The world faces growing health threats. Infectious diseases are increasing globally. Similarly, this trend impacts the United Kingdom.
Consequently, it puts pressure on our healthcare system. The NHS feels the strain from outbreaks. This rise follows the COVID-19 pandemic. For example, more social mixing is a factor.
Increased international travel also plays a role. Furthermore, lower vaccine uptake contributes significantly. Additionally, some communities face bigger impacts; deprived areas see higher hospital admissions.
Amidst this broader picture, HIV is also a major health challenge. It has been for many years. However, England has a strong ambition. Stopping new HIV transmissions is its goal.
AIDS diagnoses and HIV-related fatalities are also to be eliminated. The target year is set for 2030. This ambition is supported by the dedicated HIV Action Plan.
The Broader Picture: Rising Infectious Diseases in the UK
Infectious diseases are rising in the UK. This follows the COVID-19 pandemic. The return of social mixing is a reason. Increased international travel also plays a role.
Changing weather patterns can contribute. Lower vaccine uptake is a big concern. This impacts childhood diseases. Measles and whooping cough have resurged. These preventable illnesses can be serious.
They have sadly caused deaths. Other infections are also increasing. Mycoplasma pneumoniae saw higher cases. Legionella cases rose significantly. Tuberculosis notifications went up, too.
These outbreaks put pressure on the NHS. They demand strong responses. Some communities are affected more than others. People in deprived areas face higher risks.
Hospital admissions for infections are much higher. Rates were nearly twice as high in the 20% most deprived areas.
England’s Commitment: Towards Zero HIV by 2030
England has a dedicated plan for HIV. It is called the HIV Action Plan for England. The government set its sights high in 2019. The plan was published in 2021.
It has a clear, major goal. It aims to end all new HIV transmissions. AIDS diagnoses and HIV-related fatalities are also to be eliminated. The target year for this is 2030. The plan includes an ambitious, shorter-term goal.
This is for 2025. England aims for an 80% reduction. This is in new HIV infections. It is compared to a baseline for 2019.
The Action Plan in Detail: Four Core Pillars
There are four major pillars that support the HIV Action Plan. These are its core themes. They are Prevent, Test, Treat, and Retain.
- Prevent: This pillar focuses on stopping new infections. It involves using different prevention tools. The goal is to prevent people from getting HIV.
- Test: This pillar ensures prompt diagnosis. It means finding people with HIV quickly. Testing is scaled up in high-risk populations.
- Treat: This pillar ensures rapid access to treatment. Treatment stops the virus from spreading further. It helps people with HIV live long, healthy lives.
- Retain: This pillar supports people in ongoing care. It means keeping them engaged in services. Staying in treatment is important for health. It also prevents transmission.
Key Strategies and Investments in Action
England’s Action Plan puts key strategies into practice. It backs them with investment. Here are the main areas of focus.
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Scaling Up Testing: Finding Undiagnosed Cases
Finding HIV quickly is very important. Testing helps identify people with HIV. This reduces late diagnoses. Crucially, it helps prevent the virus from spreading.
England is scaling up testing efforts. A key component is the ED opt-out testing program. It offers HIV tests automatically in some hospital emergency departments. This happens in areas with high HIV rates. It received £20 million in funding initially. This covered three years.
Furthermore, more funding is now committed to expanding it further. Significantly, this program has been successful. It identified 201 new HIV diagnoses in 2023. It found 391 cases since April 2022 in participating sites.
Testing also happens in many other settings. Sexual health clinics are a main place. People can order online test kits. Community testing services are available.
Pregnant women receive routine testing; this is universal antenatal screening. Testing is part of blood donation screening. It is also available to TB patients. People who inject drugs are offered tests. Prisons likewise provide opt-out testing.
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Boosting Prevention: PrEP and Beyond
Stopping HIV before it can be passed on is vital. The plan uses a combination of prevention methods. These activities are being expanded across England. In order to promote prevention, England allocated £3.5 million to the National HIV Prevention Programme between 2021 and 2024. This program works with key groups and runs campaigns like National HIV Testing Week.
Access to PrEP is a major focus. PrEP is a drug used to prevent HIV infection in those without the virus. Access is expanding for key groups.
Furthermore, there are calls to offer PrEP more widely, including in community pharmacies and potentially via GPs. This aims to improve access for populations like women and targets ethnic minorities too, addressing existing inequalities.
Partner notification is another key tool in prevention. It helps find people who need testing. Also, it links partners to prevention services like PrEP.
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Ensuring Effective Treatment and Care
It’s critical to begin HIV therapy as soon as possible after being diagnosed. diagnosed. Antiretroviral treatment, known as ART, stops the virus from multiplying. Consequently, this prevents the sexual transmission of HIV. This concept is known as Treatment as Prevention, or TasP. ART also helps individuals live long, healthy lives. It reduces the chance of health complications.
A key goal of treatment is achieving viral suppression. This indicates that the virus’s level in the body drops significantly. An undetectable viral load cannot be transmitted through sex. This powerful message is known as U=U.
Furthermore, staying engaged in healthcare is vital for people with HIV. They need ongoing medical care and support. Keeping people in care ensures they stay healthy. It also helps maintain viral suppression. This, in turn, continues to prevent transmission.
The Uncomfortable Truth: Widening Inequalities in England’s HIV Response
The report shows progress is uneven. In fact, inequalities are widening. This affects many different groups. This is an uncomfortable truth the data reveals. Equitable progress is not being made across all communities.
Uneven Impact: Who is Acquiring HIV?
New HIV diagnoses show clear disparities. While overall GBMSM diagnoses fell, progress differs greatly by ethnicity. For example, white men exposed through sex with men saw a significant decrease; specifically, diagnoses fell by 44% from 2019 to 2023.
However, ethnic minority men constitute an increasing proportion of GBMSM diagnoses, rising from 26% to 33% in 2023. Furthermore, compared to white GBMSM, diagnoses of Black (+28%) and Asian (+25%) males recently rose among GBMSM in London.
In stark contrast, diagnoses rose dramatically among heterosexual people of certain ethnicities. From 2019 to 2023, diagnoses increased by 56% in Black African men and by 69% in Asian men.
Most notably, Black African women experienced an even larger rise, increasing by 88%. Meanwhile, diagnoses decreased in white heterosexual men and women. Diagnosis rates also highlight these profound disparities. Rates remain disproportionately higher for GBMSM and Black African heterosexual individuals. Moreover, rates increased in Black African heterosexual men and women since 2019, whereas they remained stable and much lower for non-Black African heterosexuals.
Disparities in Prevention and Testing Access
Access to prevention varies greatly by group. PrEP uptake shows significant inequalities. For instance, uptake is lower in ethnic minority GBMSM; specifically, around two-thirds of Black African and Black Caribbean/other GBMSM with a need initiated PrEP (65.9-66.3%), lower than overall GBMSM uptake (75.4%). Uptake is also lower for heterosexual men of Black Caribbean/other ethnicity (29.6%) compared to overall heterosexual men. Furthermore, heterosexual and bisexual women of Black African (30.2%), Indian/Bangladeshi/Pakistani (30.1%), and Black Caribbean/other (29.5%) ethnicities have lower uptake than overall heterosexual/bisexual women (40.9%). PrEP uptake is also lower for younger GBMSM aged 15 to 24 (64.6%).
Testing access likewise shows disparities. In specialist SHSs, 24% declined a test. However, uptake was much lower for women; for example, 36% of non-Black African heterosexual women declined a test, while 22% of Black African women declined one. This contrasts with only 4% of GBMSM declining.
Community testing reveals higher reactivity in certain groups; tests from people of mixed, Black African, and other ethnicities showed higher positivity. In a community survey, reactivity was highest among Black Caribbean (1.3%) and Black African (0.6%) ethnicities. More testing kits are now sent to the Black African ethnic group, increasing by 34% recently. TB testing coverage is also higher for those born in high-prevalence countries (97.5%) compared to UK-born (93.8%).
Inequalities in the Care Pathway
Disparities continue along the care pathway. Prompt ART initiation varies by group; overall, 75% started ART within 3 months in 2023. Proportionately, initiation was lowest among people of Black ethnicity (75%).
It was also lowest in London (65%) compared to other regions. Some adults attend care but are not on ART; this proportion is lowest in GBMSM. Conversely, it is higher in heterosexual men and women across various ethnicities; nearly half of this group (48%) lives in London.
Viral suppression rates also differ. While overall rates are high, disparities exist; for instance, lower proportions are virally suppressed among specific ethnic groups within heterosexual men and women. Notably, 3.2% of Black African men exposed through sex with women in London were not suppressed, higher than the rate for GBMSM in London (1.7%).
Linkage to care within two weeks also varies by exposure route and ethnicity. Retention in care similarly shows some variation across ethnic groups within different exposure routes. Concerningly, over 25% of people with transmissible levels of the virus are from a Black African background, highlighting ongoing challenges in the pathway for this group.
The Persistent Shadow of Stigma
Stigma remains a major barrier. Levels are unacceptably high despite some improvements. Many people living with HIV still face stigma. For example, 10.4% have not shared their status outside healthcare. Also, 16% felt mistreated in healthcare, and 31% worried about treatment differences.
Furthermore, 15% avoided healthcare when needed. Also, over half of the population (45.1%) suffers from self-stigma. Stigma impacts different groups unevenly. Younger people report higher stigma.
Those identifying as trans, non-binary, or other identities also report more. Sharing status outside healthcare is less likely for older people and women. It is similarly less likely for heterosexual men compared to GBMSM.
Crucially, Black African respondents are less likely to share their status (14.8%) compared to white British respondents (6.6%), showing ethnicity significantly influences willingness to share status.
Beyond the Clinic: Testing in Diverse Settings
HIV testing happens widely outside specialist clinics. Indeed, these efforts find cases across different groups. Antenatal care shows high coverage. Specifically, 99.8% of pregnant women were tested in 2022-2023.
Home and community testing is growing. It reaches people beyond traditional clinics. Reactivity varies by ethnicity; for example, it was higher in mixed, Black African, and Black Caribbean groups. Kits for the Black African group increased dramatically.
Blood donation screening finds few cases. Only 0.4 per 100,000 donations were positive in 2023. Testing is high for TB patients at 96%. Coverage is notably highest for those born in high-HIV countries at 97.5%.
Among people who inject drugs, 82% reported ever being tested. Prisons offer opt-out testing. 92% of new entrants were offered a test in 2023. The positive rate was 0.7%.
Driving Progress: Governance and Collaboration
Putting the action plan into practice requires coordination. Thus, structures are in place to drive progress. An HIV Oversight Group helps ensure continuity. It includes diverse partners, importantly featuring voices of people with HIV.
Professor Kevin Fenton serves as Chief Advisor on HIV. He leads implementation and advises ministers. Furthermore, he chairs the Implementation Steering Group, which oversees the plan’s delivery. Many partners collaborate on the plan.
Organizations like the Terrence Higgins Trust are crucial; for instance, HIV Prevention England, part of THT, runs national prevention programs. These partners also amplify campaigns and advocate for action.
Looking Ahead: Challenges and the Path to 2030
Meeting 2025 targets seems unlikely. Inequalities remain a big challenge. However, the 2030 goal is still achievable. We have the tools to end new transmissions.
Nevertheless, addressing these inequalities is urgent. Equitable progress is essential to reach the 2030 target.
A new action plan for 2025-2030 is being developed. It will use report findings. Importantly, it will prioritize equitable access to interventions.
The path to 2030 requires concerted effort. It must be evidence-driven. Above all, it needs equitable action.
Conclusion:
A rise in infectious diseases is faced by the UK, placing strain on the NHS. Alongside this, HIV is viewed as a significant challenge. An ambitious goal has been set by England: zero new HIV transmissions, AIDS diagnoses, and HIV-related deaths are targeted by 2030. The HIV Action Plan is used to guide this effort.
Notable successes have been achieved by the plan. Global 95-95-95 targets were met, and effective initiatives like ED opt-out testing have been implemented. However, major challenges are presented. The ambitious 2025 reduction targets are indicated as unlikely to be achieved by the recent report. A rise in new diagnoses in England was seen in 2023, and HIV-related deaths also increased.
Crucially, widening inequalities are revealed by the data. Progress is not being experienced equitably across different groups. Disparities are found in testing access, prevention tool usage, and care navigation. Addressing these inequalities is identified as the most urgent task.
The 2030 goal is still considered achievable because prevention and treatment tools exist. Nevertheless, success will be determined by ensuring these interventions are reached by everyone, effectively and equitably. The new HIV Action Plan for 2025-2030 will be informed by the report findings, and equitable access will be prioritized within it. Zero new transmissions by 2030 can only be achieved through concerted, evidence-driven, and above all, equitable action.
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