Research and analysis

Annual epidemiological spotlight on HIV in the South West: 2021 data

Updated 17 November 2023

Summary

This report presents data for 2021 on new HIV diagnoses, late diagnoses, people living with diagnosed HIV, HIV testing, continuum of HIV care and pre-exposure prophylaxis (PrEP) in South West England.

The impact of the COVID-19 pandemic on sexual health services and patient access in England has made it difficult to interpret changes in the epidemiology of HIV between 2019 and 2021. While the number of people tested but not seen in care (the biggest impact of the COVID-19 pandemic) recovered slightly by 2021, this was not observed uniformly across populations and risk groups (1).

Whilst rates are lower in the South West than in other regions of England, HIV remains an important public health problem in the South West. The rate of new HIV diagnoses in the South West in 2021 was 2.3 per 100,000 population. HIV prevalence is highest in urban areas: the City of Bristol, Bournemouth, Christchurch, and Poole and Swindon. Bournemouth, Christchurch, and Poole, and the City of Bristol were classified as having high HIV diagnosed prevalence (2 to 4.99 per 1,000 population). No upper-tier local authorities (UTLAs) in the South West were classified as having very high HIV diagnosed prevalence (5 and above per 1,000) (2).

The number of new HIV diagnoses in 2021 was the lowest it has ever been, but the number of deaths has remained relatively stable.

Sex between men (SBM) was the most prevalent route of transmission and the highest number of new HIV diagnoses were in males aged 25 to 34 years.

48.5% of new diagnoses in the region were diagnosed late, compared to 43% in England. In some UTLAs, late diagnoses occurred in up to 80% of diagnoses. Late diagnosis was most common in male heterosexual contact exposure groups, followed by female heterosexual contact exposure groups. Late diagnosis in SBM exposure groups has increased from 27% in 2012 to 44% in 2021. Late diagnosis occurred in 100% of black Caribbean new HIV diagnoses, almost double the percentage of late diagnoses in white and black African ethnicities.

The number of South West residents accessing care for HIV has increased by 43% since 2012, and the majority of these cases in 2021 were gay, bisexual, and other men who have sex with men (GBMSM), and aged over 50 years.

HIV test coverage at specialised sexual health services has decreased from 69% in 2017 to 36% in 2021.

New diagnoses

In 2021, an estimated 130 South West residents were newly diagnosed with HIV, accounting for 5% of new diagnoses in England. This represents a fall of 22% from 2020. Nationally, there has been a long-term trend for a decline in the overall number of new diagnoses, although there was a slight upturn in 2019.

The new diagnosis rate for South West residents (2 per 100,000) was below that of England in 2021 (5 per 100,000).

In 2021, 50% of all new diagnoses in South West residents were in GBMSM (compared to 49% in 2020 and 59% in 2012). The number of GBMSM residents in the South West newly diagnosed with HIV (65, adjusted for missing information) was 57% lower than in 2012. Of the GBMSM newly diagnosed with HIV 81% were white and 47% were UK-born.

Heterosexual contact was the second largest infection route for new diagnoses in South West residents in 2021 (38%). Infections in African born persons accounted for 50% of all heterosexually acquired cases in 2021 (n=21), compared to 33% (n=31) in 2012. Infections in UK born persons accounted for 26% of all heterosexually acquired cases in 2021.

Injecting drug use (IDU) accounted for 9% of new diagnoses in South West residents.

Black African residents represented 17% of all newly diagnosed South West residents in 2021 (compared to 19% in 2020 and 14% in 2012). A small proportion of new diagnoses in 2021 were in black Caribbean residents (2%).

The number of new diagnoses was highest in the group of males aged 25 to 34 years and the group of females aged 35 to 44 years in 2021.

Late diagnoses

Reducing late HIV diagnoses is one of the indicators in the Public Health Outcomes Framework (PHOF). 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 (3).

It is of particular concern that a large proportion of South West residents with HIV are diagnosed late (48% from 2019 to 2021, compared to 43% in England), as defined by a CD4 count of less than 350 cells/mm at diagnosis.

In the South West, heterosexual residents were more likely to be diagnosed late (63% of males, 50% of females) than GBMSM (43%) residents. By ethnic group, black African residents were more likely to be diagnosed late than the white population (57% and 50% respectively).

People living with diagnosed HIV

The 5,180 people living with diagnosed HIV in the South West in 2021 was 2% higher than 2020 and 54% higher than 2012. This increase is partly due to the effectiveness of HIV treatment, which has reduced the number of deaths from HIV.

The diagnosed prevalence rate of HIV in the South West in 2021 was one per 1,000 residents aged 15 to 59 years. This was lower than the 2 per 1,000 observed in England as a whole. Two UTLAs in the South West had a diagnosed HIV prevalence in excess of 2 per 1,000 population aged 15 to 59 years in 2021, which is the threshold for expanded HIV testing. They were Bournemouth, Christchurch and Poole (2.7) and City of Bristol (2.5).

The 2 most common probable routes of transmission for South West residents living with diagnosed HIV in 2021 were SBM (54%) and sex between men and women (42%).

In 2021, 36% of those living with diagnosed HIV in the South West were aged between 35 and 49 years, and 51% were aged 50 years and over (up from 32% in 2012). Males represented 74% of South West residents living with diagnosed HIV in 2021 and females represented 26%.

In 2021, 74% of South West residents living with diagnosed HIV were white and 16% were black African residents. 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 African residents (19 per 1,000) than in the white population (1 per 1,000).

Continuum of HIV care

In England, excluding London in 2021, 99% of HIV diagnosed residents were receiving anti-retroviral treatment (ART). Of these, 99% 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 99% in England as a whole receiving ART and 99% of these virally suppressed.

For South West residents diagnosed in 2021, the proportion starting treatment within 91 days of diagnosis for the period 2019 to 2021 was 87%. This compares to 84% for England.

People living with undiagnosed HIV

In 2021, 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 3,039 (CrI 2,305 to 4,410) undiagnosed people.

It is estimated that 1,000 GBMSM in England, outside London, are undiagnosed (CrI 500 to 1,900) and 1,900 heterosexual residents (CrI 1,400 to 3,000), including 800 black Africans residents. In England, outside London, the proportion undiagnosed varied by exposure group with the highest proportion undiagnosed among people living with HIV who inject drugs (8%, CrI 1% to 27%), non-black African heterosexual women (8%, 6% to 12%), and non-black African heterosexual men (7%, 4% to 20%).

HIV testing

A total of 30,042 people were tested in specialist sexual health services (SHSs) in the South West in 2021, a decrease of 62% since 2017. The HIV testing coverage at specialist SHSs in the South West was 36%, which compares to 46% across England. HIV testing coverage in specialist SHSs in the South West is higher in men (51%) than women (28%), and highest in GBMSM (74%).

Some HIV tests are performed in settings other than at SHSs. These include tests done through online consultations. It is not currently possible to include these in the HIV testing coverage measure. There are 2 reasons for this. Firstly, online and other non-specialist SHSs are not mandated by the British Association of Sexual Health and HIV (BASHH) to offer an HIV test to everyone. Secondly, they may not code and report the outcome of an HIV test in their GUMCAD submissions.

Since 2020, the proportion of HIV testing which takes place through online services has risen sharply. As a consequence, clients may not be fully coded in relation to HIV testing if they were referred to online testing following triage by a specialist SHS or they were referred to specialist SHS following online testing (where further testing, treatment or care was required).

Pre-exposure prophylaxis (PrEP)

In 2021, 5% of HIV-negative South West residents accessing SHSs in England were defined as having a PrEP need, (defined as people who were HIV negative accessing specialist sexual health services who were at substantial HIV risk, and therefore could benefit from receiving PrEP) (4), among whom 63% initiated or continued PrEP. Of those with PrEP need, 78% had this need identified at a clinical consultation. Among GBMSM, the group with greatest need, these proportions were: 55%, 65% and 80%. 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 key to HIV prevention.

HIV Action Plan

The 2022 to 2025 HIV Action Plan (jointly developed by the Office for Health Improvement and Disparities – OHID – and UKHSA) aims to reduce HIV transmission by 80%, and HIV related and preventable deaths and AIDS by 50% between 2019 and 2025. This will be achieved by:

• ensuring equitable access and uptake of HIV prevention programmes
• scaling up HIV testing in line with national guidelines
• optimising rapid access to treatment and retention in care
• improving the quality of life for people living with HIV
• addressing stigma

While there has been considerable progress towards ending HIV transmission in the UK, the interim ambitions of the HIV Action Plan were adversely impacted by COVID-19. To ensure the goals are reached, a number of prevention areas need to be prioritised, these include:

• PrEP access for all
• scaling up of partner notification
• increasing HIV testing among heterosexual men and women
• improving retention to care and monitoring inequalities in all aspects of HIV prevention

The further ambition to achieve zero new HIV infections, AIDS and HIV-related deaths in England by 2030 will require significant improvement in diagnoses for heterosexual residents and black African residents (3).

Charts, tables and maps

Figure 1. New HIV diagnoses per 100,000 population (all ages) by UKHSA region of residence, 2021

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 is a bar chart showing the rate of new HIV diagnoses per 100,000 population by UKHSA region of residence. In 2021, the rate of new HIV diagnoses in the South West was 2.3 per 100,000 (95% Confidence interval (CI): 1.9 to 27)) and had the lowest rate out of all UKHSA regions. The rate of new HIV diagnoses in the South West was lower than the rate for England (4.8 per 100,000 (95% CI: 4.6 to 4.9) population).

Figure 2. New HIV diagnoses per 100,000 population (all ages) by upper tier local authority of residence, South West residents, 2021

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 2 is a bar chart showing the rate of new HIV diagnoses per 100,000 population, by UTLA. In 2021, residents of the City of Bristol had the highest rate of new HIV diagnoses per 100,000 (6.0 per 100,000), followed by Bournemouth, Christchurch, and Poole (5.3 per 100,000) and Swindon (4.0 per 100,000). The lowest rate was seen in Torbay (0.7 per 100,000 population). The City of Bristol and Bournemouth, Christchurch, and Poole were the only UTLAs where the rates were higher than the national rate.

Figure 3. New HIV diagnoses and deaths, the South West, 2012 to 2021

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

The number of new diagnoses will depend on accessibility of testing as well as infection and transmission. Numbers may rise as we receive more reports and more information. This will impact on interpretation of trends in more recent years. New HIV diagnoses are shown by UK region of residence at diagnosis. Deaths are also shown by UK region of residence at diagnosis which in some instances may not be the same as UK region of death. Deaths in people living with HIV may not be related to HIV in all cases and this is likely to become increasingly true as people accessing treatment reach older ages. Charts in previous years’ reports showed deaths by region of death, rather than region of residence at diagnosis, and so the trend for deaths cannot be compared directly with that seen in earlier reports. Region of residence at diagnosis has been used for deaths due to better data quality in more recent years.

Figure 3 shows trendlines for the number of new HIV diagnoses and number of deaths, between 2012 and 2021 in the South West. The number of new HIV diagnoses decreased from 259 in 2012 to 130 in 2021 (50% decrease). There has been a gradual decline since the number of diagnoses peaked in 2014 (n=279), except for 2019 (n=252). The number of deaths remained relatively stable from 30 in 2012 to 33 in 2021. The number of deaths began to rise after 2018. However, this coincides with improved ascertainment of deaths as a result of the National HIV Mortality Review. Additional deaths due to COVID-19 were reported during the pandemic in people living with HIV.

Figure 4. Number of new HIV diagnoses by probable route of infection (adjusted for missing route of infection information), South West residents, 2012 to 2021 [note 1]

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

Asterisk (*) represents not previously diagnosed abroad (NPDA).

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 on area of residence of those diagnosed. This is more likely to affect more recent year, particularly 2021.

Figure 4 shows trendlines for the number of new HIV diagnoses, by route of infection, for all cases and then excluding those previously diagnosed abroad, for South West residents. Between 2012 and 2021, SBM has continued to be the most prevalent route of infection for all new HIV diagnoses. The number of all new HIV diagnoses attributed to SBM, decreased from 152 cases in 2012 to 65 in 2021 (57% decrease). A similar trend is seen amongst SBM – not previously diagnosed abroad (NPDA) (141 cases in 2012 to 38 cases in 2021). The number of new diagnoses through sex between men and women (SBMW) decreased from 99 in 2012 to 50 in 2021 (50% decrease). Diagnoses attributable to SBMW-NPDA, decreased from 96 cases in 2012 to 34 cases in 2021. The least prevalent route of infection was other infection routes. The number of cases attributable to other infection routes (both including and excluding those NPDA) has been more varied over the years. There was an increase from 7 cases in 2012 to 15 cases in 2021 (109% increase) in all diagnoses attributable to other infection routes.

Figure 5a. Number of new HIV diagnoses by age group and gender, South West residents, 2021

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 5a shows an age-sex pyramid for new HIV diagnoses in South West residents in 2021. In 2021, there were more males (n=100) newly diagnosed with HIV than females (n=29). The highest number of males diagnosed were within the group aged 25 to 34 years (n=36), whereas the highest number of new diagnoses in females was in those aged 35 to 44 years (n=15). There were no cases in those aged 15 years or under.

Figure 5b. Number of new HIV diagnoses by age group and probable route of infection, male South West residents aged 15 to 64 years, 2021

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 5b shows the number of new HIV diagnoses in male South West residents, aged 15 to 64, by age group and route of infection in 2021. The most prevalent route of infection was SBM (n=56), compared to all other exposure routes (n=32). This highest number of diagnoses due to SBM (n=23) and all other exposure routes (n=13) were in those aged 24 to 34 years, whereas the second highest number due to SBM was in those aged 34 to 44 years (n=15), but in all other exposures was in those aged 45 to 54 years (n=8).

Figure 6. Number of new HIV diagnoses by ethnic group (adjusted for missing ethnic group information), South West residents, 2012 to 2021 [note 2]

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

Asterisk (*) represents NPDA.

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

Note 2: Numbers may rise as further reports are received and more information is obtained on area of residence of those diagnosed. This is more likely to affect more recent year, particularly 2021.

Figure 6 shows trendlines for the number of new HIV diagnoses, by ethnic group, for all cases and then excluding those previously diagnosed abroad, for South West residents. Between 2012 and 2021, the number of new HIV diagnoses were consistently higher in those of white ethnicity. There was a 57% decrease in diagnoses of white ethnicity from 199 in 2012 to 85 in 2021. A similar trend was exhibited in cases of a white ethnicity NPDA. There was an overall decrease (-41%) in cases of black African ethnicity from 37 cases in 2012 to 22 cases in 2021, and those from all other ethnic groups, however the trend was less defined than the decline in those of white ethnicity. There was no change in the number of new HIV diagnoses from all other ethnic groups, between 2012 and 2021 (n=23 in both years). However, the trend between has been very varied between years.

Figure 7. Number of new HIV diagnoses by world region of birth (adjusted for missing world region of birth information), South West residents, 2012 to 2021 [note 3]

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

Asterisk (*) represents NPDA.

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

Note 3: Numbers may rise as further reports are received and more information is obtained on area of residence of those diagnosed. This is more likely to affect more recent year, particularly 2021.

Figure 7 shows trendlines for the number of new HIV diagnoses, by world region of birth, for all cases and then excluding those previously diagnosed abroad, for South West residents. Between 2012 and 2021, the highest number of diagnoses was consistently those born in the UK. The number of UK-born diagnoses decreased from 176 in 2012 to 50 in 2021 (71% decrease). A similar trend was seen in UK-born diagnoses NPDA. All African-born diagnoses also decreased from 38 cases in 2012 to 32 cases in 2021 (15% decrease) but exhibited high numbers of diagnoses in 2019 (n=57) and 2020 (n=41). There was a decrease in African-born diagnoses NPDA. There was an overall increase in diagnoses born in all other countries, 45 in 2012 to 47 in 2021, but a decrease compared to 2019 (n=70). The number of diagnoses born in all other countries NPDA, decreased from 37 in 2012 to 20 in 2021.

Figure 8. Percentage of new HIV diagnoses by upper tier local authority of residence that were diagnosed late, South West, aged 15 years and over, 2019 to 2021 [note 4]

Source: UKHSA, HIV and AIDS New Diagnosis Database/System, HIV and AIDS Reporting System (HARS)

Note 4: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count <350 cells/mm3.

The underlying population will impact on the proportion diagnosed late, for example MSM are less likely to be diagnosed late.

Figure 8 is a bar chart showing the percentage of new HIV diagnoses diagnosed late, by UTLA, in South Residents, aged 15 years and over, from 2019 to 2021. The regional percentage of new diagnoses that were diagnosed late was 48.5%. The UTLA with the highest percentage of new diagnoses that were diagnosed late was Bath and North East Somerset (80% (95% CI: 44 to 97%)), followed by North Somerset (71% (95% CI: 29 to 96%)) and Devon (62% (95% CI: 41 to 80%)). The UTLA reporting the lowest percentage of new diagnoses that were diagnosed late (excluding those with fewer than 5 late diagnoses) was Bournemouth, Christchurch, and Poole (28% (95% CI:14 to 45%)).

Figure 9a. Percentage of new HIV diagnoses by probable route of infection that were diagnosed late, South West residents, aged 15 years and over, 2019 to 2021 [note 5]

Source: UKHSA, HIV and AIDS New Diagnosis Database/System, HIV and AIDS Reporting System (HARS)

Note 5: Only includes new diagnoses in those aged 15 years and over 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. 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 9a is a bar chart showing the percentage of new HIV diagnoses diagnosed late, by probable route of infection, in South West residents, aged 15 years and over, from 2019 to 2021. The highest percentage of new HIV diagnoses that were diagnosed late was seen in male cases with heterosexual contact as the route of infection (63% (95% CI: 44 to 88%)), followed by heterosexual contact in females (50% (95% CI: 35 to 70%)). In persons with infection attributed to SBM, 43% (95% CI: 33 to 55%) of new HIV diagnoses were diagnosed late. Where route of infection was IDU, 27% of newly diagnosed HIV cases were diagnosed late.

Figure 9b. Percentage of new HIV diagnoses by ethnic group that were diagnosed late, South West residents, aged 15 years and over, 2019 to 2021 [note 6]

Source: UKHSA, HIV and AIDS New Diagnosis Database/System, HIV and AIDS Reporting System (HARS)

Note 6: 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. 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.

Figure 9b is a bar chart showing the percentage of new HIV diagnoses diagnosed late, by ethnicity, in South West residents, aged 15 years and over, from 2019 to 2021. Of the new HIV diagnoses, 50% (95% CI: 41 to 60%) of cases of white ethnicity were diagnosed late. This increases to 57% (95% CI: 35 to 88%) in cases of black African ethnicity, and 100% of cases of newly diagnosed black Caribbean HIV patients being diagnosed late, however numbers were small and the confidence intervals were very wide.

Figure 10. Percentage of new HIV diagnoses that were diagnosed late by probable route of infection and year of first UK HIV diagnosis, South West residents, aged 15 years and over, 2012 to 2021 [note 7]

Source: UKHSA, HIV and AIDS New Diagnosis Database/System, HIV and AIDS Reporting System (HARS)

Note 7: 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 10 shows trendlines for the number of new HIV diagnoses that were diagnosed late, by probable route of infection, for South West residents aged 15 years and over, from 2012 to 2021. The percentage of HIV diagnoses diagnosed late by SBM as route of infection steadily increased from 27% in 2012 to 44% in 2021. Alternatively, late diagnoses by other infection routes decreased from 100% in 2012 to 14% in 2021, however numbers reported are small leading to a largely variable trend. Percentage of late diagnoses because of SBMW remained relatively consistent over the years, from 62% in 2012 to 63% in 2021. There was an increase from 49% in 2019.

Figure 11. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by UKHSA region, 2021

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

Figure 11 is a bar chart showing the diagnosed HIV prevalence, per 1,000 residents, aged 15 to 59 years, by UKHSA region for 2021. The South West has the second lowest regional rate (1.3 per 1,000 (95% CI: 1.3 to 1.4)), higher than only the North East (1.1 per 1,000 (95% CI: 1.0 to 1.2)). The highest rate was in London (5.4 per 1,000 (95% CI: 5.3 to 5.4)). The national rate for England was 2.3 per 1,000 (95% CI: 2.3 to 2.4).

Figure 12. Number of residents living with diagnosed HIV and accessing care, the South West, 2012 to 2021

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

Figure 12 shows trendlines for the number of South West residents living with diagnosed HIV and accessing care, from 2012 to 2021. The number of HIV-diagnosed residents living and accessing care in the South West has risen steadily from 3,353 in 2012 to 5,180 in 2021.

Figure 13. Number of residents living with diagnosed HIV and accessing care by probable route of transmission (adjusted for missing information), the South West, 2021

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

Figure 13 is a bar chart showing the number of South West residents living with diagnosed HIV and accessing care, by probable route of transmission in 2021. In the South West, the number of residents living diagnosed and accessing care was highest in the SBM exposure group (2,776), and accounts for 54% of residents accessing care, followed by those in the SBMW exposure group (2,154). SBM and SBMW accounted for much higher proportions of residents living in diagnosed HIV and accessing care than IDU, mother-to-child transmission and blood/HCW transmission combined (250).

Figure 14. Percentage of residents with diagnosed HIV and accessing care by age group, the South West, 2012 and 2021

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

Figure 14 is a bar chart showing the percentage of South West residents with diagnosed HIV and accessing care by age group, in 2012 and 2021. In 2021, the majority of residents (51%) living diagnosed with HIV and accessing care are aged over 50 years. This is compared to only 32% of cases in 2012. In 2012, the greatest percentage of cases (48%) were aged between 35 to 49 years.

Figure 15. Diagnosed HIV prevalence per 1,000 residents by ethnic group (all ages), the South West, 2021

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

Figure 15 is a bar chart showing the HIV prevalence per 1,000 South West residents, of all ages, by ethnic group in 2021. The highest rates was found amongst those of black African ethnicity (19.1 per 1,000 population). Other high rates of HIV prevalence were found in black other/unspecified and black Caribbean ethnic groups. The lowest rate was found amongst those of white ethnicity (0.7 per 1,000 population).

Figure 16. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by local authority, the South West, 2021

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

Figure 16 is a bar chart showing the diagnosed HIV prevalence per 1,000 South West residents aged 15 to 59 years, by UTLA in 2021. Three UTLAs had a prevalence equal to or greater than 2 per 1,000 population, which was Bournemouth, Christchurch, and Poole (2.7 per 1,000 (95% CI: 2.5 to 2.9)), City of Bristol (2.5 per 1,000 population (95% CI: 2.3 to 2.6)) and Torbay (2.0 per 1,000 population (95% CI: 1.7 to 2.4)). The 5 local authorities with the highest HIV prevalence in those aged 15 to 59 years was in urban areas. The lowest diagnosed HIV prevalence was found in Cornwall and the Isles of Scilly.

Figure 17. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by local authority, the South West, 2021

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

Figure 17 is a map showing the diagnosed HIV prevalence per 1,000 residents aged 15 to 19 years in the South West in 2021, by UTLA. No UTLAs in the South West have an HIV prevalence greater than 5 per 1,000 population. 3 local authorities have a prevalence equal to or greater than 2 per 1,000 population, which were Bournemouth, Christchurch, and Poole (2.7 per 1,000 (95% CI: 2.5 to 2.9)), City of Bristol (2.5 per 1,000 population (95% CI: 2.3 to 2.6)) and Torbay (2.0 per 1,000 population (95% CI: 1.7 to 2.4)).

Figure 18. The continuum of HIV care, England excluding London, 2021

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

Figure 18 is a bar chart showing the HIV continuum of care in England, excluding London, in 2021. England, excluding London, was able to achieve the United Nations Programme on HIV/AIDS (UNAIDS) 90:90:90 targets; 95% of people living with HIV were being diagnosed, of those, 99% were on treatment and 99% of those on treatment, were virally suppressed.

Figure 19: HIV test coverage by population group, South West residents, 2017 to 2021

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 19 shows trendlines for HIV test coverage by population group, at specialist sexual health services, in South West residents from 2017 to 2021. There has been a fall in HIV test coverage in South West residents across all groups between 2017 and 2021. Across the 5 years, testing coverage has remained the lowest in females (28% in 2021), comparably lower than the testing coverage in males (51% in 2021) and GBMSM (74% in 2021).

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 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: January 2023. Updates to HANDD and SOPHID/HARS made after this date will not be reflected in this report.

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

ONS mid-year estimates for 2020 were used as a denominator for rates for 2021.

The data behind charts showing absolute numbers has 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.

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.

With the exception of deaths in Figure 3, all analyses in this report are residence-based. Information about a patient’s place of residence is not collected by HANDD. Reports to this database are cross-linked to the database of people accessing care for HIV, HARS.

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

Further information

Sexual and Reproductive Health Profiles.

Local sexual health data sources.

Spotlight on sexually transmitted infections in the South West: 2021 data.

HIV: annual data tables.

Local authorities have access to additional HIV and STI intelligence via the Data Exchange and the HIV and STI web portal. They should also have received a set of tables containing HIV data specific to their authority. They should contact Geraldine.Leong@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, Public Health Microbiology and Food, Water and Environmental Microbiology to strengthen the surveillance, intelligence and response functions of UKHSA.

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

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

Acknowledgements

We would like to thank:

• local sexual health and HIV clinics for supplying the HIV data
• Institute of Child Health
• UKHSA Centre for Infectious Disease Surveillance and Control (CIDSC) HIV and STI surveillance teams for collection, analysis and distribution of data

References

1. Lester J, Martin V, Shah A, Chau C, Mackay N, Newbigging-Lister A and others. ‘HIV testing, PrEP, new HIV diagnoses, and care outcomes for people accessing HIV services: 2022 report’ Annual official statistics data release (data to end of December 2021) 2022: viewed 29 June 2023

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. Martin V, Lester J, Adamson L, Shah A, Mackay N, Chau C and others. ‘HIV Action Plan Monitoring and Evaluation Framework: Report summarising progress from 2019 to 2021’ 2022: viewed 29 June 2023

4. Sumray K, Lloyd KC, Estcourt CS, Burns F, Gibbs J. ‘Access to, usage and clinic outcomes of, online postal sexually transmitted infection services: a scoping review’ Sexually Transmitted Infections 2022: volume 98, issue 7, pages 528 to 535