used to reduce the risk of acquiring HIV following some sexual exposures. PEP is available for free from specialist SHS and most emergency departments.

Symptoms due to HIV and AIDS may not appear for many years, and people who are unaware of living with HIV may not feel themselves to be a risk 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 about who is at risk of acquiring HIV.

People living with diagnosed HIV infection who 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.

Stigma, anxiety and depression experienced by people with HIV affect their ability to seek healthcare, engage in treatment and remain in care (6). Reducing stigma in health and care services will encourage people to seek the support and treatment they need.

Specialist SHS are free and confidential. They offer testing and treatment for HIV and STIs, condoms, vaccination, HIV PrEP and PEP. Clinic-based and online services are commissioned by local authorities for residents of all areas in England and are widely available. Information and advice about sexual health, including how to access services, is available on NHS.UK and from the national sexual health helpline on 0300 123 7123.

Local and regional prevention strategies

HIV prevention strategies at a local and regional level should consider inclusion of the following areas from the national HIV Action Plan monitoring and evaluation framework (3):

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

Charts and tables

Information on data sources and analytical methods applied for this epidemiological report can be found in Section 5.

New diagnoses

Figure 1: Rate of new HIV diagnoses per 100,000 population by UKHSA region of residence, 2023

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

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

Error bars show the confidence intervals for rates calculated to the 95% level using the Byar’s method.

Description of Figure 1

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

The chart shows that the North East had the lowest rate of all English regions (5.5 per 100,000 population). London and East Midlands had the highest rates, which were greater than the national rate.

Figure 2: Rate of new HIV diagnoses per 100,000 population by upper tier local authority of residence, North East residents, 2023

Source: UKHSA, HANDD.

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

Error bars show the confidence intervals for rates calculated to the 95% level using the Byar’s method.

Colour coding of bars does not relate to new diagnosis but to diagnosed prevalence (discussed further in Figures 16 onwards).

HIV diagnosed prevalence area (rate per 1,000 aged 15 to 59 years as per National Institute for Clinical Excellence (NICE) testing guidelines):

• low diagnosed prevalence – under 2
• high diagnosed prevalence – 2 to 5
• extremely high diagnosed prevalence – over 5

Description of Figure 2

Figure 2 is a column chart showing rates of new HIV diagnoses by North East local authority for the year 2023. 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 North East rate (5.5 per 100,000 population) 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.

The chart shows that the rate of new HIV diagnoses (for all ages) across the 12 North East local authorities ranged from 1 per 100,000 in North Tyneside to 15 per 100,000 population in Middlesbrough. In addition to Middlesbrough, Newcastle upon Tyne, Sunderland, and Gateshead had rates above the North East regional rate of 5.5 per 100,000 population. Of these, Newcastle upon Tyne was classified as an area of high diagnosed prevalence in 2023 (2.47 per 1,000 aged 15 to 59 years) (Figure 22).

Figure 3: New HIV diagnoses and deaths, North East residents, 2014 to 2023 [note 1]

Source: UKHSA, 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. An extended reporting delay may be seen for deaths as these are not always notified directly to the HIV surveillance system. Region of death may not be known for all deaths, particularly for those in the most recent years. Numbers for these years should be interpreted as minimum numbers (deaths reported and allocated to a region of death to date) and not as a trend.

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

Description of Figure 3

Figure 3 is a line chart showing the trend in number of new HIV diagnoses and deaths in HIV-diagnosed North East residents (all ages) between the years 2014 (131 new HIV diagnoses) and 2023 (148 new HIV diagnoses).

The chart shows that the number of new diagnoses increased further in 2023 compared to 2022 (from 106 to 148 new diagnoses, 40% increase), with the numbers now similar to the peak observed in 2016 (150 new diagnoses). This trend mirrors that seen nationally with the number of new diagnoses declining gradually prior to the pandemic period followed by a substantial increase in 2022 and again in 2023 (51% increase from 3,975 in 2022 to 6,008 in 2023)1.

There were 11 deaths in North East residents living with HIV in 2023, a decline of 31% compared to 2022. Additional deaths due to COVID-19 were reported during the pandemic in people living with HIV.

Figure 4: New HIV diagnoses by whether a person had been previously diagnosed abroad, North East residents, 2019 to 2023 [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 2023.

Description of Figure 4

Figure 4 is a stacked area chart displaying the trend in new HIV diagnoses in North East residents from 2019 to 2023 by whether the person had been previously diagnosed abroad or not. The solid-shaded area represents new HIV diagnoses where there had been no prior diagnosis abroad recorded and the pattern-shaded area above it represents the additional new HIV diagnoses where a prior diagnosis abroad was recorded.

The chart shows that, of the 148 new HIV diagnoses in 2023, 92 (62%) were among people not previously diagnosed abroad and 56 (38%) were among people previously diagnosed abroad. Increases in numbers were seen amongst both groups compared to 2022. Specifically, the number of individuals with a new diagnosis made in the UK increased by 37% in 2023 compared to 2022 (67 new HIV diagnoses) and the number of individuals previously diagnosed abroad increased by 44% compared to 2022 (39 new HIV diagnoses previously diagnosed abroad). The proportion of individuals previously diagnosed abroad has been increasing steadily over the past 9 years from 12% (14 of 120 new diagnoses) in 2015.

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

Source: UKHSA, HANDD.
NPDA = Not previously diagnosed abroad.

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

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 communities. If people have multiple exposures, they are allocated to the group highest in the risk hierarchy.

Numbers have been adjusted for missing transmission route allocation. Diagnoses where this information is unknown have been proportionately allocated to the 3 transmission groups.

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

Description of Figure 5

Figure 5 is a line chart showing the trend in new HIV diagnoses by probable route of acquiring HIV over the past 10 years. Three probable routes of infection are shown: sex between men, sex between men and women, and other infection routes. Each route of infection is represented by 2 lines: a solid line showing all cases and a dashed line showing only cases who were not previously diagnosed abroad. This enables better understanding of which groups remain exposed to the greatest risk of transmission in the North East.

Regardless of whether or not the new HIV diagnosis was previously diagnosed abroad, the chart shows that the numbers of HIV cases with a probable route of infection of sex between men or sex between men and women have both generally decreased between 2016 and 2020/2021 followed by a continuous increase over the past 2 years. Hence, both groups have contributed to the overall trend described in Figure 3.  

For the 92 individuals not previously diagnosed abroad (dashed lines) sex between men was the most common probable route of acquiring HIV, accounting for 52% of new diagnoses in 2023 followed by sex between men and women, which accounted for 43% in 2023. This mirrors what is seen nationally for those not previously diagnosed abroad.

When considering all new diagnoses of HIV in 2023 including those previously diagnosed abroad (solid line), sex between men and women was the most common probable route of acquiring HIV accounting for 53% of new diagnoses followed by sex between men, which accounted for 43% of new diagnoses.

All other probable routes of infection, including injecting drug use and mother to child transmission, remain low in 2023.

Figure 6a: Number of new HIV diagnoses by age group and gender, North East residents, 2023

Source: UKHSA, HANDD.

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

Description of Figure 6a

Figure 6a is a type of bar chart called an age-sex pyramid displaying the number of new HIV diagnoses in the North East in 2023 by age group and gender (male vs. female). Six age groups are displayed:

• under 15 years
• 15 to 24 years
• 25 to 34 years
• 35 to 44 years
• 45 to 54 years
• 55 years and over

This chart includes all cases, whether diagnosed previously abroad or not. In the following chart, Figure 6b, age-sex pyramids are presented separately for the new HIV diagnoses where there had been no prior diagnosis abroad recorded and for the new HIV diagnoses where a prior diagnosis abroad was recorded.

Figure 6a shows, across all cases, the highest number of new diagnoses among males is in those aged 25 to 34 years (44 new diagnoses). Among females the highest number of new diagnoses was amongst those aged 35 to 44 years (23 new diagnoses). This age-sex profile is similar to that of 2022.

Figure 6b: Number of new HIV diagnoses by age group and gender, split by whether previously diagnosed abroad, North East residents, 2023

Source: UKHSA, HANDD.

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

Description of Figure 6b

In Figure 6b age-sex pyramids are presented separately for the new HIV diagnoses that had been previously diagnosed abroad or not. This enables better understanding of which groups remain exposed to the greatest risk of transmission in the North East.

As seen in the chart on the left, individuals not previously diagnosed abroad had a wider age range than those previously diagnosed abroad. The highest number of new diagnoses among males not previously diagnosed abroad is in those aged 25 to 34 years (22 new diagnoses). Across females not previously diagnosed abroad, the highest number of new diagnoses was among those aged 35 to 44 years (12 new diagnoses).

As seen in the chart on the right, individuals previously diagnosed abroad were of working age (25 and 54 years).

Amongst females aged 45 to 54 years, those previously diagnosed abroad accounted for 90% of new diagnoses in 2023. Amongst individuals less than 25 years of age, those not previously diagnosed abroad accounted for 95% of new diagnoses in 2023.

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

Source: UKHSA, HANDD.

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

Description of Figure 6c

Figure 6c is an age-sex pyramid bar chart displaying the number of new HIV diagnoses by age group and exposure route (sex between men vs. all other exposures) for male North East residents in 2023. Sex between men accounted for 66% of new diagnoses in males (59 of 90, not adjusted for missing data) in 2023. Among these, individuals aged 25 to 34 years were the most common age group (26 of 59, 44%) followed by those aged 15 to 24 years (15 of 59, 25%) and those aged 35 to 44 years (11 of 59, 19%). Individuals aged 25 to 34 years were also the most common age group among males with other probable routes of exposure in 2023 (18 of 31, 58%) followed by those aged 45 to 64 years (9 of 31, 30%).

Figure 7a: Number of new HIV diagnoses probably acquired through sex between men by age group, North East residents aged 15 to 64 years, 2014 to 2023 [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 2023.

Description of Figure 7a

Figure 7a is a line chart displaying trend lines of the number of new HIV diagnoses probably acquired through sex between men by age group in the North East over the past 10 years (2014 to 2023). It includes all cases whether previously diagnosed abroad or not. Five age groups are displayed: 15 to 24 years, 25 to 34 years, 35 to 44 years, 45 to 54 years and 55 to 64 years. Diagnoses in those aged between 15 and 64 years accounted for an average of 99% of diagnoses in GBMSM over the 10-year period. The final points on the lines correspond to the bars on the left hand side of figure 6c.

As described previously in Figure 5, there was a general decline in the number of new diagnoses probably acquired through sex between men between 2016 and 2020/2021 followed by a continuous increase over the past 2 years. As shown above in Figure 7a, the decline in numbers between 2016 and 2020/21 was observed in all age groups with the exception of the 35 to 44 year age group. In contrast, the increase following the COVID-19 pandemic can be observed in all age groups except those aged 45 to 54 years.

Figure 7b: Number of new HIV diagnoses probably acquired through sex between men and women by age group, North East residents aged 15 to 64 years, 2014 to 2023 [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 2023.

Description of Figure 7b

Figure 7b is a line chart displaying trend lines of the number of new HIV diagnoses probably acquired through sex between men and women by age group in the North East over the past 10 years (2014 to 2023). It includes all cases whether previously diagnosed abroad or not. Five age groups are displayed: 15 to 24 years, 25 to 34 years, 35 to 44 years, 45 to 54 years and 55 to 64 years. Diagnoses in those aged between 15 and 64 years accounted for an average of 97% of diagnoses in heterosexuals over the 10-year period.

As described previously in Figure 5, there was a general decline in the number of new diagnoses probably acquired through sex between men and women between 2016 and 2020/2021 followed by a continuous increase over the past 2 years. As shown above in Figure 7b, this trend can be observed clearly in the younger age groups (15 to 24 years, 25 to 34 years, 35 to 44 years) and less so in the older age groups (45 to 54 years, 55 to 64 years).

With the exception of those aged 15 to 24 years numbers of new diagnoses in all age groups are higher in 2023 compared to 2014. In particular, the number of new diagnoses in individuals aged 25 to 34 years increased by 80% (from 15 to 27 new diagnoses) and accounts for the greatest proportion of heterosexual cases (38%) in 2023. It is important to note, that these data capture all new diagnoses including those previously diagnosed abroad. As previously shown in Figure 6b, there are differences in age and gender groups when comparing those previously diagnosed abroad with those not previously diagnosed abroad. Hence, these differences will impact upon the trends observed across transmission groups.

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

Source: UKHSA, HANDD.

NPDA = Not previously diagnosed abroad.
The number of new diagnoses will depend on accessibility of testing as well as infection and transmission.

Numbers have been adjusted for missing ethnic group. Diagnoses where this information is unknown have been proportionately allocated.

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

Description of Figure 8

Figure 8 is a line chart showing the trend in new HIV diagnoses by ethnic group over the past 10 years. The white and black African ethnic groups are represented as distinct categories. All other ethnic groups are grouped into a single category. As with the probable route of acquiring HIV line chart there is a pair of lines for each ethnic category shown, one showing all new HIV diagnoses (solid line) and one showing the number once those previously diagnosed abroad are excluded (dashed line).

The chart shows the highest number of new HIV diagnoses remained in the white ethnic group in North East residents in 2023, accounting for 43% of individuals. The number of new HIV diagnoses in the black African ethnic group has increased by 2.7 fold (167%) in 2023 compared to 2014, accounting for 38% in 2023 compared to 16% in 2014. However, this was largely driven by the increase in the number of individuals with new HIV diagnoses previously diagnosed abroad.

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

Source: UKHSA, HANDD.

NPDA = Not previously diagnosed abroad.

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

Numbers have been adjusted for missing world region of birth group. Diagnoses where this information is unknown have been proportionately allocated.

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

Description of Figure 9

Figure 9 is a line chart showing the trend in new HIV diagnoses by world region of birth over the past 10 years. The UK and Africa are represented as distinct categories. All other world regions of birth are grouped into a single category. Again, there is a pair of lines for each world region of birth shown, one showing all new HIV diagnoses (solid line) and one showing the number once those previously diagnosed abroad are excluded (dashed line).

The chart shows the number of new HIV diagnoses in North East residents born in the UK is 31% lower in 2023 compared to 2014 and accounts for 35% of new HIV diagnoses in 2023. In contrast, the number of new diagnoses in North East residents born in Africa is 137% higher in 2023 compared to 2014, and accounts for 43% of new HIV diagnoses in 2023. However, this was largely driven by the increase in the number of individuals with new HIV diagnoses previously diagnosed abroad. When considering just those individuals not previously diagnosed abroad, those born in the UK account for 58%, those born in Africa account for 29% and those born in other countries account for 14% of new HIV diagnoses in the North East in 2023.

Table 1: Number of new HIV diagnoses by ethnic group and whether born abroad, North East residents, 2019 to 2023

Ethnic group	UK-born	Born abroad	Unknown country of birth
White	176	14	15
Black African	1	34	5
Black Caribbean	0	2	0
Other	3	36	4
Unknown	3	7	62

Source: UKHSA, HANDD.

Data is for the 5-year period 2019 to 2023. Those with a prior diagnosis abroad are excluded.

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 unlike the graphs above.

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

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

Description of Table 1

Table 1 shows that the relationship between ethnic group and whether a person newly diagnosed with HIV was UK born or born abroad in North East residents. Over the past 5 years, 86% of new HIV diagnoses in the white ethnic group were in individuals born in the UK. In contrast 85%, 100% and 84% of new HIV diagnoses in the black African ethnic group, the black Caribbean ethnic group and all other ethnic groups, respectively, were in individuals born abroad. However, it is important to highlight differences in the completeness of data ascertainment across these groups.

Figure 10a: Number of new HIV diagnoses probably acquired through sex between men in those not previously diagnosed abroad by whether born abroad, North East residents, 2014 to 2023 [note 1]

Description of Figure 10a

Figure 10a is a line chart showing the trend in new HIV diagnoses in just those individuals who probably acquired HIV through sex between men by whether they were born abroad over the past 10 years. It just captures those cases not previously diagnosed abroad, excluding those previously diagnosed abroad.

The chart line shows, of those with complete information, 74% (29/39) of new diagnoses in GBMSM were in individuals born in the UK and 26% were in individuals born abroad in 2023. This is similar to the proportion in 2014 with 76% of individuals UK born and 24% born abroad.

Figure 10b: Number of new HIV diagnoses probably acquired through sex between men and women in those not previously diagnosed abroad by whether born abroad, North East residents, 2014 to 2023 [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 2023.

Description of Figure 10b

Figure 10b is a line chart showing the trend in new HIV diagnoses in just those individuals who probably acquired HIV through sex between men and women by whether they were born abroad over the past 10 years. It just captures those cases not previously diagnosed abroad, excluding those previously diagnosed abroad.

The chart line shows, of those with complete information, the proportion of new diagnoses in heterosexual individuals that were UK born was higher in 2023 compared to 2014 (38% in 2014 to 43% in 2023) while the proportion of individuals born abroad was lower (62% in 2014 to 57% in 2023).

Late diagnoses

The following set of charts relate to new HIV diagnoses that were estimated to have been made ‘late’ in relation to the time of acquisition. They include North East residents aged 15 years or older with no prior diagnosis abroad only.

The categorization of a HIV diagnosis as ‘late’ is based on CD4 count at diagnosis as this count tends to decline over time in people living with undiagnosed HIV. Most of the charts below use 3 years’ data grouped together. This is to improve robustness given that only those new HIV diagnoses that meet the specific criteria (described in each of the charts’ footnotes) can be included in the denominator.

Figure 11: Percentage of new HIV diagnoses that were diagnosed late by local authority of residence, North East residents, 2021 to 2023 [note 2]

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

Error bars show the confidence intervals for percentages calculated to the 95% level using the Wilson Score method.

Note 2: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count less than 350 cells/mm³.

Description of Figure 11

Figure 11 is a column chart showing rates of new HIV diagnoses that were diagnosed late in individuals aged 15 years and over with no prior diagnosis abroad by North East local authority for the three year period of 2021 to 2023. LAs are shown in descending order in relation to their percentage of late diagnoses. The overall North East percentage of late diagnoses (40.4%) is represented as a dashed horizontal line. Across the local authorities, the proportion of late diagnoses varied from 12% in North Tyneside to 57% in Sunderland and Northumberland.  As described below, the proportion of late diagnoses varies by risk groups. Hence, the underlying population demographics within each local authority will impact upon the overall proportion diagnosed.

Figure 12a: Percentage and number of new HIV diagnoses that were diagnosed late by probable route of infection, North East residents, 2021 to 2023 [note 2]

Source: UKHSA, HANDD, HARS.

Error bars show the confidence intervals for percentages calculated to the 95% level using the Wilson Score method.

Note 2: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count less than 350 cells/mm³.

Description of Figure 12a

Figure 12a is a column chart displaying the percentage of new HIV diagnoses that were diagnosed late (in individuals aged 15 years and over with no prior diagnosis abroad) by probable route of infection in the North East from 2021 to 2023. The four major probable routes of infection are shown: sex between men, male patients with heterosexual contact, female patients with heterosexual contact, and injecting drug use.

The chart shows that the percentage of late diagnoses varied by probable route of infection, with the highest percentage in injecting drug use (60%) and the lowest percentage in sex between men (35%).

Figure 12b: Percentage and number of new HIV diagnoses that were diagnosed late by ethnic group, North East residents, 2021 to 2023 [note 2]

Source: UKHSA, HANDD, HARS.

Error bars show the confidence intervals for rates calculated to the 95% level using the Byar’s method.

Note 2: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count less than 350 cells/mm³.

Description of Figure 12b

Figure 12b is a column chart displaying the percentage of new HIV diagnoses that were diagnosed late (in individuals aged 15 years and over with no prior diagnosis abroad) by ethnic group in the North East from 2021 to 2023. Three categories of ethnic group are displayed: white, black African, and black Caribbean.

The chart shows that the percentage of late diagnoses varied by ethnic group, with the highest percentage in black Caribbean (100%) and the lowest percentage in the white ethnic group (39%). Note: given the small numbers involved, these data should be interpreted with caution.

Figure 13: Percentage of new HIV diagnoses that were diagnosed late by probable route of infection, North East residents, 2014 to 2023 [note 1, note 2]

Source: UKHSA, HANDD, HARS.

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

Note 2: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count less than 350 cells/mm³.

Description of Figure 13

Figure 13 is a line chart showing trends in percentage of late diagnoses (in individuals aged 15 years and over with no prior diagnosis abroad) between 2014 and 2023 by exposure group. Three categories are presented: sex between men, sex between men and women and all other acquisition 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.

The chart shows a rise in the percentage of late diagnoses in both sex between men and sex between men and women from 2019 to 2022, in line with the COVID-19 pandemic. However, the proportion of late diagnoses decreased in all three categories in 2023 compared to 2022.

Figure 14: Percentage of new HIV diagnoses that were diagnosed late in GBMSM and heterosexuals by whether born abroad, North East residents, 2021 to 2023 [note 2]

Source: UKHSA, HANDD, HARS.

Note 2: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count less than 350 cells/mm³.

Description of Figure 14

Figure 14 is a column chart showing the percentage of late diagnoses (in individuals aged 15 years and over with no prior diagnosis abroad) by whether born aboard and most probable route of exposure in North East residents from 2021 to 2023. Two probable routes of exposure are included: sex between men and sex between men and women.

The chart shows that the lowest percentage of late diagnoses is in those probably exposed through sex between men who were born in the UK (30%). The percentage of individuals born in the UK and born abroad is similar in those probably exposed through sex between men and women (46% and 48%, respectively).

Figure 15a: Age distribution of new HIV diagnoses that were diagnosed late by year of diagnosis, North East residents, 2014 to 2023 [note 2]

Source: UKHSA, HANDD, HARS.

Note 2: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count less than 350 cells/mm³.

Description of Figure 15a

Figure 15a is a type of column chart in which the percentages within each column are stacked. Each column represents a year. The colours within the columns represent the percentage of all new HIV diagnoses that were diagnosed late in that year by age group. As such, each column adds up to 100% of cases. As with previous charts, this chart captures North East residents aged 15 years or older with no prior diagnosis abroad that were estimated to have been diagnosed late.    

The chart shows that in 2023 11% of those diagnosed late were aged 15 to 24 years, 30% were aged 25 to 34 years, 30% were aged 35 to 44 years, 4% were aged 45 to 54 years and 26% were aged 55 and older. These proportions have varied over the past 10 years.

Figure 15b: Percentage of all new diagnoses that were late by age group and year of HIV diagnosis, North East residents, 2014 to 2023 [note 2]

Source: UKHSA, HANDD, HARS.

Note 2: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count less than 350 cells/mm³.

Description of Figure 15b

Figure 15b is a column chart showing the percentage of late diagnoses within each age group over the past 10 years. As with previous charts, this chart captures North East residents aged 15 years or older with no prior diagnosis abroad.    

The chart shows that for all age groups except 55 years and over, the proportion of late diagnoses in 2023 is less than that of 2013. In those aged 55 and over, the proportion of late diagnoses has increased over the past 10 years.

People living with diagnosed HIV

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

Source: UKHSA, HARS.

Error bars show the confidence intervals for rates calculated to the 95% level using the Byar’s method.

Description of Figure 16

Figure 16 is a column chart displaying the prevalence of diagnosed HIV in 2023 by UKHSA region. Rates are by 1,000 population and are restricted to those aged 15 to 59 years. It shows that the rate of diagnosed HIV prevalence in the North East is the lowest of all English regions at 1.3 per 1,000 population aged 15 to 59 years.

Figure 17: Number of residents living with diagnosed HIV and accessing care, the North East, 2014 to 2023

Source: UKHSA, HARS.

Figure 17 is a line chart showing the number of North East residents living with diagnosed HIV who accessed HIV related care over the past 10 years. This number acts as a proxy for the number of people living with diagnosed HIV in the region.

As can be seen in Figure 17, the number of North East residents living with diagnosed HIV in 2023 was 2,437. There has been an increasing trend in the number of North East residents living with diagnosed HIV over the past 10 years. This reflects advances in testing as well as HIV treatments and care and, consequently, reductions in mortality associated with HIV. Disruptions to care, changes in residence and migration during the main pandemic years can also be observed.

Figure 18: Number of residents living with diagnosed HIV and accessing care by probable route of transmission (adjusted for missing route information), the North East, 2023

Source: UKHSA, HARS.

Numbers have been adjusted for missing transmission route allocation. Diagnoses where this information is unknown have been proportionately allocated to the transmission groups.

Description of Figure 18

Figure 18 is a column chart displaying the number of North East residents living with diagnosed HIV and accessing care in 2023 broken down by probable route of transmission. Five categories of probable route of transmission are shown: sex between men, sex between men and women, mother-to-child transmission, blood/healthcare worker and injecting drug use.

As can been seen, of the 2,437 North East residents accessing HIV care in 2023 97% of them are likely to have acquired HIV via sex, with 1,234 having probably acquired HIV through sex between men and 1,124 having probably acquired HIV through sex between men and women. Only a small number of individuals are likely to have acquired HIV via the 3 other transmission routes presented.

Figure 19: Percentage of residents with diagnosed HIV who are accessing care in each age group, the North East, 2014 and 2023

Source: UKHSA, HARS.

Description of Figure 19

Figure 19 is a column chart displaying the age distribution of North East residents with diagnosed HIV who accessed care in 2014 (dark column) and 2023 (light column). Five age groups are displayed: under 15 years, 15 to 24 years, 25 to 34 years, 35 to 49 years and 50 and over years.

The chart shows for all age groups except 50 years and over, the percentage of residents with diagnosed HIV was lower in 2023 compared to 2014. This shows an ageing cohort effect in which there is reduced transmission and fewer new diagnoses feeding into the younger age groups in combination with improved treatments and fewer premature deaths such that more individuals living with diagnosed HIV are moving up into older age groups.

Figure 20: Diagnosed HIV prevalence per 1,000 residents by ethnic group (all ages), the North East, 2023

Source: UKHSA, HARS.

Error bars show the confidence intervals for rates calculated to the 95% level using the Byar’s method.

Description of Figure 20

Figure 20 is a column chart displaying the prevalence of diagnosed HIV in the North East in 2023 by ethnic group. Six categories of ethnic group are shown: black African, black Caribbean, black other or unspecified, other or mixed, white, and Asian.

The chart shows the diagnosed HIV prevalence per 1,000 North East residents was highest in the black African ethnic group (24.2) and lowest in the white (0.6) and Asian (0.5) ethnic groups. Notably the North East has a small population of black African and black Caribbean ethnic groups. While these groups show the greatest prevalence, absolute numbers are small. In 2023 there were 1,575 individuals with a white ethnic background, 533 individuals with a black African ethnic background, 139 other or mixed, 52 Asian, 19 black other and 18 black Caribbean ethnic backgrounds living with diagnosed HIV and accessing care in the North East.

Figure 21: Diagnosed HIV prevalence per 1,000 population by Index of Multiple Deprivation decile, the North East, 2023

Source: UKHSA, HARS.

Error bars show the confidence intervals for rates calculated to the 95% level using the Byar’s method.

Index of Multiple Deprivation decile: 1=most deprived to 10=least deprived.

Description of Figure 21

Figure 21 is a column chart displaying the diagnosed HIV prevalence per 100,000 North East residents in 2023 by index of multiple deprivation (IMD) decile (1 is the most deprived, 10 is the least deprived). The chart shows the rate across the North East continues to increase with increasing deprivation in 2023, increasing from 0.3 per 1,000 population in the least deprived areas to 1.4 per 1,000 population in the most deprived areas.

Figure 22: Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by local authority, the North East, 2023

Source: UKHSA, HARS.

Error bars show the confidence intervals for rates calculated to the 95% level using the Byar’s method.

HIV diagnosed prevalence area (rate per 1,000 aged 15 to 59 years as per NICE testing guidelines):

• low diagnosed prevalence – less than 2
• high diagnosed prevalence – 2 to 5
• extremely high diagnosed prevalence – over 5

Description of Figure 22

Figure 22 is a column chart which displays the prevalence of diagnosed HIV by North East local authority of residence in 2023. Rates are restricted to those aged 15 to 59 years and are by 1,000 population.

The chart shows the regional rate in 2023 is 1.3 per 1,000 residents aged 15 to 59 years (presented by the dashed line). Three local authorities had rates higher that the regional rate: Newcastle upon Tyne (2.5 per 1,000), Middlesbrough (1.6 per 1,000) and Gateshead (1.6 per 1,000). Of these, Newcastle upon Tyne was classified as an area of high diagnosed prevalence. Redcar and Cleveland and Northumberland have the lowest rates (0.7 and 0.8 per 1,000, respectively).

Continuum of HIV care

Figure 23: The continuum of HIV care, 2023

Source: UKHSA, HARS, MPES model.

Description of Figure 23

Figure 23 is a column chart graphically depicting the continuum of care in England outside of London and how this cohort compares to the UNAIDS 95:95:95 HIV targets.

The 4 bars represent the 4 stages of the continuum of care. The bar on the left represents all England excluding London residents believed to be living with HIV (both diagnosed and undiagnosed) and acts as the reference for all other stages. As can be seen in the figure, in 2023, 95% of all England excluding London residents believed to be living with HIV had a HIV diagnosis, 93% were on treatment and 91% were virally suppressed and therefore cannot transmit HIV to others.

The UNAIDS 95:95:95 HIV targets are based on percentages of the preceding stage. These are presented in the arrows. The chart shows that in 2023, 95% of people living with HIV in England (excluding London) are diagnosed. Of those diagnosed, 99% are on treatment. And of those on treatment, 98% are virally suppressed. Hence, in 2023, England (excluding London) met the UNAIDS 95:95:95 HIV targets.

It is important to note that as these data capture all regions outside of London it includes regions with very high prevalence areas as well as regions with very low prevalence areas such as the North East. It may therefore not be very representative of all regions and local authorities.

It is not possible to extrapolate the number of North East residents living with undiagnosed HIV. However, from the available information, 94% of North East residents diagnosed with HIV were receiving ART and 97% were virally suppressed (viral load less than 200) and very unlikely to pass on HIV in 2023.

A more detailed analysis at the regional level may be required to inform regional action plans.

HIV testing

Figure 24: HIV testing rate per 100,000 by population group, North East residents attending specialist sexual health services only, 2019 to 2023

Source: UKHSA, GUMCAD.

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

Description of Figure 24

Figure 24 is a line chart presenting testing rates at specialist sexual health services in North East residents over the last 5 years. Rates are per 100,000 population and are not age restricted. Three categories are presented: all individuals, males and females.

The chart shows that, following the decline in testing rate in 2020, rates have increased continuously over the past 3 years and are higher than in 2019 for all individuals as well as for males and females.

Table 2: People tested for HIV by population group, North East residents attending all SHSs, 2019 to 2023

Gender/sexual orientation	2019	2020	2021	2022	2023	% change
2019 to 2023	% change
2022 to 2023
Heterosexual men	14,521	7,247	7,695	9,762	12,759	-12%	31%
GBMSM	4,167	3,747	5,480	5,361	5,981	44%	12%
Subtotal (men)	19,393	11,508	13,960	16,031	19,847	2%	24%
Hetero/bisexual women	19,619	12,096	14,916	17,665	21,737	11%	23%
WOSW	176	178	289	300	357	103%	19%
Subtotal (women)	20,853	12,829	16,029	18,923	23,413	12%	24%
Total (all genders)	41,475	25,466	31,619	37,659	44,756	8%	19%

Source: UKHSA, GUMCAD.

Table 2 presents the number of North East residents tested for HIV in all sexual health services over the last 5 years by population group. There is a noticeable drop in the number of HIV tests performed in heterosexual men in 2020, attributable to restrictions during the COVID-19 pandemic. Whilst the number of HIV tests have increased by 31% compared to 2022 they remain 12% below that of 2019 for heterosexual men. HIV testing in SHS dropped slightly in GBMSM in 2020 and has increased consistently since then. The number of HIV tests performed in SHS in GBMSM has increased by 44% in 2023 compared to 2019. HIV testing in SHS also decreased substantially in heterosexual/bisexual female North East residents in 2020 but has increased consistently since then and is now 11% higher than it was in 2019. The number of HIV tests in women who only sleep with women has increased consistently over the past 5 years and is 103% higher in 2023 compared to 2019.

PrEP

Figure 25: HIV pre-exposure prophylaxis (PrEP) need and initiation/continuation in residents attending specialist sexual health services (SHSs), the North East, 2023

Source: UKHSA, GUMCAD.

Description of Figure 25

Figure 25 is a column chart showing information about PrEP need and use by gender and sexual orientation in 2023. Four groups are shown:

• GBMSM
• heterosexual or bisexual women
• heterosexual men
• women who sleep with women

For each group there are 3 columns. The first column represents the percentage of North East residents attending specialist SHSs who were determined to have a PrEP need 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. 

The chart shows that recognized PrEP need was substantially higher among GBMSM (59%) residents in the North East compared to other population groups (less than 1% to 6%). The percentage of individuals in which PrEP need was identified during consultation varied by population group (ranging from 48% of consulations in heterosexual men to 85% in WOSW). The percentage of individuals in which PrEP was initiated or continued also varied by population group (ranging from 19% in heterosexual men to 63% in GBMSM).

Information on data sources

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

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

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

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

The most recent ONS mid-year estimates at the time of analysis were used as denominators for rates. For UTLAs 2023 estimates were used (published June 2024), for MSOAs 2022 estimates were used (published November 2024), for LTLAs 2021 estimates were used (published 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 infection is ‘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 infection was sex between men would be calculated using new diagnoses for which route of infection was known as the denominator.

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

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

Further information

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

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

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

See the national HIV report: 2023 data.

For the HIV Action Plan monitoring and evaluation framework 2024 report, access: HIV Action Plan monitoring and evaluation framework.

For the Towards Zero: the HIV Action Plan for England – 2022 to 2025, access: Towards Zero: the HIV Action Plan for England - 2022 to 2025.

For the Routine commissioning of HIV PrEP in England: Monitoring and evaluation framework 2022, access Routine commissioning of HIV PrEP in England: Monitoring and evaluation framework 2022.

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

About the Field Service

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

You can contact your local FS team at yhfs@ukhsa.gov.uk.

If you have any comments or feedback regarding this report or the Field Service, contact your local FS team at the address above.

Acknowledgements

We would like to thank:

• 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

References

1. Kitt H, Shah A, Chau C, Okumu-Camerra K, Bera S, Schoemig V, Mackay N, Kolawole T, Ratna N, Martin V, Đjuretić T, Brown A. HIV testing, PrEP, new HIV diagnoses, and care outcomes for people accessing HIV services: 2024 report UK Health Security Agency (UKHSA) 2024
2. Towards Zero: the HIV Action Plan for England – 2022 to 2025 UK Government White Paper 2021
3. Schoemig V, Martin V, Shah A, Okumu-Camerra K, Mackay N, Bera S, Kitt H, Kelly C, Kolawole T, Ratna N, Chau C, Duretić T, Brown A and contributors. HIV Action Plan monitoring and evaluation framework 2024 report: Report summarising progress from 2019 to 2023 UKHSA 2024
4. Mitchell H, Enayat Q, Buitendam E, Parmar S, Wilkinson G, Everall I, Prochazka M, Saunders J and contributors. Routine commissioning of HIV Pre-Exposure Prophylaxis (PrEP) in England: Monitoring and evaluation framework UKHSA 2022
5. Office for National Statistics (ONS)  Long-term international migration, provisional: year ending June 2023 ONS 2023: statistical bulletin
6. 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. Report summarising data from 2022 and measuring change since 2017 UKHSA 2023