Research and analysis

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

Updated 1 October 2024

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Summary

This report presents data for 2022 on new HIV diagnoses, late diagnoses, people living with diagnosed HIV, HIV testing, continuum of HIV care and pre-exposure prophylaxis (PrEP) in North West England.

Patterns of sexual behaviour were changed by both the COVID-19 pandemic (in 2020 and 2021) and the mpox outbreak in 2022. HIV testing and the provision of sexual healthcare was also disrupted during 2020 and 2021. These factors, combined with challenges in data collection and completeness, and improvements in data coding for PrEP, mean that trends remain difficult to interpret between 2019 and 2022 (1).

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

New HIV diagnoses have gradually trended downwards in the region since a peak in 2014. There were 349 new diagnoses in the North West in 2022, 5% lower than in 2021 (in contrast to a 22% increase nationally) and 14% lower than in 2019. 34% of these new diagnoses were in people previously diagnosed abroad, an increase compared to 2021 (27%), primarily in people of black African ethnicity.  New diagnoses in heterosexuals declined slightly following a rise between 2020 and 2021, despite a small increase in HIV testing coverage at specialist sexual health services in this group.

Diagnosed prevalence of HIV in the North West is the second highest in England after London; Manchester city is classified as an area of very high HIV diagnosed prevalence (5 and above per 1,000 people aged 15 to 59). Seven areas (Salford, Blackpool. Liverpool, Rochdale, Tameside, Bury and Bolton) are classified as areas of high diagnosed HIV prevalence (2 to 4.99 per 1,000). HIV prevalence in the North West was 20 times higher in people of black African ethnicity than white ethnicity (20 compared to 1 per 1000).

The proportion of new HIV diagnoses which were diagnosed late (late diagnosis is defined as CD4 count of less than 350 cells/mm3) continues to remain an issue in the North West (42%), although this figure is consistent with the proportion diagnosed late in England (43%). Heterosexuals were more likely to be diagnosed late (49% of males, 48% of females) than gay, bisexual and other men who have sex with men (GBMSM) (35%). People of black African ethnicity were more likely to be diagnosed late than the white population (53% and 39% respectively). Further work is required to improve the prompt detection of HIV and to reduce the number of people living with undiagnosed infection.

HIV testing coverage [note 1] increased from 41% to 44% overall but remained below pre-pandemic levels. Coverage varied between population groups and was lower for heterosexual women (32%) and heterosexual men (59%) than in GBMSM (75%). This figure however excludes tests done through online consultations and there has been an expansion of online services since 2020 (see section 1.6). The lower uptake of HIV testing in women is partially explained by data quality issues such as some reproductive health related attendances being miscoded as sexual health attendances. (1). However, unequal HIV testing uptake across different groups persists, which means that opportunities for prevention interventions (including PrEP) may have been missed. This reinforces the need for increased levels of, and expanded access to, HIV testing across a wide range of settings.

Similarly, uptake of HIV PrEP in the North West was lower among heterosexuals than GBMSM. Addressing this disparity is key to HIV prevention.

Note 1: 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.  HIV testing coverage is not calculated for online services.

New diagnoses

In 2022, an estimated 349 North West residents were newly diagnosed with HIV. This represents a fall of 5% from 2021 and of 14% from 2019.  New diagnoses in North West residents accounted for 9% of new diagnoses in England. 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 2022.

The new diagnosis rate for North West residents (5 per 100,000) was below that of England in 2022 (7 per 100,000). The number of new diagnoses was highest in males aged 25 to 44 and females aged 35 to 44 years in 2022.

In 2022, 48% of all new diagnoses in North West residents were GBMSM (compared to 49% in 2021 and 58% in 2013). The number of GBMSM residents in the North West newly diagnosed with HIV (166, adjusted for missing information  ) was 46% lower than in 2013. Of the GBMSM newly diagnosed with HIV, 63% were white and 48% were UK-born.

A similar proportion of new diagnoses in the North West in 2022 (47%) were acquired through heterosexual contact. Infections in African born persons accounted for 56% of all heterosexually acquired cases in 2022 (n=72), compared to 44% (n=82) in 2013. Infections in UK born persons accounted for 26% of all heterosexually acquired cases in 2022.

People of black African ethnicity represented 32% of all newly diagnosed North West residents in 2022 (compared to 25% in 2021 and 21% in 2013). 55% of new diagnoses in people of black African ethnicity in 2022 were previously diagnosed abroad. A small proportion of new diagnoses in 2022 were in the black Caribbean ethnic group (2%).

Injecting drug use accounted for 3% of new diagnoses in North West residents.

Late diagnoses

Reducing late HIV diagnoses is one of the indicators in the Public Health Outcomes Framework. People who are diagnosed late have a ten-fold risk of mortality within one year of diagnosis compared to those diagnosed promptly. There are also increased healthcare costs associated with late diagnosis.

It is of particular concern that a large proportion of North West residents with HIV are diagnosed late (42% from 2020 to 2022, compared to 43% in England), as defined by a CD4 count of less than 350 cells/mm3 at diagnosis.

In the North West, the proportion of late diagnoses remained similar to 2019 levels in GBMSM and heterosexuals. Heterosexuals were more likely to be diagnosed late (49% of males, 48% of females) than GBMSM (35%). By ethnic group, people of black African ethnicity were more likely to be diagnosed late than the white population (53% and 39% respectively).

People living with diagnosed HIV

The 10,200 people living with diagnosed HIV in the North West in 2022 was 1% higher than 2021 and 38% higher than 2013. 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 North West in 2022 was similar to the rate in England as a whole at 2 per 1,000 residents aged 15 to 59 years.

In 2022, 8 local authorities in the North West 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 [note 1]. These were Manchester (5.8 per 1,000) which is classified as an area of very high HIV diagnosed prevalence (5 and above per 1,000) and seven local authorities classified as areas of high diagnosed HIV prevalence (2 to 4.99 per 1,000):  

  • Salford (4.8)
  • Blackpool (4.2)
  • Liverpool (2.4)
  • Rochdale (2.2)
  • Tameside (2.2)
  • Bury (2.1)
  • Bolton (2.1)

The two most common probable routes of transmission for North West residents living with diagnosed HIV in 2022 were sex between men (54%) and sex between men and women (42%).

In 2022, 41% of those living with diagnosed HIV in the North West were aged between 35 and 49 years, and 45% were aged 50 years and over (up from 24% in 2013). Males represented 73% of North West residents living with diagnosed HIV in 2022 and females represented 27%.

In 2022, 65% of North West residents living with diagnosed HIV were white and 25% were of black African ethnicity. 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 the black African (20 per 1,000) than in the white population (1 per 1,000).

Note 1: the ‘British HIV Association (BHIVA) and the British Association for Sexual Health and HIV (BASHH) Infection Association Adult HIV Testing Guidelines 2020’ recommend that all patients attending primary and secondary healthcare in areas of high and very high HIV diagnosed prevalence should be offered a test for HIV.

Continuum of HIV care

In 2022, 98% of HIV-diagnosed residents in England, excluding London, were receiving anti-retroviral treatment (ART). Of these, 98% were virally suppressed (viral load less than 200) and were very unlikely to pass on HIV, even if having sex without condoms (untransmissible virus). This compares to 99% in England  as a whole receiving ART and 98% of these virally suppressed.

For North West residents diagnosed in 2022, the proportion starting treatment within 91 days of diagnosis for the period 2020 to 2022 was 85%. This compares to 85% for England.

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.

It is estimated that 1,000 GBMSM in England, outside London, are undiagnosed (CrI 500 to 1,900) as are 1,900 heterosexuals (CrI 1,400 to 3,000), including 800 people of black African ethnicity. 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%), and non-black African heterosexual men (7%, CrI 4 to 20%).

HIV testing

A total of 78,133 people were tested for HIV in SHSs (Sexual health services providing specialist (level 3) STI related care) in the North West in 2022, a decrease of 26% since 2018. The HIV testing coverage at specialist SHSs in the North West was 44%, which compares to 48% across England. HIV testing coverage in specialist SHSs in the North West is higher in men (63%) than women (32%), and highest in GBMSM (75%).

Some HIV tests are performed in settings other than at SHSs. These include tests done through online consultations (as well as emergency department opt out testing, tests conducted in hospital settings prompted by indicator conditions, drug and alcohol services and prisons, antenatal screening, community testing provided by the voluntary sector and the national HIV self-sampling and self-testing scheme (SH:24)).

It is not currently possible to include these tests in the HIV testing coverage measure. There are two reasons for this. Firstly, online and other non-specialist SHSs are not mandated by 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).

PrEP

In 2022, 7% of HIV-negative North West residents accessing SHSs in England were defined as having a PrEP need [note 1], among whom 70% initiated or continued PrEP (PrEP need is defined as the number of people who were HIV negative accessing specialist SHSs who were at substantial HIV risk and could benefit from receiving PrEP). Of those with PrEP need, 86% had this need identified at a clinical consultation.

Among HIV-negative GBMSM resident in the North West accessing SHSs in England, 66% were defined as having a PrEP need [note 1], 72% of these individuals initiated or continued PrEP and 87% had this need identified at a clinical consultation. Consistent use of PrEP can be an efficacious and effective intervention to prevent HIV acquisition.

Note 1: 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 in 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 and black African populations.

HIV Prevention Messages

To ensure that the goals of the 2022 to 2025 HIV Action Plan 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 (2).

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 unlikely 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 (3). 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, and HIV PrEP and PEP. Clinic-based services are commissioned by local authorities for residents of all areas in England and online self-sampling for HIV and STIs is widely available. Information and advice about sexual health including how to access services is available at NHS.UK and from the national sexual health helpline on 0300 123 7123.

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, HANDD.

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

The error bars show the confidence intervals for rates calculated to the 95% level using the Byar’s method

Figure 1 is a bar chart which shows the rate of new HIV diagnoses in 2022 per 100,000 population by UKHSA region of residence. The North West rate was the third-lowest in the country at 4.7 diagnoses per 100,000. London had the highest rate at 15.5 per 100,000. The rate of new HIV diagnoses across England was 6.7 per 100,000. 

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

Sources: UKHSA, HANDD.

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

Note 2: The error bars show the confidence intervals for rates calculated to the 95% level using the Byar’s method. The colour of the bars relates to the HIV diagnosed prevalence not new HIV diagnoses.

Note 3: HIV diagnosed prevalence (rate per 1,000 aged 15 to 59 years as per NICE testing guidelines):

  • Lower diagnosed prevalence: less than 2 per 1,000 aged 15 to 59 years
  • High diagnosed prevalence: 2 to 5 per 1,000 aged 15 to 59 years
  • Extremely high diagnosed prevalence: more than 5 per 1,000 aged 15 to 59 years

Figure 2 is a bar chart displaying the rate of new HIV diagnoses in 2022 per 100,000 among upper tier local authorities in the North West. Manchester, Salford, and Blackpool had the highest rates of new HIV diagnoses in the North West at 16, 9, and 9 diagnoses per 100,000 respectively. Bury had the lowest rate of new HIV diagnoses at 1 diagnosis per 100,000. The rate of new HIV diagnoses across the North West was 4.7 per 100,000 in 2022.

The bars are coloured according to the diagnosed HIV prevalence in upper tier local authority of residence. The areas with the highest rates of new HIV diagnoses also had extremely high or high diagnosed HIV prevalence. Bolton, Tameside, Rochdale and Bury are high diagnosed HIV prevalence areas, yet the number of new diagnoses in these areas in 2022 was among the lowest in the North West region.

Figure 3. New HIV diagnoses and deaths, the North West, 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 chart displaying two trend lines: the number of new HIV diagnoses and deaths from 2013 to 2022. Overall, HIV diagnoses have decreased from 532 in 2013 to 349 in 2022, however, there have been fluctuations in the trend. Diagnoses increased in 2014 before decreasing in 2015 and then remaining stable through 2018. From 2018 to 2020, HIV diagnoses decreased from close to 500 to just over 300. Diagnoses increased slightly in 2021 before decreasing to 349 in 2022.

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

Figure 4 is a stacked area chart displaying a breakdown of new HIV diagnoses into two categories: people who were previously diagnosed abroad and people who were not previously diagnosed abroad. The chart displays data from 2018 to 2022. The trend in new HIV diagnoses is described in the caption for Figure 3. The percentage of new HIV diagnoses previously diagnosed abroad has remained generally stable at approximately 20% of total new HIV diagnoses each year. That percentage has increased slightly in 2021 and 2022 to approximately 30% of total new HIV diagnoses.

Sources: UKHSA, HANDD.

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 chart displaying trend lines of the number of new HIV diagnoses by probable route of infection over the past 10 years (2013 to 2022). Three probable routes of infection are shown: sex between men, sex between men and women, and other infection routes. Each route of infection is represented by two lines: a solid line showing all cases and a dashed line showing only cases who were not previously diagnosed abroad. Sex between men has been the probable route of infection for the largest number of cases for the past 10 years, excluding 2019 when the largest number of cases were likely infected through sex between men and women.

The numbers of HIV cases with a probable route of infection of sex between men or sex between men and women have both generally trended downwards since 2014 but have plateaued since 2020. The largest reduction has been seen in the number of cases where the probable route of infection was sex between men. This has resulted in reducing disparity between the total number of new HIV diagnoses with a probable route of infection of sex between only men and between men and women over the past 10 years. The total number of new HIV diagnoses with a probable route of infection of sex between men was 103 higher than those with a probable route of infection of sex between men and women in 2013 (310 and 207 diagnoses respectively), but in 2022 that difference has reduced to just 3 (166 and 163 diagnoses respectively). New HIV diagnoses in the North West have been equally attributable to sex between men and women as they have been to sex between only men since 2019.

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

Figure 5b. New HIV diagnoses detailed ‘other’ route of acquiring HIV (not adjusted for missing information), North West residents, 2013 to 2022   

Sources: UKHSA, HANDD.

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.

Note 2: 2021 and 2022 paediatric data on new diagnoses from the Integrated Screening Outcomes Surveillance Service (ISOSS) and the Children’s HIV and AIDS Reporting System (CHARS) were not available at the point of publication. As a result, data on new diagnoses in the under 15 age group has been suppressed and therefore mother-to-child transmission may be under-estimated.

Figure 5b is a line chart displaying trend lines of the number of new HIV diagnoses by probable route of infection over the past 10 years (2013 to 2022). The routes of infection included in this chart are those grouped into the “Other infection routes” category in Figure 5a. Three probable routes of infection are shown: intravenous drug use, mother-to-child, and other. The numbers of new HIV diagnoses across these three probable routes of infection are very small so be cautious interpreting trends from this figure as small changes in the number of diagnoses can appear dramatic. Over the past decade, mother-to-child transmission appears to have trended downwards, going from nine new HIV diagnoses in 2013 to only one in 2022. New HIV diagnoses associated with intravenous drug use have remained similar (around 10 diagnoses per year) since 2017.

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

Sources: UKHSA, HANDD.

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

Note 2: Paediatric data on new diagnoses from the Integrated Screening Outcomes Surveillance Service (ISOSS) and the Children’s HIV and AIDS Reporting System (CHARS) were not available at the point of publication. As a result, data on new diagnoses in the under 15 age group has been suppressed and is underreported in the 15 to 24 age group.

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

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

Within each age group, consistently fewer new HIV diagnoses are seen in women in comparison to men. The largest number of new HIV diagnoses in men are in the 25 to 34 year-old and 35 to 44 year-old age groups (70 and 68 diagnoses respectively).

Among women, the largest number of new HIV diagnoses are in the 35 to 44 year-old age group (51 diagnoses).

Figure 6b. Number of new HIV diagnoses by age group and probable route of acquiring HIV, male North West 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 pyramid bar chart showing the number of new HIV diagnoses among male North West residents by age group and probable route of infection. Probable route of infection is divided into two groups: sex between men and all other exposures. Five age groups are displayed:

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

Within most age groups, the number of new HIV diagnoses where the probable route of infection is sex between men is higher than all other exposures combined. The exception is among men aged 55 to 64 where 8 new diagnoses had a probable route of infection of sex between men while 11 diagnoses had other probable routes of infection. The largest number of new HIV diagnoses is found among men aged 25 to 34 with a probable exposure of sex between men.

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.

Figure 7a is a line chart displaying trend lines of the number of new HIV diagnoses probably acquired through sex between men by age group in the North West over the past 10 years (2013 to 2022). Five age groups are displayed:

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

As seen in Figure 5a, the number of HIV diagnoses where the probable route of infection is sex between men has generally decreased across all age groups since 2013. This decrease appears to have plateaued since 2020. The highest number of new HIV diagnoses has consistently been among those aged 25 to 34 while the lowest has been among those aged 55 to 64.

Sources: UKHSA, HANDD.

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 7b is a line chart displaying trend lines of the number of new HIV diagnoses probably acquired through sex between men and women by age group in the North West over the past 10 years (2013 to 2022). Five age groups are displayed:

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

Long-term trends are less clear in this chart with most age groups fluctuating but remaining reasonably stable. A decrease has been seen among those aged 25 to 34, going from 62 new HIV diagnoses in 2013 to 28 diagnoses in 2022. The highest number of new HIV diagnoses has consistently been among those aged 35 to 44 while the lowest has primarily been among those aged 15 to 24.

Sources: UKHSA, HANDD.

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 8 is a line chart displaying trend lines of the number of new HIV diagnoses by ethnic group in the North West over the past 10 years (2013 to 2022). Ethnicity is divided into three groups: white, black African, and all other ethnic groups. Each ethnic group is represented by two lines: one solid line showing all cases and a dashed line showing only cases who were not previously diagnosed abroad. The number of new HIV diagnoses among people who are white increased from 2013 to 2014 but has generally trended downwards since 2014. The number of new HIV diagnoses among people who are black African decreased slightly from 2013 to 2020 but has increased in the past two years. The number of new HIV diagnoses in the ‘all other ethnic groups’ category has remained relatively stable and low over the past 10 years but appears to also have increased slightly since 2020. The highest number of new HIV diagnoses has consistently been among people who are white, however, the difference in the number of new HIV diagnoses between ethnic groups has decreased since 2013.

Sources: UKHSA, HANDD.

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 9 is a line chart displaying trend lines of the number of new HIV diagnoses by world region of birth for North West residents over the past 10 years (2013 to 2022). World region of birth is broken into three categories: UK, Africa, and all other countries. Each world region of birth category is represented by two lines: one solid line showing all cases and a dashed line showing only cases who were not previously diagnosed abroad. Among people born in the UK, new HIV diagnoses increased from 2013 to 2014 but have generally trended downwards since 2014, going from 353 new HIV diagnoses in 2013 to 128 diagnoses in 2022. The number of new HIV diagnoses among people born in Africa has remained stable (103 in 2013, 110 in 2022). The number of new HIV diagnoses among people born in countries outside of the UK and Africa has increased slightly from 77 in 2013 to 111 in 2022.

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 below 350 cells/mm3.

The underlying population will impact on the proportion diagnosed late, for example GBMSM are less likely to be diagnosed late. The error bars show the confidence intervals for percentages calculated to the 95% level using the Wilson Score method.

Figure 10 is a bar chart displaying the percentage of new HIV diagnoses that were diagnosed late by upper-tier local authority from 2020 to 2022. It shows that the highest percentages of late HIV diagnoses were in Halton (75%) followed by the Wirral, Cumberland, and Blackburn with Darwen (all 60%). The upper-tier local authorities with the lowest percentages were Warrington (14%), Sefton, and Westmorland and Furness (both 29%). Across the entire North West, 42.1% of new HIV diagnoses were diagnosed late from 2020 to 2022.

Figure 11a. Percentage and number of new HIV diagnoses by probable route of infection that were diagnosed late, North West residents, aged 15 years and over, 2020 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 below 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. The error bars show the confidence intervals for percentages calculated to the 95% level using the Wilson Score method.

Figure 11a is a bar chart displaying the percentage of new HIV diagnoses that were diagnosed late by probable route of infection in the North West from 2020 to 2022. Four probable routes of infection are shown: sex between men, male patients with heterosexual contact, female patients with heterosexual contact, and injecting drug use.  It shows that the percentage of new HIV diagnoses that were diagnosed late is higher among those where the probable route of infection is heterosexual contact (49% of men diagnosed late, 48% of women) in comparison to those where the probable route of infection is sex between men or injecting drug use (35% and 44% diagnosed late respectively). However, these differences are not statistically significant.

Figure 11b. Percentage and number of new HIV diagnoses by ethnic group that were diagnosed late, North West residents, aged 15 years and over, 2020 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 below 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. The error bars show the confidence intervals for percentages calculated to the 95% level using the Wilson Score method.

Figure 11b is a bar chart displaying the percentage of new HIV diagnoses that were diagnosed late by ethnic group in the North West from 2020 to 2022. Three categories of ethnic group are displayed: white, black African, and black Caribbean. It shows that the percentage of late new HIV diagnoses was higher among people who are black African (53%) in comparison to people who are white (39%) or black Caribbean (20%). However, these differences are not statistically significant.

Figure 12. Percentage of new HIV diagnoses that were diagnosed late by probable route of infection and year of first UK HIV diagnosis, North West residents, aged 15 years and over, 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 below 350 cells/mm3.

Figure 12 is a line chart displaying trend lines of the percentage of new HIV diagnoses that were diagnosed late by probable route of infection in the North West for the past 10 years (2013 to 2022). Three categories of probable route of infection are displayed: sex between men, sex between men and women, and other infection routes. The percentage of new HIV diagnoses that were diagnosed late where sex between men and women was the probable route of infection has remained similar (57% in 2013, 52% in 2022). The percentage of late new HIV diagnoses with a probable route of infection of sex between men has trended upward since 2013, going from 24% in 2013 to 37% in 2022. The percentage of new late HIV diagnoses among those with other probable infection routes has fluctuated greatly due to the small overall number of people in that category.

Figure 13. Age distribution of new HIV diagnoses that were diagnosed late by year of first UK HIV diagnosis, North West residents, aged 15 years and over, 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 below 350 cells/mm3.

Figure 13 is a line chart displaying trend lines of the percentage of late new HIV diagnoses that fall into each age group in the North West from 2013 to 2022. Five age groups are displayed:

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

The largest percentage of new diagnoses in 2022 were among 35 to 44 and 45 to 54 year-olds (29% and 28% of late diagnoses respectively). The smallest percentage was among people aged 15 to 24 (8% of late diagnoses in 2022).

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

Sources: UKHSA, HARS.

Note: The error bars show the confidence intervals for rates calculated to the 95% level using the Byar’s method.

Figure 14 is a bar chart displaying the prevalence of diagnosed HIV in 2022 among people aged 15 to 59 by UKHSA region. It shows that the prevalence of HIV in the North West is the second highest in England at 2.0 diagnoses per 1,000 residents aged 15 to 59.

The highest prevalence is found in London (5.3 diagnoses per 1,000 residents aged 15 to 59) while the lowest is found in the South West and North East (1.3 and 1.2 diagnoses per 1,000 residents aged 15 to 59 respectively).

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

Sources: UKHSA, HARS.

Figure 15 is a line chart displaying the trend in the number of North West residents living with diagnosed HIV and accessing care from 2013 to 2022. The number living with HIV and accessing care has steadily increased since 2013.

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

Sources: UKHSA, HARS.

HCW: healthcare worker

Figure 16 is a bar chart displaying the number of North West residents living with diagnosed HIV and accessing care in 2022 broken down by probable route of transmission. Five categories of probable route of transmission are shown: sex between men, sex between men and women, mother-to-child transmission, injecting drug use, and blood/healthcare worker. It shows that sex between men (5,517 diagnoses) and sex between men and women (4,290 diagnoses) were the probable route of transmission for far more HIV diagnoses than mother to child transmission (157 diagnoses), injecting drug use (137 diagnoses), and blood/healthcare worker (100 diagnoses) combined.

Figure 17. Age-distribution of residents with diagnosed HIV who are accessing care, the North West, 2013 and 2022

Sources: UKHSA, HARS.

Figure 17 is a bar chart displaying the age distribution of North West residents with diagnosed HIV who accessed care in 2013 and 2022. Five age groups are displayed:

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

It shows that in 2013 the majority of North West residents living with diagnosed HIV and accessing care were in the 35 to 49 year-old age group (51%) while in 2022 the percentage was similar in the 35 to 49 and 50 and older age groups (41% and 45% respectively). The percentage of people 34 and under with diagnosed HIV and accessing care decreased across all age groups from 2013 to 2022.

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

Sources: UKHSA, HARS.

Note: The error bars show the confidence intervals for rates calculated to the 95% level using the Byar’s method.

Figure 18 is a bar chart displaying the prevalence of diagnosed HIV in the North West in 2022 by ethnic group. Six categories of ethnic group are shown: black African, black Caribbean, black other/unspecified, other/mixed, white, and Asian. The chart shows that diagnosed HIV prevalence is significantly higher among people who are black African (20.0 diagnoses per 1,000 residents) in comparison to all other ethnic groups).

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

Note: The error bars show the confidence intervals for rates calculated to the 95% level using the Byar’s method.

Sources: UKHSA, HARS.

Figure 19 is a bar chart displaying the rate of HIV diagnoses per 100,000 North West residents in 2022 by index of multiple deprivation (IMD) decile (1 is the most deprived, 10 is the least deprived). It shows that the rate of HIV diagnoses consistently increases with increasing deprivation, going from 0.5 diagnoses per 100,000 residents in IMD 10 to 2.4 diagnoses per 100,000 residents in IMD 1.  

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

Sources: UKHSA, HARS.

The error bars show the confidence intervals for rates calculated to the 95% level using the Byar’s method.

Figure 20 is a bar chart displaying diagnosed HIV prevalence per 100,000 residents aged 15 to 59 in 2022 by North West local authority. It shows that diagnosed HIV prevalence per 1,000 residents is significantly higher in Manchester, Salford, and Blackpool in comparison to the other local authorities in the North West. Across the North West, the prevalence rate of diagnosed HIV in 2022 was 2.0 per 1,000 residents.

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

Sources: UKHSA, HARS.

Figure 21 is a map displaying diagnosed HIV prevalence per 100,000 residents aged 15 to 59 in 2022 by North West local authority. It displays the same information as Figure 20.

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

Sources: UKHSA, HARS.

Figure 22 is a map displaying the diagnosed HIV prevalence per 1,000 residents in 2022 by middle super output area.

Figure 23. The continuum of HIV care, 2022

Sources: UKHSA, HARS (MPES model).

Figure 23 is a bar chart displaying how England (excluding London) compares to the UNAIDS 90:90:90 HIV targets. It shows that, if London is excluded, England is meeting the UNAIDS targets. Of those in England (excluding London) who are estimated to be living with HIV, 95% have been diagnosed with HIV, 93% of them are on treatment, and 91% of them are virally suppressed.

Figure 24. HIV test coverage by population group, North West 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 24 is a line chart displaying trend lines of the percentage of eligible attendees at specialist sexual health services (SHS) who accepted an HIV test in the North West over the past five years (2018 to 2022). Trends for four population groups are shown: all, males, females, and GBMSM. Percentage test coverage is consistently highest in GBMSM, followed by all men, then all people, and then women. Test coverage decreased in 2020 across all population groups due to the COVID-19 pandemic. Although test coverage has increased since 2020 across all population groups, percentages have not returned to pre-pandemic levels. It should be noted however that it is not currently possible to include tests performed in settings other than at specialist sexual health services (SHSs), including through online consultations, in the HIV testing coverage measure. Since 2020, the proportion of HIV testing which takes place through online services has increased.

Table 1. People tested for HIV by population group, North West 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 41,429 43,279 22,366 25,531 25,724 −38% 1%
GBMSM 12,058 14,775 13,571 20,110 17,736 47% −12%
Subtotal (men) 55,461 60,498 37,802 48,041 45,034 −19% −6%
Hetero/bisexual women 57,988 62,750 39,169 50,876 47,215 −19% −7%
WOSW 380 471 457 745 637 68% −14%
Subtotal (women) 60,648 66,307 42,581 54,967 49,623 −18% −10%
Total (all genders) 117,341 130,075 82,998 111,979 111,736 −5% 0%

Sources: UKHSA, GUMCAD.

WOSW: women who only have sex with women

Includes tests carried out at sexual health services providing both specialist (level 3) and non-specialist (level 2) STI related care

Table 1 displays the number of people tested for HIV in the North West by population group and year (2018 to 2022). Six population groups are shown:

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

Figure 25. HIV PrEP need and initiation or continuation in residents attending specialist sexual health services (SHSs), the North West, 2022

Sources: UKHSA, GUMCAD.

Figure 25 is a bar chart displaying the percentage of HIV PrEP need and initiation or continuation among residents attending specialist sexual health services (SHSs) in the North West in 2022 by population group. Four population groups are displayed:

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

Three categories of PrEP are displayed: PrEP need, PrEP need identified, and PrEP initiated or continued. ‘PrEP need’ represents the percentage of people attending SHSs who were at substantial HIV risk and could benefit from receiving PrEP. This assessment of risk is based on a combination of clinical codes reported through GUMCAD within the previous 12 months of each consultation including PrEP eligibility codes, and other clinical or behavioural markers known to indicate higher risk of HIV seroconversion in the year following an attendance. PrEP need is defined differently for different population groups. Further details are available in the PrEP monitoring and evaluation framework. ‘PrEP need identified’ represents the percentage of people in the ‘PrEP need’ category who had their need identified at a clinical consultation. ‘PrEP initiated or continued’ represents the percentage of people in the ‘PrEP need’ category who take PrEP (started or continued PrEP in 2022).

The figure shows that 66% of North West GBMSM who attended specialist sexual health services in 2022 had a PrEP need. Of those, 87% had their need identified at a clinical consultation and 72% initiated or continued PrEP. A far smaller percentage of women who only have sex with women had a PrEP need (5%). Of those, 92% had their need identified at a clinical consultation and 68% initiated or continued PrEP. Heterosexual men and heterosexual and bisexual women had the smallest PrEP needs (1% and less than 1% respectively). However, fewer of those with a PrEP need had their need identified (63% and 64% respectively) and fewer initiated or continued PrEP (both 38%).

What’s happening in the North West?

George House Trust, Greater Manchester

African Men’s Engagement

The African Men’s Engagement Project at George House Trust provides tailored support to African men living with HIV.

Recognising the unique challenges faced by this demographic, the project offers a comprehensive range of activities and initiatives aimed at improving wellbeing, fostering self-confidence, and reducing feelings of social isolation.

Through 42 facilitated ‘Calabash’ group sessions since the start of the work in 2021, the project has fostered a sense of belonging and empowerment helping to equip attendees with practical skills and knowledge to live confidently despite the challenges posed by HIV.

The project has enabled the training of twelve men as first aiders to equip them with life-saving skills, and has recruited two African men to the George House Trust Positive Speaker programme - sharing their stories and inspiring others within the community, further demonstrating the project’s emphasis on empowerment and leadership development.

The impact of the project is reflected in the positive outcomes reported by participants with 88% reporting increased confidence in managing HIV day-to-day and 85% expressing feeling more confident about living with HIV. 78% of participants reported improved social engagement and connectivity, and 76% reported reduced feelings of social isolation.

Peer Navigator

Since March 2023 the George House Trust HIV Peer Navigator has been based at the Manchester Centre for Sexual Health providing support for people living with HIV and connecting them to social support at any point in their clinical journey.  By supporting people living with HIV to navigate their way through the health and social care system and community-based support, the Peer Navigator has enabled them to maximise their use of appropriate services and opportunities. The project aims to build the confidence and skills that will enable people living with HIV to thrive rather than just survive.

The Peer Navigator programme is holistic and person-centred, co-designed with people living with HIV to address psycho-social needs. The project aims to improve the lives of people living with HIV and put them at the heart of their own treatment and care. By building on George House Trust’s existing Peer Mentoring project and relationships with the HIV clinicians at the Manchester Centre for Sexual Health, the project has harnessed lived experience and real-life knowledge to support people to live healthily and confidently with HIV.

Liverpool City Council

Improving access to HIV PrEP in Liverpool

Axess Sexual Health is operating a PrEP Express service from their clinic locations in Liverpool. The service is designed to improve access to HIV PrEP, allowing some people to obtain a repeat HIV PrEP prescription via a consultation with a non-registered health practitioner.

Dr Martyn Wood, Clinical Director of Axess Sexual Health, comments:

 “Traditionally people would have to see a doctor or nurse, but by offering this service we are able to provide more appointments. People are in and out in 15 minutes and we can offer same-day appointments if people need them.

“The online assessment filters out the more complex cases that need to be seen by a nurse or doctor. That includes occasions where there has been a change in circumstances, perhaps the individual has started a new medication or something like that.

“PrEP Express has proved incredibly popular. In fact, one lesson for us was that you need to be prepared for the demand. When we first started the Express clinics we were a little overwhelmed.

“What we have also noticed is that way people use PrEP has evolved. When it started being prescribed, we all envisaged people would be on it constantly. But instead we have found people come on and off it depending what is happening with their sex lives.

Around 50 per cent of PrEP consultations are now with a non-registered practitioner after the first PrEP Express service was introduced two years ago.

Professor Matt Ashton, Director of Public Health for Liverpool City Council, adds:

“PrEP is a vital game changing drug that helps people maintain HIV negative status and we know access here in Liverpool has so far been very good.

“However, like many areas it has not been accessed by certain risk groups as well as others. PrEP express has already made a difference and is ensuring equitable access to PrEP in the city. This is crucial if we are to ensure we reach and achieve our zero new HIV transmissions target by 2030.

Cheshire and Chester Sexual Health, HCRG Care Group

Chester HIV service was one of the first spoke clinics to offer long acting injectables (LAI) for people living with HIV. This new treatment can be more effective for patients who experience problems with adherence, swallowing tablets or other psychological issues associated living with HIV and taking daily medications. Patients are initially assessed and approved by the medical team prior to commencing treatment to ensure they meet the eligibility criteria. The treatment involves a one-month oral lead in of the tablet formulations of the drugs, followed by the LAI formulations of the next-generation integrase inhibitor cabotegravir and the NNRTI rilpivirine. Both injections are administered within the clinic by a trained professional, usually the HIV specialist nurse or doctor into each gluteal muscle and patients are then followed up two monthly to continue receiving the LAI treatment and to ensure viral suppression.

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 antiretroviral therapy (ART). In 2015, SOPHID reporting in England was replaced by the 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 (Persons with missing fields (for example ethnicity or age group) may have been assigned values based on subsequent years data if available); however, unless stated otherwise, the numbers in the summary section are the unadjusted counts as reported. 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. For example, when calculating the proportion of new diagnoses where probable route of infection was sex between men, new diagnoses where route of infection was known would be used 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

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
  • Colin Armstead, George House Trust for providing a summary of projects and activities to support people living with HIV
  • James Woolgar, Liverpool City Council for providing a summary of projects and activities to increase access to HIV PrEP
  • Bradley Pearson-Barnard and Jennifer Harrison, Cheshire and Chester Sexual Health, HCRG Care Group for providing a summary of projects and activities to support people living with HIV

References

  1. UK Health Security Agency HIV testing, PrEP, new HIV diagnoses and care outcomes for people accessing HIV services: 2023 report 2024

  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. Aghaizu A, Martin V, Kelly C, Kitt H, Farah A, Latham V, Brown AE, Humphreys C. Positive Voices: The National Survey of People Living with HIV. Findings from 2022. Report summarising data from 2022 and measuring change since 2017. December 2023: UK Health Security Agency
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