Research and analysis

Annual epidemiological spotlight on HIV in Yorkshire and Humber: 2021 data

Updated 1 August 2023

Applies to England

Summary

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

The number of HIV-related and preventable deaths fell in 2021, whilst the number of AIDS diagnoses remained stable. In the UK in 2021, there were 797 deaths and 177 AIDS diagnoses reported in people living with HIV, compared with 814 deaths and 178 AIDS diagnoses in 2020 (1). The one-year mortality rate increased in those diagnosed late in 2020 and may be due to both the direct and indirect impacts of COVID-19 infection.

HIV remains an important public health problem in Yorkshire and Humber. The region has the second highest rate outside of London (4.3 new HIV diagnoses per 100,000 population in 2021). Within Yorkshire and Humber, there is substantial variation across local authorities with Leeds reporting the highest rate of new HIV diagnoses (9 new diagnoses per 100,000 population). Three other local authorities reported rates above the regional average (Sheffield, City of Kingston upon Hull and Bradford, respectively), with considerable variation reported across all local authorities in Yorkshire and Humber.

Amongst new cases who are Yorkshire and Humber residents, heterosexual contact accounted for the majority of new diagnoses (52%) and new diagnoses were highest amongst males aged 25 to 34 years. Late diagnosis is the most significant predictor of premature mortality among people with HIV infection (2). In Yorkshire and Humber in 2021, heterosexual residents and black Caribbean residents were more likely to be diagnosed late.

Nearly 35,000 people were tested in specialist SHSs in Yorkshire and Humber in 2021, which represents a decrease of 51% since 2017. Of Yorkshire and Humber residents diagnosed in 2021, 84% started treatment within 91 days of diagnosis for the period 2019 to 2021. Wide reaching HIV testing is necessary for reducing HIV transmission and enabling more timely diagnosis and the initiation of treatment.

New diagnoses

In 2021, an estimated 240 Yorkshire and Humber residents were newly diagnosed with HIV, accounting for 9% of new diagnoses in England. This represents a rise of 25% 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 2021. This was due to a small increase among gay, bisexual and other men who have sex with men (GBMSM) (699 to 721), and heterosexual and bisexual women (392 to 429) (1).

The small increase in HIV diagnoses between 2020 and 2021 in GBMSM may be a temporary departure from the trend, and the result of deferred tests from 2020. The rise in new diagnoses in heterosexual adults is concerning against the backdrop of lower numbers having an HIV test. The new diagnosis rate for Yorkshire and Humber residents (4 per 100,000) was below that of England in 2021 (5 per 100,000).

In 2021, 41% of all new diagnoses in Yorkshire and Humber residents were in GBMSM, compared to 43% in 2020 and 43% in 2012. The number of GBMSM residents in Yorkshire and Humber newly diagnosed with HIV (99, adjusted for missing information) was 34% lower than in 2012. Of the GBMSM newly diagnosed with HIV, 64% were white and 42% were UK-born.

Heterosexual contact was the most common infection route for new diagnoses in Yorkshire and Humber residents in 2021 (52%). Infections in African born persons accounted for 61% of all heterosexually acquired cases in 2021 (n=53), compared to 55% (n=92) in 2012. Infections in UK-born persons accounted for 16% of all heterosexually acquired cases in 2021.

Injecting drug use accounted for 5% of new diagnoses in Yorkshire and Humber residents. Black African people represented 34% of all newly diagnosed Yorkshire and Humber residents in 2021 (compared to 30% in 2020 and 28% in 2012). A small proportion of new diagnoses in 2021 were in black Caribbean residents (less than 1%). The number of new diagnoses was highest in males aged 25 to 34 years and 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).

In the UK, the proportion and number of people diagnosed late rose between 2020 and 2021, from 44% to 46% in 2021 (1). A comparison with 2019 data suggests there may have been some delay to testing and diagnosis due to the COVID-19 pandemic, particularly affecting heterosexual men and women. This is supported by a fall in median CD4 count, a rise in the proportion testing positive within some groups (despite decreased testing), and a rise in the number of people diagnosed late (1).

It is of particular concern that a large proportion of Yorkshire and Humber residents with HIV are diagnosed late (50% from 2019 to 2021, compared to 43% in England), as defined by a CD4 count of less than 350 cells/mm³ at diagnosis. Within Yorkshire and Humber there is substantial variation between local authorities, with 86% of new HIV diagnoses amongst residents in York being diagnosed late compared to 25% in North East Lincolnshire.

In Yorkshire and Humber, heterosexual residents were more likely to be diagnosed late (61% of males, 40% of females) than GBMSM (41%). By ethnic group, black African residents were more likely to be diagnosed late than the white population (58% and 45% respectively). Further work is required to explore individual and population level factors associated with late diagnosis of HIV in Yorkshire and Humber.

People living with diagnosed HIV

The 5,670 people living with diagnosed HIV in Yorkshire and Humber in 2021 was 3% higher than 2020 and 41% 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 Yorkshire and Humber in 2021 was 1.5 per 1,000 residents aged 15 to 59 years. This was similar to the 2 per 1,000 observed in England as a whole. One local authority in Yorkshire and Humber had a diagnosed HIV prevalence in excess of 2 per 1,000 population aged 15 to 59 years, which is the threshold for expanded HIV testing; this was Leeds (2.8).

The 2 most common probable routes of transmission for Yorkshire and Humber residents living with diagnosed HIV in 2021 were sex between men and women (58%) and sex between men (37%).

In 2021, 44% of those living with diagnosed HIV in Yorkshire and Humber were aged between 35 and 49 years, and 44% were aged 50 years and over (up from 21% in 2012). Males represented 62% of Yorkshire and Humber residents living with diagnosed HIV in 2021 and females represented 38%.

In 2021, 51% of Yorkshire and Humber residents living with diagnosed HIV were white and 38% were black African. 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 (26 per 1,000) than in the white population (1 per 1,000).

Continuum of HIV care

In England 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.

For Yorkshire and Humber residents diagnosed in 2021, 84% started treatment within 91 days of diagnosis for the period 2019 to 2021 which is the same as England overall (84%).

Free and effective ART has transformed HIV from a fatal infection into a chronic, manageable condition. People living with HIV in the UK can now expect to live into old age if diagnosed promptly. It is now widely understood that effective HIV treatment results in an ‘undetectable’ viral load which protects individuals living with HIV from passing on the virus to others. The key message is that Undetectable = Untransmittable (U=U).

People with HIV who maintain an undetectable viral load for at least 6 months do not transmit HIV. It is, however, important to note that people exposed by vertical transmission and injecting drug use continue to display significantly lower levels of viral suppression.

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 African 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%, CrI 6% to 12%)
• non black African heterosexual men (7%, CrI 4% to 20%)

HIV testing

A total of 34,777 people were tested for HIV in specialist SHSs in Yorkshire and Humber in 2021, a decrease of 51% since 2017. The HIV testing coverage at specialist SHSs in Yorkshire and Humber was 44%, which compares to 46% across England. HIV testing coverage in specialist SHSs in Yorkshire and Humber is higher in men (56%) than women (38%), and highest in GBMSM (73%).

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 (4). Secondly, these services may not code and report the outcome of an HIV test in their GUMCAD STI Surveillance System (GUMCAD) submissions.

Since 2020, the proportion of HIV testing which takes place through online services has risen sharply. Internet testing was the main route of access to HIV testing in England in 2021, but was disproportionately accessed by GBMSM, especially outside London (1). 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).

Wide-reaching HIV testing is pivotal for reducing HIV transmission. For those groups with relatively high numbers of undiagnosed infections, people who inject drugs, heterosexual people and people residing in England outside London, HIV testing is of particular importance. Partner notification following diagnosis remains a highly effective way to detect undiagnosed HIV.

Pre-exposure prophylaxis (PrEP)

In 2021, 6% of HIV-negative Yorkshire and Humber residents accessing SHSs in England were defined as having a PrEP need, among whom 59% initiated or continued PrEP. Of those with PrEP need, 80% had this need identified at a clinical consultation.

Among GBMSM, the group with greatest need, these proportions were 65%, 63% and 83%. Whilst PrEP need is lower in heterosexual residents, those with a PrEP need are less likely to be identified (men 59%, women 35%), and less likely to initiate or continue PrEP (men 35%, women 20%).

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 UK Health Security Agency (UKHSA), aims to reduce HIV transmission by 80%, and HIV related and preventable deaths and AIDS by 50% between 2019 and 2025 (2). 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 and addressing stigma (2)

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 (5). 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 (5)

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 (2).

Charts, tables and maps

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

Data 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 that London reported the highest rate of new HIV diagnoses per 100,000 population in 2021, with the North West, Yorkshire and Humber and East of England reporting the second and joint third highest rates (4.4 and 4.3, respectively; Figure 1).

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

Data source: UKHSA, HANDD.

The number of new diagnoses will depend on accessibility of testing as well as infection and transmission. Please note, the number along the x-axis refers to the nearest rate rounded to 1 significant figure.

Figure 2 is a bar chart showing that Leeds reported the highest rate of new HIV diagnoses per 100,000 population in 2021. Sheffield and Kingston upon Hull reported the second and third highest rates (both reporting a rate of 6 new diagnoses per 100,000 respectively).

Figure 3. New HIV diagnoses and deaths, Yorkshire and Humber, 2012 to 2021

Data 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 also shown by UK region of residence at diagnosis which in some instances may not be the same as UK region of death. People living with HIV may die, but their death may not be related to their HIV infection, this is in part due to the success and life prolonging effects of HIV treatment.

Charts in previous years’ reports showed deaths by region of death, rather than attributing a death to the region where an individual was initially diagnosed. Therefore, 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.

Figure 3 is a line graph showing that between 2012 and 2021, the number of new HIV diagnoses decreased. New HIV diagnoses decreased from 347 in 2012 to 240 in 2021 whereas HIV deaths increased from 34 in 2012 to 60 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.

However, it is important to note that an extended reporting delay may be seen for deaths as these are not always notified directly to the HIV surveillance system. In addition, region of death may not be established immediately.

Figure 4. New HIV diagnoses by probable route of infection (adjusted for missing route of infection information), Yorkshire and Humber residents, 2012 to 2021 [note 1]

Data source: UKHSA, HANDD.

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

[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 is a trend line showing that all types of probable route of infection decreased between 2012 and 2021 except transmission via another infection route. This type of transmission increased from 13 new HIV diagnoses to 17 between 2012 and 2021 and for those not previously diagnosed abroad increased from 8 new HIV diagnoses to 11.

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

Data source: UKHSA, HANDD.

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

Figure 5a is a bar chart showing that, of the new HIV diagnoses reported in 2021 in Yorkshire and Humber residents, the highest number of new diagnoses was reported in males.

The largest number of new HIV diagnoses were reported in males aged 25 to 34 years (number of diagnoses 45), males aged 45 to 54 years (number of diagnoses 41) and males aged 35 to 44 years (number of diagnoses 35), respectively. The largest number of new diagnoses in females was reported in those aged 35 to 44 years (number of diagnoses 33).

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

Data source: UKHSA, HANDD.

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

Figure 5b is a bar chart showing that the probable route of infection for most new HIV diagnoses in males was due to sex between men. This transmission route accounted for 76 cases compared to 44 which were transmitted via other routes. The age group reporting the largest number of new HIV diagnoses transmitted via sex between men was those aged 25 to 34 years.

Figure 6. Number of new HIV diagnoses by ethnic group (adjusted for missing ethnic group information), Yorkshire and Humber residents, 2012 to 2021

Data source: UKHSA, HANDD

*NPDA = Not previously diagnosed abroad.

See [note 1] above on interpreting trends.

The number of new diagnoses will depend on accessibility of testing as well as infection and transmission. Numbers may rise as further reports are received and more information is obtained on area of residence of those diagnosed. This is more likely to affect more recent year, particularly 2021.

Figure 6 shows the number of new HIV diagnoses have decreased amongst white and black African Yorkshire and Humber residents between 2012 and 2021. It has however increased or stayed consistent amongst all other ethnic groups between 2012 and 2021.

Figure 7. Number of new HIV diagnoses by world region of birth (adjusted for missing world region of birth information), Yorkshire and Humber residents, 2012 to 2021

Data source: UKHSA, HANDD.

*NPDA = Not previously diagnosed abroad.

See [note 1] above on interpreting trends.

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

Figure 7 shows the number of new HIV diagnoses have decreased in those born in the UK and Africa between 2012 and 2021, whereas it has increased amongst those born in all other countries.

Figure 8. Percentage of new HIV diagnoses by upper tier local authority of residence that were diagnosed late, Yorkshire and Humber, aged 15 years and over, 2019 to 2021 [note 2]

Data source: UKHSA, HIV and AIDS New Diagnosis Database/System, HIV and AIDS Reporting System (HARS).

See [note 1] above on interpreting trends.

[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 <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 that York was the local authority which reported the highest percentage of late HIV diagnoses, followed by East Riding of Yorkshire and Calderdale (86%, 77% and 62% respectively).

Figure 9a. Percentage of new HIV diagnoses by probable route of infection that were diagnosed late, Yorkshire and Humber residents, aged 15 years and over, 2019 to 2021 [note 3]

Data source: UKHSA, HIV and AIDS New Diagnosis Database/System, HARS.

[note 3] 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, with 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 shows that amongst those aged 15 years and over, the percentage of new HIV diagnoses that were diagnosed late, using data from 2019 and 2021, was highest amongst males with heterosexual contact (61%).

Figure 9b. Percentage of new HIV diagnoses by ethnic group that were diagnosed late, Yorkshire and Humber residents, aged 15 years and over, 2019 to 2021 [note 4]

Data source: UKHSA, HIV and AIDS New Diagnosis Database/System, HARS.

[note 4] 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, with 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 shows that amongst those aged 15 years and over, the percentage of new HIV diagnoses that were diagnosed late with data from 2019 and 2021, was highest among black Caribbean Yorkshire and Humber residents (75%).

Figure 10. Percentage of new HIV diagnoses that were diagnosed late by probable route of infection and year of first UK HIV diagnosis, Yorkshire and Humber residents, aged 15 years and over, 2012 to 2021 [note 5]

Data source: UKHSA, HIV and AIDS New Diagnosis Database/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, with late diagnosis defined as CD4 count <350 cells/mm³.

Figure 10 shows that between 2012 and 2021, the number of new HIV diagnoses that were diagnosed late decreased for those infected through sex between men and women and other infections routes and increased for those infected through sex between men.

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

Data source: UKHSA, HARS.

Figure 11 shows that HIV prevalence (per 1,000 residents) is highest in London (5.4/1,000), followed by North West (2.1 per 1,000) and West Midlands (1.9 per 1,000). Yorkshire and Humber reports the third lowest HIV prevalence at 1.5 per 1,000.

Figure 12. Number of residents living with diagnosed HIV and accessing care, Yorkshire and Humber, 2012 to 2021

Data source: UKHSA, HARS.

Figure 12 shows that the number of Yorkshire and Humber residents living with diagnosed HIV and accessing care between 2012 to 2021 increased from 4,021 in 2012 to 5,670 in 2021.

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

Data source: UKHSA, HARS.

Figure 13 shows that the number of residents living with diagnosed HIV and accessing care in Yorkshire and Humber, using data from 2021, is highest amongst those who have sex between males and females (3,303), and lowest amongst those whose likely transmission route was via blood or healthcare worker (58).

Figure 14. Percentage of residents with diagnosed HIV and accessing care by age group, Yorkshire and Humber, 2012 and 2021

Data source: UKHSA, HARS.

Figure 14 shows that of the Yorkshire and Humber residents who have been diagnosed with HIV, the percentage of those accessing care has decreased in all age groups between 2012 and 2021 apart from for those who are aged 50 years and over. Amongst this age group it has increased from 21% to 44%.

Figure 15. Diagnosed HIV prevalence per 1,000 residents by ethnic group (all ages), Yorkshire and Humber, 2021

Data source: UKHSA, HARS.

Figure 15 shows that amongst Yorkshire and Humber residents (of all ages), HIV prevalence was highest amongst black African residents (26.5 per 1,000), black Other/Unspecified residents (3.6 per 1,000) and black Caribbean residents (2.8 per 1,000).

Figure 16. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by local authority, Yorkshire and Humber, 2021

Data source: UKHSA, HARS.

Figure 16 is a map that shows HIV prevalence (per 1,000 residents) amongst those aged 15 to 59 years in Yorkshire and Humber is highest in Leeds, followed by Sheffield and Barnsley.

Figure 17. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by local authority, Yorkshire and Humber, 2021

Data source: UKHSA, HARS. Map contains Ordnance Survey data (© Crown copyright and database right 2023) and National Statistics data (© Crown copyright and database right 2023).

HIV prevalence (per 1,000 residents) amongst those aged 15 to 59 years in Yorkshire and Humber is highest in Leeds with all other local authorities reporting lower rates.

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

Data source: UKHSA, HARS, and MPES model.

Figure 18 shows that England, excluding London, surpassed the UNAIDS 90:90:90 target for HIV care in 2021, with 95% of individuals diagnosed with HIV knowing their infection status and of these 94% were on treatment and 93% had viral suppression.

Figure 19. HIV test coverage by population group, Yorkshire and Humber residents, 2017 to 2021

Data source: UKHSA, GUMCAD.

The proportion of eligible attendees at specialist 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 that between 2017 and 2021, HIV test coverage decreased across all population groups, with the largest decrease observed in males which reported 73% test coverage in 2017 and 56% test coverage in 2021.

Information on data sources

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.

The date of data extract for this report was November 2021. Updates to HANDD, SOPHID and HARS made after this date will not be reflected in this report.

Calculations

Confidence Intervals were calculated using Byar’s method.

Office for National Statistic (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.

All analyses in this report are residence-based. Numbers may change as more information becomes available to assign area of residence to cases and historical data is refreshed accordingly.

Further information

For further information, access the Sexual and Reproductive Health Profiles.

Find more information on local sexual health data sources on GOV.UK.

Find more information in the annual epidemiological spotlight on STIs in Yorkshire and Humber: 2021.

Find more information in the national HIV report: 2021.

Local authorities have access to additional HIV and STI intelligence via Data Exchange and the HIV and STI web portal. They should also have HIV data specific to their local 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 yhreu@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
• the Institute of Child Health
• the UKHSA Blood Safety, Hepatitis, STI and HIV Division 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’ The annual official statistics data release (data to end of December 2021). London; 2022.

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. Byrne R, Curtis H, Sullivan A, Freedman A, Chadwick D and Burns F. ‘A National Audit of late diagnosis of HIV: action taken to review previous healthcare among individuals with advanced HIV’ British HIV Association 2018

4. British Association for Sexual Health and HIV. ‘BASHH Guidelines’ (lasted accessed 29 June 2023)

5. Martin V, Lester J, Adamson L, Shah A, Mackay N, Chau C and others. ‘HIV Action Plan Monitoring and Evaluation Framework’ 2022.