Research and analysis

Annual epidemiological spotlight on HIV in the North West: 2023 data

Updated 7 October 2025

Summary

Overview

For this report, people receiving their first HIV positive test result in the UK are included in the count for new HIV diagnoses and include people living with diagnosed HIV continuing care in England.

HIV remains an important public health problem in the North West.

In the North West, new HIV diagnoses reached 620 in 2023, the highest number in the last 10 years. This was a 61% increase compared to 2022 (386 cases) and a 52% increase compared to 2019 (409 cases) (Figure 3). For the national trend: new diagnoses rose by 46% compared to 2022 and 49% compared to 2019 (1).

HIV testing at all (specialist and non-specialist) sexual health services (SHSs) in the North West was 8% higher than in 2022 but 7% lower than in 2019 (Table 2).

Main changes in the North West

New diagnoses in people previously diagnosed abroad:

• increased by 123% between 2022 and 2023 (from 144 to 322 diagnoses).
• comprised 52% (322 of 620) of all new diagnoses in 2023, up from 20% to 30% in previous years (Figure 4, Figure 5a).
• this matches national trends

Shift in transmission route:

• 63% (388 of 620) of new diagnoses in 2023 were attributed to sex between men and women, a marked change from previous years where a similar or higher proportion were among GBMSM (Figure 5a)

For the trends by ethnic group: the White ethnic group has consistently had the highest number of new diagnoses since 2014. However, in 2023 diagnoses among the Black African ethnic group rose sharply, making up 47% of new diagnoses, while the White ethnic group accounted for 30%.

For the Black African ethnic group 68% of cases were previously diagnosed abroad (198 of 291) (Figure 8). This matches the national trend outside London.

Indicators consistent with the previous report

Late diagnoses:

• 40% of new HIV diagnoses were diagnosed late for the period 2021 to 2023 (Figure 11). This is the same as for England (1).
• late diagnoses were higher in heterosexual men (52%) and women (42%) compared to GBMSM (34%) (Figure 12a) and in people in the Black African ethnic group (45%) compared to people in the White ethnic group (40%) (Figure 12b)

Diagnosed HIV prevalence in the North West had the second highest regional diagnosed HIV prevalence after London (2 compared to 5 per 1000 aged 15 to 59 years) (Figure 16). This was the same as the overall prevalence in England.

One NW local authority had very high diagnosed HIV prevalence (more than 5 per 1,000 population aged 15 to 59 years) in 2023 and 7 had high HIV diagnosed prevalence (2 to 5 per 1,000 population aged 15 to 59 years) (Figure 22).

New diagnoses

In 2023, 620 new HIV diagnoses were recorded to residents of the North West, accounting for 10% of new diagnoses in England (Figure 3). This represents a rise of 61% 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.

298 residents of the North West were newly diagnosed with HIV in 2023. 322 people with diagnosed HIV moved to the UK from abroad and continued treatment in the North West in 2023.

The new diagnosis rate for North West residents (8 per 100,000) was below that of England in 2023 (10 per 100,000 ) (Figure 1).

In 2023, 32% of all new diagnoses in North West residents were in gay, bisexual and other men who have sex with men (GBMSM) (compared to 45% in 2022 and 60% in 2014) (Figure 5a). The number of GBMSM resident in the North West newly diagnosed with HIV (197, adjusted for missing information) was 45% lower than in 2014. Of the GBMSM newly diagnosed with HIV, 55% were White and 48% were UK-born.

Heterosexual contact was the largest infection route for new diagnoses in North West residents in 2023 (63%) (Figure 5a). Infections in African born persons accounted for 77% of all heterosexually acquired cases in 2023 (232 cases, of which 151 were previously diagnosed abroad), compared to 40% (86 cases, of which 10 were previously diagnosed abroad) in 2014. Infections in UK born persons accounted for 17% of all heterosexually acquired cases in 2023.

Injecting drug use accounted for 2% of new diagnoses in North West residents (Figure 5b).

Black Africans represented 47% of all newly diagnosed North West residents in 2023 (compared to 33% in 2022 and 16% in 2014) (Figure 8). A small proportion of new diagnoses in 2023 were in Black Caribbeans (less than 1%)

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 2023 (Figure 6a).

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 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 West residents with HIV are diagnosed late (40% from 2021 to 2023, compared to 40% in England), as defined by a CD4 count of less than 350 cells/mm at diagnosis.

In the North West, heterosexuals were more likely to be diagnosed late (52% of males, 42% of females) than GBMSM (34%) ((Figure 12a). By ethnic group, Black Africans were more likely to be diagnosed late than the White population (45% and 40% respectively) (Figure 12b).

People living with diagnosed HIV

The 11,052 people living with diagnosed HIV in the North West in 2023 was 8% higher than in 2022 and 43% higher than in 2014 (Figure 17). This increase is partly due to the effectiveness of HIV treatment, which has reduced the number of deaths from HIV, as well as people newly diagnosed with HIV entering care

The diagnosed prevalence rate of HIV in the North West in 2023 was 2 per 1,000 residents aged 15 to 59 years (Figure 16). This was equal to the 2 per 1,000 observed in England as a whole (small differences may be hidden by rounding). There were 8 local authorities in the North West that 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 (Figure 22). They were:

• Blackpool (4.3)
• Bolton (2.1)
• Bury (2.3)
• Liverpool (2.4)
• Manchester (6.2)
• Rochdale (2.4)
• Salford (4.4)
• Tameside (2.2)

The 2 most common probable routes of transmission for North West residents living with diagnosed HIV in 2023 were sex between men (52%) and sex between men and women (44%) (Figure 18).

In 2023, 41% of those living with diagnosed HIV in the North West were aged between 35 and 49 years, and 46% were aged 50 years and over (up from 26% in 2014) (Figure 19). Males represented 72% of North West residents living with diagnosed HIV in 2023 and females represented 28%. The rate of diagnosed HIV prevalence increased with increasing residential area-level deprivation (Figure 21).

In 2023, 62% of North West residents living with diagnosed HIV were White and 27% 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 (23 per 1,000) than in the White population (1 per 1,000) (Figure 20).

Continuum of HIV care

In England, excluding London in 2023, 99% of HIV diagnosed residents were receiving anti-retroviral treatment. Of these, 98% were virally suppressed (viral load less than 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 antiretroviral therapy (ART) and 98% of these virally suppressed (Figure 25).

For North West residents, the proportion starting treatment within 91 days of diagnosis for the period 2021 to 2023 was 89%. 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.

Outside London

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 non-Black African heterosexual men (7%, 5% to 11%).

London

It is estimated that 500 GBMSM in London are undiagnosed (CrI 300 to 1000) and 600 heterosexuals (CrI 500 to 900), including 300 Black Africans. In London, the proportion undiagnosed varied by exposure group with the highest proportion undiagnosed among people living with HIV who inject drugs (8%, CrI 2% to 18%), non-Black African heterosexual women (4%, 3% to 6%), and non-Black African heterosexual men (4%, 2% to 11%).

HIV testing

A total of 93,969 people were tested in specialist sexual health services (SHSs) in the North West in 2023, a decrease of 19% since 2019 and an increase of 14% since 2022. The HIV testing rate (per 100,000 population) at all SHSs (specialist and non-specialist services) in the North West was 1,929, which compares to 2,771 across England. HIV testing rates in specialist SHSs in the North West was similar in men (1,777) and women (1,767) (Figure 26).

The overall number of people tested for HIV in the North West at all SHSs increased by 8% in 2023 compared to 2022 but was 7% lower than in 2019 (Table 2). There was variation in testing between population subgroups; testing increased by 26% in GBMSM in 2023 compared to 2019 while it decreased in heterosexual men (-25%), all men (-15%), heterosexual and bisexual women (-8%) and all women (-11%) (Table 2).

PrEP

In 2023, 8% of HIV-negative North West residents accessing SHSs in England were defined as having a PrEP need, among whom 71% initiated or continued PrEP. Of those with PrEP need, 84% had this need identified at a clinical consultation. Among GBMSM, the group with greatest need, these proportions were: 66%, 73% and 85% (Figure 27).

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. Addressing this disparity is vital to HIV prevention.

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 key 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 (4). 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 (4). 

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 (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 (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 10 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  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 should have an STI screen, including an HIV  test, on at least an annual basis, if having condomless sex with new or casual partners. 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 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 (5). Reducing stigma in healthcare services will encourage people from seeking the healthcare services 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 services are commissioned by local authorities for residents of all areas in England and online self-sampling for HIV and STIs is 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 the following areas from the national HIV Action plan monitoring and evaluation framework (3). They include:

• implementation and monitoring of 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, tables and maps

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

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

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

Figure 1 shows the North West had the third lowest rate of new HIV diagnoses at 8.2 per 100,000 population for all ages in 2023. London had the highest rate at 17.2 per 100,000. The rate of new HIV diagnoses across England was 10.4 per 100,000 (Figure 1).

Figure 2: Rate of new HIV diagnoses per 100,000 population (all ages) by upper tier local authority of residence, North West residents, 2023

Source: UKHSA, HANDD.

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

Figure 2 is a bar chart displaying the rate of new HIV diagnoses in 2023 per 100,000 among upper tier local authorities in the North West. Manchester, Blackpool, and Liverpool had the highest rates of new HIV diagnoses in the North West at 28, 13, and 13 diagnoses per 100,000 respectively. St Helens had the lowest rate of new HIV diagnoses at 3 diagnoses per 100,000. The rate of new HIV diagnoses across the North West was 8.2 per 100,000 in 2023.

The bars are coloured according to the diagnosed HIV prevalence in the upper tier local authority of residence. The areas with the highest rates of new HIV diagnoses also had extremely high or high diagnosed HIV prevalence. Tameside, Rochdale and Bury are high diagnosed HIV prevalence areas, yet the number of new diagnoses in these areas in 2023 was low compared to other areas in the North West region.

Figure 3: New HIV diagnoses and deaths, the North West, 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. Region of death may not be known for all deaths, particularly for those in the most recent years. Numbers for these years should be interpreted as minimum numbers (deaths reported and allocated to a region of death to date) and not as a trend.

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

Figure 3 is a line chart displaying 2 trend lines: the number of new HIV diagnoses and deaths from 2014 to 2023. In 2023, 620 HIV diagnoses were recorded, the highest number of HIV diagnoses in the period 2014 to 2023, and an increase of 61% compared to 2022.Over the 10 year period between 2014 and 2023, there was an initial steady decline in diagnoses between 2014 and 2020 from 601 to 325 diagnoses. Diagnoses gradually increased between 2020 and 2022 from 325 to 386, and then increased sharply between 2022 and 2023 to 620. The number of HIV deaths increased from 61 in 2022 to 85 in 2023, an increase of 39%.

Figure 4: New HIV diagnoses by whether a person had been previously diagnosed abroad, the North West, 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.

Figure 4 is a stacked area chart displaying a breakdown of new HIV diagnoses into 2 categories: people who were previously diagnosed abroad and people who were not previously diagnosed abroad. The chart displays data from 2019 to 2023. The trend in new HIV diagnoses is described in the caption for Figure 3. The percentage of new HIV diagnoses previously diagnosed abroad remained generally stable at approximately 20 to 30% of total new HIV diagnoses each year until 2022 but this increased markedly in 2023 to approximately 50% of total new HIV diagnoses.

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

Source: UKHSA, HANDD.

NPDA means not previously diagnosed abroad.

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

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

Figure 5a is a line chart displaying trend lines of the number of new HIV diagnoses by probable route of infection over the past 10 years (2014 to 2023). There are 3 probable routes of infection 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. Overall, sex between men was the probable route of infection for the largest number of cases between 2014 and 2018 but steadily declined over this period and reached a level similar to that for sex between men and women by 2019. New diagnoses attributed to both infection routes remained similar and stable until 2022. There was a sharp increase in diagnoses attributed to sex between men and women in 2023, predominantly in people previously diagnosed abroad. There was a small decrease in new diagnoses attributed to sex between men overall in 2023 but a slight decline in those not previously diagnosed abroad. 

The number of new HIV diagnoses with other probable infection routes has remained consistently low.

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

Source: UKHSA, HANDD.

NPDA means not previously diagnosed abroad.

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

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

Figure 5b is a line chart displaying trend lines of the number of new HIV diagnoses by probable route of infection over the past 10 years (2014 to 2023). The routes of infection included in this chart are those grouped into the “other infection routes” category in Figure 5a. There are 3 probable routes of infection shown: intravenous drug use, mother-to-child, and other.

The numbers of new HIV diagnoses across these 3 probable routes of infection are very small so be cautious interpreting trends from this figure as small changes in the number of diagnoses can appear dramatic. New diagnoses attributed to mother-to-child transmission increased between 2022 and 2023 from 5 to 10. There has been a steady upward trend in new HIV diagnoses related to intravenous drug use since 2017, rising from 8 to 12 in 2023.

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

Source: UKHSA, HANDD.

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

Figure 6a is a type of bar chart called an age-sex pyramid displaying the number of new HIV diagnoses in the North West in 2022 by age group and gender (male vs. female).

There are 6 age groups displayed:

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

Within each age group, consistently fewer new HIV diagnoses are seen in women in comparison to men, with the exception of under 15s with 2 new diagnoses in females and none in males. The largest number of new HIV diagnoses in men are in the 25 to 34 year-old and 35 to 44 year-old age groups (122 and 117 diagnoses respectively).  Among women, the largest number of new HIV diagnoses are in the 35 to 44 year-old age group (106 diagnoses).

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

Source: UKHSA, HANDD.

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

Figure 6b shows 2 pyramid bar charts comparing the number of new HIV diagnoses among North West residents by age group and sex in people first diagnosed in the UK to people previously diagnosed abroad.

There are 5 age groups displayed:

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

With the exception of under 15 year olds first diagnosed in the UK and 35 to 44 year olds previously diagnosed abroad, more new HIV diagnosis are consistently seen amongst males compared to females. In both people first diagnosed in the UK and previously diagnosed abroad, the majority of new diagnoses are aged 25 to 34 and 35 to 44 years. New diagnoses are more evenly distributed by sex in people previously diagnosed abroad (47% female) compared to people first diagnosed in the UK (35% female).

Figure 6c: Number of new HIV diagnoses by age group and probable route of acquiring HIV, male North West 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.

Figure 6c is a pyramid bar chart showing the number of new HIV diagnoses among male North West residents by age group and probable route of infection. Probable route of infection is divided into 2 groups: sex between men and all other exposures.

There are 5 age groups displayed:

• under 15
• 15 to 24
• 25 to 34
• 35 to 44
• 45 to 54
• 55 to 64

Within age groups 15 to 24 and 25 to 34, the number of new HIV diagnoses where the probable route of infection is sex between men is higher than all other exposures. Among men aged 35 to 44, 45 to 54 and 55 to 64, the number of new HIV diagnoses where the probable route of infection was sex between men is lower than all other exposures. The largest number of new HIV diagnoses is found among men aged 25 to 34 with a probable exposure of sex between men.

Figure 7a: Number of new HIV diagnoses probably acquired through sex between men by age group and year of first UK HIV diagnosis, North West 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.

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 West over the past 10 years (2014 to 2023).

There are 5 age groups displayed:

• under 15
• 15 to 24
• 25 to 34
• 35 to 44
• 45 to 54
• 55 to 64

As seen in Figure 5a, the number of HIV diagnoses where the probable route of infection is sex between men has generally decreased across all age groups since 2014. This decrease appears to have plateaued since 2020 for all age groups with the exception of the 25 to 34 year olds, where number of new HIV diagnoses increased in 2023. The highest number of new HIV diagnoses has consistently been among those aged 25 to 34 while the lowest has been among those aged 55 to 64.

Figure 7b: Number of new HIV diagnoses probably acquired through sex between men and women by age group (in years) and year of first UK HIV diagnosis, North West 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.

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 West over the past 10 years (2014 to 2023).

There are 5 age groups displayed:

• under 15
• 15 to 24
• 25 to 34
• 35 to 44
• 45 to 54
• 55 to 64

New diagnoses in the 25 to 34, 35 to 44 and 45 to 54 age groups increased steeply in 2023 to the highest level in the previous 10 years while the trend for age groups 15 to 24 and 55 to 64 remained stable. The highest number of new HIV diagnoses has consistently been among those aged 35 to 44 while the lowest has primarily been among those aged 15 to 24.

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

Source: UKHSA, HANDD.

NPDA means not previously diagnosed abroad.

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

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

Figure 8 is a line chart displaying trend lines of the number of new HIV diagnoses by ethnic group in the North West over the past 10 years (2014 to 2023). Ethnicity is divided into 3 groups: White, Black African, and all other ethnic groups.

Each ethnic group is represented by 2 lines: one solid line showing all cases and a dashed line showing only cases who were not previously diagnosed abroad.

The number of new HIV diagnoses among people who are White has generally trended downwards since 2014.

The number of new HIV diagnoses among people of Black African ethnicity decreased slightly from 2014 to 2020 but increased between 2020 and 2023. There was a particularly sharp increase in 2023 to the highest level in the previous 10 years. 68% (198 of 291) of new diagnoses in the Black African ethnic group in 2023 were in people who had been previously diagnosed abroad.

The number of new HIV diagnoses in the ‘all other ethnic groups’ category remained relatively stable and low between 2014 and 2020 and similarly increased from 2020, predominantly in people previously diagnosed abroad. The highest number of new HIV diagnoses has consistently been among people who are White until 2023, when the majority of new diagnoses (47%) were in people of Black African ethnicity.

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

Source: UKHSA, HANDD.
NPDA means not previously diagnosed abroad.
The number of new diagnoses will depend on accessibility of testing as well as infection and transmission.

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

Figure 9 is a line chart displaying trend lines of the number of new HIV diagnoses by world region of birth for North West residents over the 10 year period 2014 to 2023. World region of birth is broken into 3 categories: UK, Africa, and all other countries.

Each world region of birth category is represented by 2 lines: one solid line showing all cases and a dashed line showing only cases who were not previously diagnosed abroad. Among people born in the UK, new HIV diagnoses have generally trended downwards since 2014, going from 418 new HIV diagnoses in 2014 to 168 diagnoses in 2023. The number of new HIV diagnoses among people born in Africa remained stable until 2023, when a sharp increase in the number of new HIV diagnoses was observed (96 in 2014, 322 in 2023), predominantly in people who had previously been diagnosed abroad. The number of new HIV diagnoses among people born in countries outside of the UK and Africa has increased slightly from 87 in 2014 to 130 in 2023.

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

Ethnic group	UK-born	Born abroad	Unknown country of birth
White	660	126	9
Black African	13	229	9
Black Caribbean	8	3	1
Other	48	142	11
Unknown	9	37	55

Source: UKHSA, HANDD.

Table 1 shows the relationship between ethnic group and whether a person newly diagnosed with HIV was born abroad. 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.

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.

Table 1 displays the number of new HIV diagnoses over the 5-year period 2019 to 2023 combined, by ethnic group and whether born abroad for North West residents. Amongst those born in the UK, White people represented the highest number of new HIV diagnoses, with 660 new diagnoses between 2019 and 2023. Amongst people born abroad, Black African people had the highest number of new HIV diagnoses, with 229 diagnoses between 2019 and 2023.

Figure 10a: New HIV diagnoses in GBMSM not previously diagnosed abroad by whether born abroad, North West 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.

Figure 10a is a line chart displaying trend lines of the number of new HIV diagnoses in GBMSM not previously diagnosed abroad for North West residents by whether they were born abroad over a 10 year period (2014 to 2023). The number of new HIV diagnoses in GBMSM not previously diagnosed abroad that were born in the UK decreased between 2014 and 2023, going from 280 in 2014 to 70 in 2023. The trend for number of new HIV diagnoses in GBMSM not previously diagnosed abroad for those born abroad and of unknown country of birth has remained stable over the past 10 years.

Figure 10b: New HIV diagnoses in heterosexuals not previously diagnosed abroad by whether born abroad, North West 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.

Figure 10b is a line chart displaying trend lines of the number of new HIV diagnoses in heterosexuals not previously diagnosed abroad for North West residents by whether they were born abroad, over the 10 year period 2014 to 2023.

The number of new HIV diagnoses in heterosexuals not previously diagnosed abroad that were born in the UK decreased between 2014 and 2023, going from 97 in 2014 to 45 in 2023. Following a steady downward trend in the number of new HIV diagnoses in heterosexuals not previously diagnosed abroad that were born abroad between 2014 and 2020, there was an increase between 2020 and 2023 nearing the level seen in 2014. The trend for number of new HIV diagnoses in heterosexuals not previously diagnosed abroad for those of unknown country of birth increased slightly from 1 in 2014 to 10 in 2023.

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

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

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

Figure 11 is a bar chart displaying the percentage of new HIV diagnoses that were diagnosed late by upper-tier local authority for the period 2021 to 2023. It shows that the highest percentage of late HIV diagnoses were in Halton and Cumberland (both 60%) followed by Blackburn with Darwen (56%), and Cheshire East (52%). The upper-tier local authorities with the lowest percentage of late diagnoses were Westmorland and Furness (9%), Bury (12%), and Bolton (22%). Across the entire North West, 40% of new HIV diagnoses were diagnosed late from 2021 to 2023.

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

Source: UKHSA, HANDD, HARS.

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

Figure 12a is a bar chart displaying the percentage of new HIV diagnoses that were diagnosed late by probable route of infection in the North West from 2021 to 2023. Four probable routes of infection are shown: sex between men, male patients with heterosexual contact, female patients with heterosexual contact, and injecting drug use.  It shows that the percentage of new HIV diagnoses that were diagnosed late is higher among those where the probable route of infection was injecting drug use (67%), in comparison to those where the probable route of infection is heterosexual contact (52% of men, 42% of women) or sex between men or (34%). The difference in the proportion of late diagnoses was statistically significant between sex between men and men with heterosexual contact.

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

Source: UKHSA, HANDD, HARS.

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

Figure 12b is a bar chart displaying the percentage of new HIV diagnoses that were diagnosed late by ethnic group in the North West for the period 2021 to 2023. Three categories of ethnic group are displayed: White, Black African and Black Caribbean. It shows that the percentage of late new HIV diagnoses was higher among people who are Black Caribbean (60%) in comparison to people who are White (40%) or Black African (45%). However, these differences are not statistically significant and the number of new diagnoses in the Black Caribbean group is less than 5.

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

Source: UKHSA, HANDD, HARS.

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

Figure 13 is a line chart displaying trend lines of the percentage of new HIV diagnoses that were diagnosed late by probable route of infection in the North West for the 10 year period 2014 to 2023. Three categories of probable route of infection are displayed: sex between men, sex between men and women, and other infection routes.

The percentage of new HIV diagnoses that were diagnosed late where sex between men and women was the probable route of infection decreased (58% in 2014, 42% in 2023). The percentage of late new HIV diagnoses with a probable route of infection of sex between men has remained similar since 2014, going from 30% in 2014 to 27% in 2023. The percentage of new late HIV diagnoses among those with other probable infection routes has fluctuated greatly due to the small overall number of people in that category.

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

Source: UKHSA, HANDD, HARS.

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

Figure 14 is a bar chart displaying the percentage of new HIV diagnoses that were diagnosed late in GBMSM and heterosexuals by whether born abroad, among North West residents aged 15 and over, for the period 2021 to 2023. Among GBMSM, 36% of those born in the UK were diagnosed late, compared to 28% of those born abroad. Among heterosexuals born abroad, 51% of new diagnoses were diagnosed late, compared to 43% for UK-born.

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

Source: UKHSA, HANDD, HARS.

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

Figure 15a is a bar chart displaying trends of the percentage of late new HIV diagnoses by age group in the North West from 2014 to 2023.

There are 5 age groups displayed:

• 15 to 24
• 25 to 34
• 35 to 44
• 45 to 54
• 55 and older

Across all age groups, a decreasing trend in the percentage of new diagnoses that were late is observed between 2022 and 2023, with the age group 15 to 24 showing the biggest percentual decrease over this period.

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

Source: UKHSA, HANDD, HARS.

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

Figure 15b is a bar chart displaying trends of the percentage of late new HIV diagnoses for each age group in the North West from 2014 to 2023.

There are 5 age groups displayed:

• 15 to 24
• 25 to 34
• 35 to 44
• 45 to 54
• 55 and older

The proportion of new diagnoses which were diagnosed late increases with increasing age. In the 15 to 24 and over 55 age groups, a decreasing trend in the percentage of new diagnoses that were diagnosed late was observed between 2020 and 2023, with the age group 15 to 24 showing the biggest percentual decrease between 2022 and 2023. In all age groups, the proportion of late new diagnoses decreased in 2023 compared to 2022.

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

Source: UKHSA, HARS.

Figure 16 is a bar chart displaying the prevalence of diagnosed HIV in 2023 among people aged 15 to 59 by UKHSA region. It shows that the prevalence of HIV in the North West in 2023 was the second highest in England at 2.1 diagnoses per 1,000 residents aged 15 to 59.

The highest prevalence was found in London (5.2 diagnoses per 1,000 residents aged 15 to 59) while the lowest was found in the South West and North East (1.4 and 1.3 diagnoses per 1,000 residents aged 15 to 59 respectively).

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

Source: UKHSA, HARS.

Description for Figure 17

Figure 17 is a line chart displaying the trend in the number of North West residents living with diagnosed HIV and accessing care from 2014 to 2023. The number living with HIV and accessing care has steadily increased since 2014.

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

Source: UKHSA, HARS.

Figure 18 is a bar chart displaying the number of North West residents living with diagnosed HIV and accessing care in 2023 broken down by probable route of transmission.

There are 5 categories of probable route of transmission shown:

• sex between men
• sex between men and women
• mother-to-child transmission
• injecting drug use
• blood or healthcare worker

It shows that sex between men (5,780 diagnoses) and sex between men and women (4,813 diagnoses) were the probable route of transmission for 52% and 44% of people living with diagnosed HIV respectively, more than mother to child transmission (197 diagnoses), injecting drug use (144 diagnoses), and blood/healthcare worker (117 diagnoses) combined (4%).

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

Source: UKHSA, HARS.

Figure 19 is a bar chart displaying the age distribution of North West residents with diagnosed HIV who accessed care in 2014 and 2023.

There are 5 age groups displayed:

• younger than 15
• 15 to 24
• 25 to 34
• 35 to 49
• 50 and older

It shows that in 2014 the majority of North West residents living with diagnosed HIV and accessing care were aged 35 to 49 years (50%), while in 2023 the proportion aged 35 to 49 years and 50 years and above was similar (41% and 46% respectively). Among people aged less than 50 years, the proportion living with diagnosed HIV and accessing care decreased in 2023 compare to 2014, whereas in those aged 50 years and above, it increased.

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

Source: UKHSA, HARS.

Figure 20 is a bar chart displaying the prevalence of diagnosed HIV in the North West in 2023 by ethnic group.

There are 6 categories of ethnic group shown:

• Black African
• Black Caribbean
• Black other or unspecified
• Other or mixed
• White
• Asian

The chart shows that diagnosed HIV prevalence is significantly higher among people who are Black African (23.0 diagnoses per 1,000 residents) in comparison to all other ethnic groups.

Figure 21: Rate of HIV diagnoses per 1,000 population by Index of Multiple Deprivation decile, the North West, 2023

Source: UKHSA, HARS.

Figure 21 is a bar chart displaying the rate of HIV diagnoses per 1,000 North West residents in 2023 by index of multiple deprivation (IMD) decile (1 is the most deprived, 10 is the least deprived). It shows that the rate of HIV diagnoses consistently increases with increasing deprivation, going from 0.5 diagnoses per 1,000 residents in IMD 10 to 2.4 diagnoses per 1000 residents in IMD 1. 

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

Source: UKHSA, HARS.

Figure 22 is a bar chart displaying diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years in 2023 by North West local authority. It shows that diagnosed HIV prevalence per 1,000 residents was classified as extremely high in Manchester (more than 5 per 1,000 population aged 15 to 59) and was high (2 to 5 per 1,000 population aged 15 to 59) in 7 other local authorities (Salford, Blackpool, Liverpool, Rochdale, Bury, Tameside, Bolton). In the other 16 local authorities, diagnosed HIV prevalence was classed as low (less than 2 per 1,000 population aged 15 to 59). Across the North West, the prevalence of diagnosed HIV in 2023 was 2.1 per 1,000 residents.

Figure 23: Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by local authority, the North West, 2023

Source: UKHSA, HARS.

Figure 23 is a map displaying diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years in 2023 by North West local authority. It displays the same information as Figure 22.

Figure 24: Diagnosed HIV prevalence per 1,000 residents (all ages) by middle super outer area of residence the North West, 2023

Source: UKHSA, HARS.

Figure 24 is a map displaying the diagnosed HIV prevalence per 1,000 residents in 2023 by middle super output area.

Figure 25: The continuum of HIV care, 2023

Source: UKHSA, HARS, MPES model.

Figure 25 is a bar chart displaying how England (excluding London) compares to the UNAIDS 90:90:90 HIV targets. It shows that, if London is excluded, England is meeting the UNAIDS targets. Of those in England (excluding London) who are estimated to be living with HIV, 95% have been diagnosed with HIV, 93% of them are on treatment, and 91% of them are virally suppressed.

Figure 26: HIV testing rate per 100,000 by population group, North West residents, 2019 to 2023

Source: UKHSA, GUMCAD.

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

Figure 26 is a line chart displaying trend lines of the HIV testing rate per 100,000 by sex among North West residents between 2019 and 2023.Trends for the whole population, males, and females are displayed. Annual testing rates were virtually the same in males and females between 2019 and 2023. The testing rate declined sharply in 2020 (during the COVID-19 pandemic) and has steadily increased since, almost returning to 2019 levels by 2023.

Table 2: People tested for HIV by population group, North West 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	41,930	21,803	24,794	26,251	31,539	-25%	20%
GBMSM	14,196	13,325	19,870	18,027	17,871	26%	-1%
Subtotal (men)	60,530	37,863	47,478	46,163	51,466	-15%	11%
Hetero/bisexual women	60,403	37,870	49,357	48,340	55,806	-8%	15%
WOSW	521	484	786	733	767	47%	5%
Subtotal (women)	66,236	42,542	54,109	51,018	58,969	-11%	16%
Total (all genders)	130,073	83,003	109,954	111,662	120,920	-7%	8%

Source: UKHSA, GUMCAD.

Table 2 displays the number of people tested for HIV in the North West by population group and year (2019 to 2023). Seven population groups are shown: heterosexual men, GBMSM, all men, heterosexual and bisexual women, women who only have sex with women, all women and all genders. The percentage change in the number of people tested for HIV in each population group is shown for 2019-2023 and 2022-2023.

Between 2022 and 2023, there was an increase in testing across all population groups except for GBMSM; the largest increase was seen in heterosexual men (up 20%).

However, testing was lower in 2023 compared to 2019 for 5 of 7 groups including heterosexual men (-25%), all men (-15%), heterosexual and bisexual women (-8%), all women (-11%) and all genders (-7%). Although there was a 1% decrease in the number of GBMSM tested in 2023 compared to 2022, testing was still 26% higher than in 2019

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

Source: UKHSA, GUMCAD.

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

Figure 27 is a bar chart displaying the percentage of HIV PrEP need and initiation or continuation among residents attending specialist sexual health services (SHSs) in the North West in 2023 by population group.

There are 4 population groups displayed:

• GBMSM
• heterosexual men
• heterosexual and bisexual women
• women who only have sex with women.

There are 3 categories of PrEP are displayed:

• PrEP need
• PrEP need identified
• PrEP initiated or continued

‘PrEP need’ represents the percentage of people attending SHSs who were at substantial HIV risk and could benefit from receiving PrEP. This assessment of risk is based on a combination of clinical codes reported through GUMCAD within the previous 12 months of each consultation including PrEP eligibility codes, and other clinical or behavioural markers known to indicate higher risk of HIV seroconversion in the year following an attendance. PrEP need is defined differently for different population groups.

Further details are available in the PrEP monitoring and evaluation framework. ‘PrEP need identified’ represents the percentage of people in the ‘PrEP need’ category who had their need identified at a clinical consultation. ‘PrEP initiated or continued’ represents the percentage of people in the ‘PrEP need’ category who take PrEP (started or continued PrEP in 2023).

The figure shows that 66% of North West GBMSM who attended specialist sexual health services in 2023 had a PrEP need. Of those, 85% had their need identified at a clinical consultation and 73% initiated or continued PrEP. A far smaller percentage of women who only have sex with women had a PrEP need (8%). Of those, 97% had their need identified at a clinical consultation and 79% initiated or continued PrEP. Heterosexual men and heterosexual and bisexual women had the smallest PrEP needs (1% and less than 1% respectively). However, fewer of those with a PrEP need had their need identified (63% and 67% respectively) and fewer initiated or continued PrEP (41% and 46% respectively).

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 = ‘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 FES.NorthWest@ukhsa.gov.uk.

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

Acknowledgements

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

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. October 2024, UK Health Security Agency, London.

2. Department of Health and Social Care UK. Towards Zero - An action plan towards ending HIV transmission, AIDS and HIV-related deaths in England - 2022 to 2025. UK Government White Paper. 2022.

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. November 2024, UK Health Security Agency, London.

4. Office for National Statistics (ONS), released 23 November 2023, ONS website, statistical bulletin, Long-term international migration, provisional: year ending June 2023.

5. 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. December 2023, UK Health Security Agency, London.