Research and analysis

Annual epidemiological spotlight on HIV in the North East: 2022 data

Updated 28 November 2024

Applies to England

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Summary

HIV remains an important public health issue in the North East. Although the region continues to have a low prevalence of HIV compared to other England regions, the area faces its own challenges in HIV prevention and control. With this in mind a regional HIV steering group was formed in November 2023 to provide system-wide support and accountability to ensure progress towards the national HIV Action Plan (‘Towards Zero – An action plan towards ending HIV transmission, AIDS and HIV-related deaths in England – 2022 to 2025’) across the North East of England and North Cumbria.

This report presents data on new and late HIV diagnoses, people living with diagnosed HIV and continuum of care, HIV testing and HIV pre-exposure prophylaxis (PrEP). Data is mostly focused on activity in 2022 in the North East. Where appropriate, data for the past 10 years is provided to understand trends. Whilst the data show that access to services have improved following the impact of the COVID-19 pandemic, it is important to note that trends in HIV testing and patterns of sexual behaviour remain difficult to interpret between 2019 and 2022.

New diagnoses

In 2022, an estimated 97 North East residents were newly diagnosed with HIV, accounting for 3% of new diagnoses in England. Although this number of new diagnoses represents a rise of 13% from 2021, there has been a 11% decline compared to 2013. Nationally, there has been a long-term trend for a decline in the overall number of new diagnoses.

The new diagnosis rate for North East residents (4 per 100,000) was below that of England in 2022 (7 per 100,000). Rates within local authorities in the North East ranged from 1 per 100,000 in Redcar and Cleveland to 9 per 100,000 in Sunderland. In addition to Sunderland; Middlesbrough, Newcastle upon Tyne and Hartlepool had rates above the regional rate. Newcastle upon Tyne was classified as an area of high diagnosed prevalence in 2022 (high HIV diagnosed prevalence: 2 to 5 per 1,000 aged 15 to 59 years as per NICE testing guidelines).  

In 2022, 67% were diagnoses first made in the UK and 33% were among people previously diagnosed abroad. The number and proportion of new diagnoses among people previously diagnosed abroad has increased in 2021 (28%) and 2022 compared to previous years (range of 18% to 24% in 2016 to 2020). This is consistent with England as a whole, with 36% of all HIV diagnoses among individuals previously diagnosed abroad in 2022 compared to 22% to 27% since 2016. Diagnoses previously made abroad are unlikely to reflect HIV acquired in England.

In 2022, 50% (49 out of 97, adjusted for missing information) of all new diagnoses in North East residents were in gay, bisexual and other men who have sex with men (GBMSM) compared to 48% in 2021 and 67% in 2013. Of the GBMSM newly diagnosed with HIV 76% were white and 67% were UK-born (unadjusted for missing information). 

Heterosexual contact was the second most common route of infection for North East residents newly diagnosed in 2022 (44%, 43 out of 97, adjusted for missing information). Infections in African born persons accounted for 58% of all heterosexually acquired cases in 2022 compared to 25% in 2013 (unadjusted for missing information). Infections in UK born persons accounted for 35% of all heterosexually acquired cases in 2022 (unadjusted for missing information).

The number with a probable route of infection involving injecting drug use has increased to 3 cases in 2022, accounting for 4% of all new diagnoses in North East residents.

Black Africans represented 24% of all newly diagnosed North East residents in 2022 (compared to 20% in 2021 and 9% in 2013).

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 2022.

Late diagnoses

Reducing late HIV diagnoses is one of the indicators in the Public Health Outcomes Framework. People who are diagnosed late have a tenfold risk of mortality within one year of diagnosis compared to those diagnosed promptly and have increased healthcare costs. Late diagnosis is defined as a CD4 count less than 350 cells/mm3 at diagnosis.

From 2020 to 2022, 42% of North East residents with HIV were diagnosed late, similar to the proportion seen nationally (43% in England). Nationally, the number diagnosed late was 27% higher in 2022 compared to 2020. This rise is likely to reflect delays in diagnoses from 2020 due to the impact of COVID-19 pandemic on sexual health and HIV services as well as a rise in diagnoses among people likely to have acquired HIV abroad in the same period. Furthermore, as transmission falls and hence the number of new diagnoses decline, the proportion of cases who are diagnosed late will increase over time.  

In the North East, men who have sex with women were more likely to be diagnosed late (50%) than GBMSM (39%). By ethnic group, black Africans were less likely to be diagnosed late than the white population (33% and 49% respectively).

People living with diagnosed HIV

The 2,151 people living with diagnosed HIV in the North East in 2022 was 7% higher than 2021 and 42% higher than 2013. This increase is predominantly due to the effectiveness of HIV treatment, which has reduced the number of deaths from HIV and AIDS.

The diagnosed prevalence rate of HIV in the North East in 2022 was 1.2 per 1,000 residents aged 15 to 59 years. This was lower than the 2 per 1,000 observed in England as a whole. In 2022, one local authority in the North East had a diagnosed HIV prevalence in excess of the threshold for expanded HIV testing (2 per 1,000 population aged 15 to 59 years), namely Newcastle upon Tyne (2 per 1,000 population aged 15 to 59 years).

The 2 most common probable routes of transmission for North East residents living with diagnosed HIV in 2022 were sex between men (51%) and sex between men and women (46%).

In 2022, 38% of those living with diagnosed HIV in the North East were aged between 35 and 49 years, and 46% were aged 50 years and over (up from 28% in 2013). Males represented 73% of North East residents living with diagnosed HIV in 2022 and females represented 27%.

In 2022, 69% of North East residents living with diagnosed HIV were white and 22% 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 (21 per 1,000) than in the white population (1 per 1,000).

Continuum of HIV care

In England, excluding London in 2022, 98% of HIV diagnosed residents were receiving anti-retroviral treatment. Of these, 98% were virally suppressed (viral load <200) and were very unlikely to pass on HIV, even if having sex without condoms.

For North East residents diagnosed in 2022, the proportion starting treatment within 91 days of diagnosis for the period 2020 to 2022 was the same proportion as England: 85%.

People living with undiagnosed HIV

In 2022, 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 3,080 (CrI 2,293 to 4,513) undiagnosed people. Estimates are not currently available for the North East region.

It is estimated that in England, outside London, there are 1,000 GBMSM (Confidence Interval (CI) 500 to 1,900) and 1,900 heterosexuals (CI 1,400 to 3,000), including 800 black Africans, living with undiagnosed HIV. 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

Since 2020, the proportion of HIV testing which takes place through online services has risen sharply. It is not currently possible to include these in the HIV testing coverage measure for two reasons. Firstly, online and other non-specialist sexual health services (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. As a consequence, clients may not be fully coded in relation to HIV testing if for example they were referred to specialist SHS following online testing (where further testing, treatment or care was required).

A total of 29,175 people were tested in specialist sexual health services (SHSs) in the North East in 2022, a decrease of 27% since 2018. The HIV testing coverage at specialist SHSs in the North East was 55%, which compares to 48% across England. HIV testing coverage in specialist SHSs in the North East is higher in men (70%) than women (47%), and highest in GBMSM (80%).

PrEP

In 2022, 6% of HIV-negative North East residents accessing SHSs in England were defined as having a PrEP need compared to 4% in 2021. Among those identified, 57% initiated or continued PrEP compared to 53% in 2021. Of those with PrEP need, 75% had this need identified at a clinical consultation compared to 65% in 2021. Among GBMSM, the group identified as having the greatest need, these proportions were: 57%, 62% and 78% compared to 51%, 58% and 69% in 2021.

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 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 and 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 heterosexuals and black Africans.

A regional HIV steering group was formed in November 2023 to provide system-wide support and accountability to ensure progress towards the national HIV Action Plan (‘Towards Zero – An action plan towards ending HIV transmission, AIDS and HIV-related deaths in England – 2022 to 2025’) across the North East of England and North Cumbria. This steering group will provide strategic oversight to 4 working groups, dedicated to each of the 4 themes and objectives of the national plan:

  • prevention
  • testing
  • treatment and care
  • quality of life and stigma

HIV prevention messages

The 2022 to 2025 HIV Action Plan (jointly developed by the Office for Health Improvement and Disparities and UKHSA) aims to reduce HIV transmission by 80%, and HIV related and preventable deaths and AIDS by 50% between 2019 and 2025 (1).To ensure these goals are reached, a number of prevention areas need to be prioritised, these include PrEP access for all who need it, increasing HIV testing among heterosexual men and women, and rapid access to treatment and care.

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 for those testing HIV negative, or life-saving treatment which also prevents onward transmission for those testing positive. 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 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 PEP can be used to reduce the risk of acquiring HIV following some sexual exposures. PEP is available for free from most specialist SHS and most emergency departments.

Symptoms due to HIV and AIDS may not appear for many years, and people who are unaware of their infection 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 HIV.

People living with diagnosed HIV infection who are on treatment and have an undetectable viral load are unable to pass on the infection to others during sex. 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 (2). 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 Sexwise, NHS.UK and from the national sexual health helpline on 0300 123 7123.

Charts, tables and maps

Figure 1. Rate of new HIV diagnoses per 100,000 population (all ages) by UKHSA region of residence, 2022

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

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

Figure 1 is a bar graph showing the rate of new HIV diagnoses in 2022 by UKHSA region of residence. The rate of new HIV diagnoses in the North East (3.7 per 100,000) is the second lowest of all UKHSA regions and below the England rate (6.7 per 100,000) in 2022.

Figure 2. Rate of new HIV diagnoses per 100,000 population (all ages) by upper tier local authority of residence, North East residents, 2022

Sources: UKHSA, HANDD

Notes: 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.

The colour coding does not relate to new diagnosis but to the data in the diagnosed prevalence section later.

Figure 2 is a bar graph showing Sunderland (9 per 100,000) having the highest rate of new HIV diagnoses and Redcar & Cleveland (1 per 100,000) the lowest in the North East. Sunderland, Middlesbrough, Newcastle upon Tyne and Hartlepool had rates above the regional rate. Of note, the rate in Newcastle upon Tyne doubled in 2022 compared to 2021 (3 per 100,000) whilst the rate in Redcar & Cleveland dropped from 4 per 100,000 in 2021.

Figure 3. Number of new HIV diagnoses and deaths (all ages), the North East, 2013 to 2022

Sources: UKHSA, HANDD

Note: 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.

Figure 3 is a line graph showing there were 97 new HIV diagnoses in 2022 in the North East. This is 5% lower compared to 2019 (102 diagnoses) but 21% and 13% higher compared to pandemic years 2020 and 2021, respectively (80 and 86 diagnoses). This trend in numbers returning close to those seen in 2019 has been seen across other regions and nationally. Prior to the pandemic, the number of new diagnoses were declining gradually across England as a whole (from 5,462 in 2013 to 3,864 in 2019).

The number of deaths in 2022 (13) was slightly lower compared to 2021 (15). In recent years, ascertainment of deaths has been enhanced by the National HIV Mortality Review. Additional deaths due to COVID-19 were reported during the pandemic in people living with HIV. 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. Number of new HIV diagnoses (all ages) by whether a person had been previously diagnosed abroad, the North East, 2018 to 2022

Sources: UKHSA, HANDD

Note: The number of new diagnoses will depend on accessibility of testing as well as infection and transmission. Numbers may rise as further reports are received and more information is obtained. This is more likely to affect more recent years, particularly 2022.

Of the 97 new HIV diagnoses in 2022, 67% were diagnoses first made in the UK (65 cases) whilst 33% were among people previously diagnosed abroad (32 cases). The number of new diagnoses first made in the UK has remained stable over the past 3 years. In contrast, the number and proportion of new diagnoses among people previously diagnosed abroad has increased compared to previous years; specifically, the proportion of new diagnoses among people previously diagnosed abroad in 2016 to 2019 ranged from 18% to 24%, and was 28% in 2021 (24 out of 86 cases).

Sources: UKHSA, HANDD

Note: NPDA = Not previously diagnosed abroad.

Note 1: The number of new diagnoses will depend on accessibility of testing as well as infection and transmission.

Numbers may rise as further reports are received and more information is obtained. This is more likely to affect more recent years, particularly 2022.

Figure 5a is a line graph showing the trend over time in the most probable route of acquiring HIV. In 2022, sex between men remained the most common probable route of acquiring HIV accounting for 51% of new diagnoses followed by sex between men and women, which accounted for 44% of new diagnoses in 2022. All other probable routes of infection remain low.

Figure 5b. Number of new HIV diagnoses (all ages) detailed ‘other’ route of acquiring HIV (not adjusted for missing information), North East residents, 2013 to 2022

Sources: UKHSA, HANDD

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

Numbers may rise as further reports are received and more information is obtained. This is more likely to affect more recent years, particularly 2022.

The detailed breakdown for other routes of probable infection shows the number of new diagnoses acquired from mother-to-child transmission has remained low in 2022 (one case). The number with a probable route of infection involving injecting drug use has increased to 3 cases in 2022, accounting for 4% of all new diagnoses in North East residents.

Figure 6a. Number of new HIV diagnoses by age group and gender, North East residents, 2022

Sources: UKHSA, HANDD

Note: The number of new diagnoses will depend on accessibility of testing as well as infections and transmission. Paediatric data (new diagnosis or HIV care from 2021 and 2022) were not available at the point of publication.

Figure 6a shows the number of new HIV diagnoses in North East residents were highest in the 25 to 34 age group in males (number of new diagnoses 23) and highest in the 35 to 44 year age group in females (number of new diagnoses 14) in 2022, similar to 2021.

However, the number of new diagnoses in males aged 15 to 24 years increased by 167% from 6 new diagnoses in 2021 to 16 in 2022, and also increased in females aged 25 to 34 years by 233% from 3 new diagnoses in 2021 to 10 in 2022, making these younger age groups the second highest groups in males and females respectively.

Data on people under 15 years of age was not available at the time of writing this report.

Figure 6b. Number of new HIV diagnoses by age group and probable route of acquiring HIV, male North East residents aged 15 to 64 years, 2022

Sources: UKHSA, HANDD

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

Figure 6b 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 38 cases compared to 16 which were transmitted via other routes. The age groups reporting the largest number of new HIV diagnoses transmitted via sex between men in 2022 were 15 to 24 and 25 to 34 years.

Sources: UKHSA, HANDD

Note: 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 2022.

Figure 7a is a line graph showing the trend over time in the number of new HIV diagnoses probably acquired through sex between men by age group.

Between 2013 and 2022 the number of new HIV diagnoses probably acquired through sex between men has decreased in the 25 to 34 years and 35 to 44 years age groups. The number in other age groups in 2022 was similar to that in 2013. The number of new HIV diagnoses probably acquired through sex between men remained highest in those aged 25 to 34 years in 2022.

Sources: UKHSA, HANDD

Note: 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 2022.

Figure 7b is a line graph showing the trend over time in the number of new HIV diagnoses probably acquired through sex between men and women by age group.

Between 2013 and 2022 the number of new HIV diagnoses probably acquired through sex between men and women has increased in the 25 to 34 years and 35 to 44 years age groups. The number in other age groups in 2022 was similar to that in 2013.

Sources: UKHSA, HANDD

Note: 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. This is more likely to affect more recent years, particularly 2022.

Figure 8 is a line graph showing the highest number of new HIV diagnoses remained in the white ethnic group in North East residents in 2022, with lower numbers of new diagnoses in all other ethnic groups and the black African ethnic group.

Sources: UKHSA, HANDD

Notes: 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. This is more likely to affect more recent years, particularly 2022.

Figure 9 is a line graph showing the number of new HIV diagnoses by region of birth was highest in UK born individuals resident in the North East in 2022. The number of new HIV diagnoses recorded in North East residents born in Africa increased by 65% from 23 to 38 in 2022, however this includes individuals previously diagnosed abroad.

Sources: UKHSA, HANDD, HIV & AIDS Reporting System (HARS)

Note 1: 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.

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

Figure 10 is a bar graph showing the percentage of new HIV diagnoses that were diagnosed late in 2020 to 2022, was highest in Northumberland (75%) and lowest in South Tyneside (20%). Northumberland, Sunderland and Gateshead were above the region rate (42.1%).

Figure 11. Percentage and number of new HIV diagnoses by (a) probable route of infection and (b) ethnic group that were diagnosed late, North East residents, aged 15 years and over, 2020 to 2022 [note 1]

(a) Sources: UKHSA, HANDD, HARS

(b) Sources: UKHSA, HANDD, HARS

Note 1: 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.

(a) 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

(b) 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 11a is a bar graph showing the proportion of new HIV diagnoses that were diagnosed late by probable route of infection in North East residents in 2022. The highest percentage of new HIV diagnoses that were diagnosed late was seen in males with heterosexual contact (50%).  

Figure 11b shows that in North East residents of white ethnicity, 49% of new HIV diagnoses were diagnosed late between 2020 and 2022.

Figure 12. Percentage of new HIV diagnoses that were diagnosed late by probable route of infection and year of first UK HIV diagnosis, North East residents, aged 15 years and over, 2013 to 2022 [note 1]

Sources: UKHSA, HANDD, HARS

Note 1: 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 12 is a line graph showing the percentage of new HIV diagnoses that were diagnosed late by probable route of infection over time. In 2022, the percentage of new HIV infections acquired through sex between men and women was 39% and lower than the percentage in 2013. The percentage of new HIV infections acquired through sex between men and through other routes was similar in 2022 to that in 2012.  

Figure 13. a) Age distribution of all new HIV diagnoses that were diagnosed late and b) proportion of new HIV diagnoses that were diagnosed late by age group and year of first UK HIV diagnosis, North East residents, aged 15 years and over, 2013 to 2022 [note 1]    

Sources: UKHSA, HANDD, HARS

Note 1: 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 13a is a bar chart showing the age distribution of new HIV diagnoses that were diagnosed late. In 2022, individuals aged 25 to 34 years made up 35% of all late diagnoses. This was similar a similar distribution to 2021.

Figure 13b is a bar chart showing the proportion of new HIV diagnoses that were diagnosed late for each age group. In 2022, the proportion of late diagnoses in those aged 15 to 24 years (25%), those aged 25 to 34 years (44%) and those aged 55 years and above (50%) was lower that the previous year. In contrast, the proportion of late diagnoses in those aged 35 to 44 years (36%) and 45 to 54 years (63%) was higher than in 2021.Those aged 45 to 54 years had the highest proportion of individuals diagnosed late in 2022.

Figure 14. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by UKHSA region, 2022

Sources: UKHSA, HARS

Figure 14 shows the diagnosed HIV prevalence by UKHSA region was lowest in the North East (1.2 per 1,000) and highest in London (5.3 per 1,000).

Figure 15. Number of residents living with diagnosed HIV and accessing care, the North East, 2013 to 2022

Sources: UKHSA, HARS

Figure 15 shows the continuing increasing trend in the number of North East residents living with diagnosed HIV. This is due to advances in testing and HIV care.

Figure 16. Number of residents living with diagnosed HIV and accessing care by probable route of transmission (adjusted for missing route information), the North East, 2022

Sources: UKHSA, HARS

Figure 16 shows the number of North East residents living with diagnosed HIV and accessing care was highest in those with a probable route of infection of sex between men, followed by sex between men and women. Numbers were lowest among those whose likely transmission route was via injecting drug use, via blood or healthcare worker (HCW) or mother to child transmission.

Figure 17. Percentage of residents with diagnosed HIV who are accessing care in each age group, the North East, 2013 and 2022

Sources: UKHSA, HARS

Figure 17 shows that in all age groups except those 50 years and older, the percentage of residents with diagnosed HIV and accessing care was lower in 2022 compared to 2013. This is largely due to those affected in previous years moving up into older age groups and lower numbers of new diagnoses in more recent years feeding into the younger age groups.

Figure 18. Diagnosed HIV prevalence per 1,000 residents by ethnic group (all ages), the North East, 2022

Source: UKHSA, HARS

Figure 18 shows the diagnosed HIV prevalence per 1,000 residents was highest in the black African ethnic group (20.6) and lowest in the white (0.6) and Asian (0.4) ethnic groups. Notably the North East has a small population of black African and black Caribbean ethnic groups.

Figure 19. Rate of HIV diagnoses per 100,000 population by Index of Multiple Deprivation decile, the North East, 2022

Sources: UKHSA, HARS

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

Figure 19 shows the rate of HIV diagnoses per 100,000 population was highest in the most deprived areas across the North East in 2022.

Figure 20. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by local authority, the North East, 2022

Sources: UKHSA, HARS

Figure 20 shows the diagnosed HIV prevalence (per 1,000 residents aged 15 to 59 years) was highest in Newcastle and lowest in Redcar and Cleveland. Prevalence in Newcastle, Middlesbrough, Gateshead, Stockton-on-Tess and Darlington were above the region rate (1.2).

Figure 21. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by local authority, the North East, 2022

Sources: UKHSA, HARS

HIV prevalence (per 1,000 residents aged 15 to 59 years) across the North East region in highest in Newcastle with all other local authorities reporting lower rates.

Figure 22. Diagnosed HIV prevalence per 1,000 residents (all ages) by middle super outer area of residence the North East, 2022

Sources: UKHSA, HARS

Note: Middle layer Super Output Areas (MSOAs) – census boundary areas that contain an average population of 7,700.

In 2022, a number of middle super output areas across the North East show higher HIV prevalence (per 1,000 residents) amongst those aged 15 to 59. These include areas within Newcastle, North Tyneside, Gateshead, Stockton-on-Tees, Middlesbrough and Darlington.

Figure 23. The continuum of HIV care, 2022

Sources: UKHSA, HARS (MPES model)

Figure 23 is a bar graph showing of those people living with HIV in England (excluding London), 95% of people are diagnosed. Of these, 98% are on treatment and of these, 98% are virally suppressed. These figures are above the UNIAIDS 90:90:90 target.

Figure 24. HIV test coverage by population group, North East residents, 2018 to 2022

Sources: UKHSA, GUMCAD

Note: 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 is a line graph showing HIV testing coverage in North East residents by population group over time. HIV test coverage remains highest in the GBMSM population group in 2022. After a drop in coverage in 2020 attributable to restrictions during the COVID-19 pandemic, testing has continued to pick up in 2022 but remains below pre-pandemic coverage for all population groups. Test coverage currently only includes individuals attending SHSs.

Table 1. People tested for HIV by population group, North East residents attending all SHSs, 2018 to 2022

Gender/sexual orientation 2018 2019 2020 2021 2022 % change 2018 to 2022 % change 2021 to 2022
Heterosexual men 15,707 14,856 7,298 7,725 9,670 -38% 25%
GBMSM 3,650 4,269 3,797 5,533 5,359 47% -3%
Subtotal (men) 19,458 19,424 11,530 13,932 15,908 -18% 14%
Hetero/bisexual women 20,831 20,337 12,185 15,038 17,508 -16% 16%
WOSW 161 160 166 274 261 62% -5%
Subtotal (women) 21,206 20,881 12,830 15,988 18,688 -12% 17%
Total (all genders) 41,548 41,472 25,459 31,594 37,636 -9% 19%

Sources: UKHSA, GUMCAD

Note: WOSW = women who only have sex with women

Table 1 presents the number of North East residents tested for HIV in SHSs between 2018 and 2022 by population group. There is a noticeable drop in the number of tests performed in heterosexual men in 2020, attributable to restrictions during the COVID-19 pandemic, and levels remain low in 2022 (38% less compared to 2018). Similarly, testing in women decreased during 2020 and in 2022 remains 16% lower than 2018. The number of tests performed in GBMSM and WOSW is 47% and 62% higher in 2022 compared to 2018, respectively.

Figure 25. HIV pre-exposure prophylaxis (PrEP) need and initiation/continuation in residents attending specialist sexual health services (SHSs), the North East, 2022

Sources: UKHSA, GUMCAD

Recognised PrEP need was substantially higher among GBMSM (57%) compared to other population groups (<1% to 8%). The percentage of individuals in which PrEP need was identified during consultation varied by population group (ranging from 36% of consultations in heterosexual men to 87% in WOSW). The percentage of individuals in which PrEP was initiated or continued also varied by population group (ranging from 11% in heterosexual men to 62% in GBMSM).

Information on data sources

HIV & 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 & AIDS Reporting System (HARS) which captures information at every attendance for HIV care.

Date of data extract: November 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. Confidence intervals presented in the text are produced by Bayesian analysis.

ONS mid-year estimates for 2021 were used as a denominator for rates for 2022 by local authority of residence. ONS mid-year estimates for 2020 were used as a denominator for rates for 2022 by middle super output area of residence. ONS estimates of population by ethnic group for 2021 were used as a denominator for rates for 2022 by ethnic group.

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.

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

Sexual and Reproductive Health Profiles for a whole range of sexual health indicators.

Sexual and reproductive health in England: local and national data

Annual epidemiological spotlight on STIs in North East: 2022 data

National HIV report: 2022 data

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 [email protected] 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 Field Service team at [email protected].

If you have any comments or feedback regarding this report or the Field Service, contact [email protected].

Acknowledgements

We would like to thank the following:

  • 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. 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

  2. Aghaizu A, Martin V, Kelly C, Kitt H, Farah A, Latham V, Brown AE and Humphreys C. ‘Positive Voices: The National Survey of People Living with HIV. Findings from 2022’ December 2023, UK Health Security Agency

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