Research and analysis

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

Updated 9 August 2024

Applies to England

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Summary

HIV remains an important public health problem in the South East. In 2022, 11,680 people were living with diagnosed HIV in the South East. This represents 12% of all people living with HIV in England. See the UKHSA’s national report (1) for broader context.

New diagnoses

In 2022, an estimated 490 South East residents were newly diagnosed with HIV, accounting for 13% of new diagnoses in England. This represents a rise of 24% from 2021. Nationally, there has been a long-term decline in the overall number of new diagnoses, although there was a slight upturn in 2022.

The new diagnosis rate for South East residents (5 per 100,000) was below that of England in 2022 (7 per 100,000).

In 2022, 32% of all new diagnoses in South East residents were in gay, bisexual and other men who have sex with men (GBMSM) (compared to 44% in 2021 and 52% in 2013) (2). The number of GBMSM resident in the South East newly diagnosed with HIV (156, adjusted for missing information) was 51% lower than in 2013. Of the GBMSM newly diagnosed with HIV in 2022, 60% were white and 35% were UK-born.

Heterosexual contact was the most common infection route for new diagnoses in South East residents in 2022 (63%). Infections in African-born persons accounted for 69% of all heterosexually-acquired cases in 2022 (n=175), compared to 48% (n=121) in 2013. Infections in UK-born persons accounted for 18% of all heterosexually-acquired cases in 2022.

Injecting drug use accounted for 2% of new diagnoses in South East residents.

Black Africans represented 38% of all newly diagnosed South East residents in 2022 (compared to 22% in 2021 and 21% in 2013). A small proportion of new diagnoses in 2022 were in black Caribbeans (less than 1%).

The number of new diagnoses was highest in the 25 to 34 year age group in men and the 35 to 44 year age group in women in 2022.

Late diagnoses

Reducing late HIV diagnoses is one of the indicators in the Public Health Outcomes Framework (3). People who are diagnosed late, as defined by a CD4 count of less than 350 cells/mm3  of blood within 91 days of diagnosis, excluding those with evidence of recent infection, have a tenfold risk of mortality within one year of diagnosis compared to those diagnosed promptly and they have increased healthcare costs.

It is of particular concern that a large proportion of South East residents with HIV are diagnosed late (48% from 2020 to 2022, compared to 43% in England).

In the South East, heterosexuals were more likely to be diagnosed late (63% of males, 53% of females) than GBMSM (37%). By ethnic group, black Africans were more likely to be diagnosed late than the white population (52% and 45% respectively).

People living with diagnosed HIV

The 11,680 people living with diagnosed HIV in the South East in 2022 was 5% higher than 2021 and 30% higher than 2013. This increase is partly due to the effectiveness of HIV treatment, which has significantly reduced mortality from HIV.

The diagnosed prevalence rate of HIV in the South East in 2022 was 1.8 per 1,000 residents aged 15 to 59 years. This was lower than the 2 per 1,000 observed in England as a whole. Six upper tier local authorities in the South East had a diagnosed HIV prevalence of at least 2 per 1,000 population aged 15 to 59 years in 2022, which is the threshold for expanded HIV testing. They were Brighton and Hove (7.3), Slough (3.0), Reading (2.9), Southampton (2.7), Portsmouth (2.5) and Medway (2.0).

The two most common probable routes of transmission for South East residents living with diagnosed HIV in 2022 were sex between men (50%) and sex between men and women (47%).

In 2022, 36% of those living with diagnosed HIV in the South East were aged between 35 and 49 years, and 53% were aged 50 years and over (up from 30% in 2013). Males represented 69% of South East residents living with diagnosed HIV in 2022 and females represented 31%.

In 2022, 61% of South East residents living with diagnosed HIV were white and 25% 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 (23 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 antiretroviral treatment. Of these, 98% were virally suppressed (which means they viral load of fewer than 200 copies/ml) and cannot pass on HIV, even if having sex without condoms (untransmissible virus)(1). This compares to 99% in England as a whole receiving ART and 98% of these virally suppressed.

For South East 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) and 1,900 heterosexuals (CrI 1,400 to 3,000), including 800 black Africans. In England, outside London, the proportion undiagnosed varied by exposure group and ethnicity with the highest proportion undiagnosed among people living with HIV who inject drugs (8%, CrI 1% to 27%), non-black African heterosexual women (8%, 6% to 12%), and non-black African heterosexual men (7%, 4% to 20%).

HIV testing

A total of 77,931 people were tested for HIV in specialist sexual health services (SHSs) in the South East in 2022, a decrease of 47% since 2018. The HIV testing coverage at specialist SHSs (proportion of eligible attendees tested) in the South East (and England overall) was 48%. HIV testing coverage in specialist SHSs (proportion of eligible attendees tested) in the South East was higher in men (64%) than women (40%), and highest in GBMSM (71%).

Some HIV tests are performed in settings other than at SHSs. These include tests done through online consultations. It is not currently possible to include these in the HIV testing coverage measure. There are 2 reasons for this. Firstly, online and other non-specialist SHSs are not mandated by the British Association of Sexual Health and HIV (BASHH) to offer an HIV test to everyone. Secondly, these SHSs 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 in the South East has risen sharply (from 25% in 2019 to 54% in 2020) and has remained high (48% in 2022). As a consequence, clients may not be fully coded in relation to HIV testing if they were referred to online testing following triage by a specialist SHS or they were referred to specialist SHS following online testing (where further testing, treatment or care was required).

Pre-Exposure Prophylaxis (PrEP)

In 2022, 8% of HIV-negative South East residents accessing SHSs in England were defined as having a PrEP need, among whom 68% initiated or continued use of PrEP. Of those with a PrEP need, 82% had this need identified at a clinical consultation. Among GBMSM, the group with greatest need, these proportions were: 66%, 71% and 84%. 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 (3). 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 (4). 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 areas 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 also for black Africans.

HIV prevention messages

To ensure the HIV Action Plan 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 sexually transmitted infections (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 having condomless sex with new or casual partners should have an STI screen, including an HIV test, on at least an annual basis. GBMSM should have tests for HIV and STIs annually, or every 3 months if having condomless sex with new or casual partners.

HIV PrEP 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 (4). HIV post-exposure prophylaxis (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 (5). 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’ (4).

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 in 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 NHS sexual health services 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

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

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

Figure 1 is a bar chart showing that the rate of new HIV diagnoses per 100,000 in the South East (5.4 per 100,000) was the fifth highest regional rate. The rate in London (15.5 per 100,000) was more than double of the other UKHSA regions.

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

Source: UKHSA, HANDD.

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

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

Figure 2 is a bar chart showing the rate of new HIV diagnoses per 100,000 population in South East residents by UTLA of residence. Four of the UTLAs (Southampton, Slough, Portsmouth and Reading) had rates double that of the South East regional rate (5.4 per 100,000, represented as a dashed horizontal line), and Brighton and Hove continue to be higher than the regional rate. The rates in local authorities ranged from 16 per 100,000 in Southampton to 1 per 100,000 in the Isle of Wight.

The colour coding of the columns is designed to help relate new HIV diagnosis rates to the diagnosed prevalence for each UTLA. A column that is on the left of the chart (higher column) but which has mid-teal shading may represent a UTLA where new HIV diagnosis rates are increasing or where they have increased in recent years in comparison with earlier in the epidemic. A column that is on the right of the chart (lower column) but which has a mid-teal or dark-teal shading may represent a UTLA where new diagnosis rates are decreased or where they have decreased in recent years in comparison with earlier in the epidemic, for example, Brighton and Hove.

Figure 3: New HIV diagnoses and deaths, the South East, 2013 to 2022

Source: UKHSA, HANDD.

The number of new diagnoses will depend on accessibility of testing as well as infection and transmission. Numbers may rise as we receive more reports and more information. This will impact on interpretation of trends in more recent years. New HIV diagnoses are shown by UK region of residence at diagnosis. Deaths are 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 shows the number of new HIV diagnoses and deaths in people with HIV in the South East from 2013 to 2022. In 2022, an estimated 490 South East residents were newly diagnosed with HIV. This represents a rise of 24% from 2021 (395), however, the number diagnosed in 2022 was far fewer than the 615 diagnosed in 2013 (20% fall). The number of deaths began to rise after 2019. However, this coincides with improved ascertainment of deaths as a result of the National HIV Mortality Review. Additional deaths due to COVID-19 were reported during the pandemic in people living with HIV. The chart shows 71 deaths in 2022, however, an extended reporting delay may be seen for deaths as these are not always notified directly to the HIV surveillance system.

Figure 4: New HIV diagnoses by whether a person had been previously diagnosed abroad, the South East, 2018 to 2022

Source: UKHSA, HANDD.

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 an area chart. It displays the 5-year trend in new HIV diagnoses in South East residents between 2018 and 2022 by whether the person had been previously diagnosed abroad or not. This has become an issue of increasing importance as access to testing and treatment has improved worldwide. The chart shows that the proportion of South East residents newly diagnosed with HIV who were previously diagnosed abroad has increased over the 5-year period from 24% in 2018 (108 new HIV diagnoses) to 47% in 2022 (228).

Source: UKHSA, HANDD.

In the chart, NPDA means 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 5a shows the trend of new HIV diagnoses by probable route of exposure in South East residents from 2013 to 2022. Numbers of HIV diagnoses have been adjusted for missing transmission route allocation. Diagnoses where this information is unknown have been proportionately allocated to the three transmission groups. For each group, an additional dashed line shows a trend where people known to have been previously diagnosed abroad are excluded.

Between 2021 and 2022, the number of new diagnoses among heterosexuals not previously diagnosed abroad (NPDA) rose by 5% (142 to 149) and among GBMSM NPDA the number fell by 21% (133 to 104).

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

Source: UKHSA, HANDD.

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 5b is a line chart which provides more detail about the HIV transmission routes grouped into ‘other routes of acquiring HIV’ in figure 5a. The group is broken down into subcategories: injecting drug use, vertical (mother-to-child) transmission and other transmission routes which include transmission via blood or tissue. The chart displays data from 2013 to 2022. There are no additional lines showing numbers when those with a prior diagnosis abroad are excluded, nor have the data been adjusted for missing information. This is because of the small number of diagnoses in these subcategories.

The chart shows that the number of new HIV diagnoses in South East residents whose probable route of HIV acquisition belonged to any of these subcategories remained low throughout the ten-year period. Apparent trends need to be interpreted with caution given the small numbers involved.

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

Source: UKHSA, HANDD.

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

Figure 6a is a bar chart showing the number of new HIV diagnoses by age group and gender in 2022. Among males, the highest number of new HIV diagnoses was among those in the 25 to 34 year group (86), and among females, the 35 to 44 year group (78).

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

Source: UKHSA, HANDD.

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

Figure 6b is a bar chart showing the number of new HIV diagnoses, among male residents, by age group and probable route of exposure in 2022. This figure excludes males without a known exposure. The number of new HIV diagnoses was highest among GBMSM in the 25 to 34 year group (60).

Source: UKHSA, HANDD.

[Note 2] 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 showing the number of new HIV diagnoses by age group for GBMSM South East residents aged 15 to 64 years from 2013 to 2022. The highest number of new HIV diagnoses have been in the 25 to 34 age group for the past 10 years. The lowest number of new HIV diagnoses were in the 55 to 64 age group. 

Diagnoses in 2022 were lower for all age groups compared to 2013, the first year in the trend period.

Source: UKHSA, HANDD.

Figure 7b is a line chart showing the number of new HIV diagnoses by age group for heterosexual South East residents aged 15 to 64 years from 2013 to 2022. Bisexual women are also included.

Diagnoses increased among heterosexuals for the age groups 25 to 34, 35 to 44 and 55 to 64 when 2022 is compared to 2013, the first year of the trend period.

When 2022 is compared to the previous year rises are seen for all age groups other than the 55 to 64 year group, with more than a 70% rise being seen for four age groups (ranging from 15 to 54 years).

Source: UKHSA, HANDD.

NPDA means not previously diagnosed abroad.

Figure 8 shows the number of new HIV diagnoses by ethnic group in South East residents from 2013 to 2022. It shows a fall, over the 10 years, in the number of new HIV diagnoses among the white group (53%; 391 in 2013 to 183 in 2022) and a rise among the black African ethnic group (45%; 129 in 2013 to 187 in 2022). There was a significant increase in the number of new HIV diagnoses between 2021 and 2022 among both black African ethnic group (115%) and the other ethnic group category (25%). 

For South East residents not previously diagnosed abroad, the rise in the number of new diagnoses among the black African ethnic groups (25%) was less pronounced and there was no change for the other ethnic group category from 2021 to 2022.

Source: UKHSA, HANDD.

In the chart, NPDA means not previously diagnosed abroad.

Figure 9 shows the number of new HIV diagnoses by world region of birth from 2013 to 2022. It shows that year-on-year the number of new HIV diagnoses were highest in residents born in the UK bar 2022 where those born in Africa and in ‘all other countries’ surpassed the UK born. Excluding people diagnosed with HIV abroad, the number of new HIV diagnoses remains highest among UK-born residents.

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

[Note 3] 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 of fewer than 350 cells/mm3. The underlying population will impact on the proportion diagnosed late, for example, men who have sex with men (MSM) are less likely to be diagnosed late.

Figure 10 is a bar chart showing the percentage of new HIV diagnoses that were diagnosed late in South East residents by upper tier local authority (UTLA). The percentage of those diagnosed late was highest in Slough (71%) and lowest in West Berkshire where there were no late HIV diagnoses. The regional mean was 48.5%.

Figure 11a: Percentage and number of new HIV diagnoses by probable route of exposure that were diagnosed late, South East residents, aged 15 years and over, 2020 to 2022 [Note 4]

Source: UKHSA, HANDD and HARS.

[Note 4] Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count of fewer than 350 cells/mm3. Proportions are only shown for the sex between men, heterosexual contact (males), heterosexual contact (females) and injecting drug use exposure groups and are withheld for any of these categories if they contain fewer than 5 late diagnoses.

Figure 11a shows the percentage of new HIV diagnoses that were diagnosed late in the South East (2020 to 2022) by probable route of exposure. The percentage diagnosed late was highest among males that had heterosexual contact (63%) and lowest among GBMSM (37%).

Figure 11b: Percentage and number of new HIV diagnoses by ethnic group that were diagnosed late, South East residents, aged 15 years and over, 2020 to 2022 [Note 5]

Source: UKHSA, HANDD and HARS.

[Note 5] 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 of fewer than 350 cells/mm3. Proportions are only shown for the white, black African and black Caribbean ethnic groups and are withheld for any of these ethnic group categories if they contain fewer than 5 late diagnoses.

Figure 11b shows the percentage of new HIV diagnoses by ethnic group that were diagnosed late in South East residents (2020 to 2022). It shows that 52% of black Africans and 45% of the white ethnic group were diagnosed late.

Figure 12: Percentage of new HIV diagnoses that were diagnosed late by probable route of infection and year of first UK HIV diagnosis, South East residents, aged 15 years and over, 2013 to 2022 [Note 6]

Source: UKHSA, HANDD and HARS.

[Note 6] Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count of fewer than 350 cells/mm3.

Figure 12 shows the percentage of new HIV diagnosis that were diagnosed late by probable route of exposure from 2013 to 2022.  Late diagnoses increased from 28% among GBMSM in 2013 to 41% in 2021 and decreased to 36% in 2022. Whereas among heterosexuals the percentage of new HIV diagnoses that were late increased gradually to 63% in 2018 and decreased to 53% in 2021 and increased to 59% in 2022.

Figure 13: Age distribution of new HIV diagnoses that were diagnosed late by year of first UK HIV diagnosis, South East residents, aged 15 years and over, 2013 to 2022 [Note 6]

Source: UKHSA, HANDD and HARS.

Figure 13 is a line chart showing the age distribution of those diagnosed late between 2013 and 2022. Unlike the previous late diagnosis charts the percentages indicate the proportion of late diagnoses that occurred within each age group, rather than showing the proportion within each group that were diagnosed late. Percentages in this chart are less robust as they are by single year and numbers are small when broken down by age group. They should be interpreted as indicative of broad trends only.

The proportion of those diagnosed late that were in the youngest age groups has remained broadly stable over the 10-year trend period. People aged 15 to 24 years accounted for 3% of those diagnosed late in 2013 and 5% in 2022, while those aged 45 to 54 years accounted for 29% of those diagnosed late in 2013 and 30% in 2022.

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

Source: UKHSA, HARS.

Figure 14 shows that the diagnosed HIV prevalence, in those aged 15 to 59 years, in the South East (1.8 per 1,000) was the fourth highest regional rate in 2022. The highest rate was in London (5.3 per 1,000).

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

Source: UKHSA, HARS.

Figure 15 shows the number of South East residents living with diagnosed HIV and accessing care rose 30% from 9,014 in 2013 to 11,680 in 2022.

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

Source: UKHSA, HARS.

Figure 16 shows the number of South East residents living with diagnosed HIV and accessing care by exposure group in 2022. The number of those accessing HIV care was highest among GBMSM (5,792) followed by heterosexuals (5,436).

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

Source: UKHSA, HARS.

Figure 17 shows the percentage of South East residents living with diagnosed HIV and accessing care in each age group in 2013 and in 2022. The figure shows an ageing population living with diagnosed HIV in 2022. Those aged 50 years and over constituted more than half of people living with diagnosed HIV in 2022, compared to 30% in 2013.

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

Source: UKHSA, HARS.

Figure 18 shows the rate of HIV prevalence by ethnic group in South East residents in 2022. The rate was highest among black Africans (22.5 per 1,000) and lowest among Asians (0.8 per 1,000).

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

Figure 19 is a column chart. It shows rates of diagnosed HIV prevalence for South East residents by decile of deprivation for 2022. Deciles are calculated for England as a whole and patients are assigned on the basis of their lower super output area (LSOA) of residence. These rates are not age restricted.

The chart shows that the diagnosed prevalence rate for areas of the South East that fell into the most deprived decile (decile 1) was over three and a half times the rate for areas that fell into the least deprived decile. While not everyone who lives in an area of higher deprivation may be deprived, the differences seen suggest that people living with diagnosed HIV are also at higher risk of additional stresses relating to financial pressures. For some people these may have an impact on their ability to access HIV-related services.

Figure 20: Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by upper tier local authority, the South East, 2022

Figure 20 shows the diagnosed HIV prevalence rate in those aged 15 to 59 years, by UTLA in the South East in 2022. Six UTLAs had a HIV prevalence rate at least 2/1,000. These were all in more urban areas: Brighton and Hove (7.3), Slough (3.0), Reading (2.9), Southampton (2.7), Portsmouth (2.5) and Medway (2.0).

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

Figure 21 shows a map of HIV prevalence per 1,000 South East residents, aged 15 to 59 years, by UTLA. Six UTLAs had a HIV prevalence rate at least 2 per 1,000. These are:

  • Brighton and Hove (7.3)
  • Slough (3.0)
  • Reading (2.9)
  • Southampton (2.7)
  • Portsmouth (2.5)
  • Medway (2.0)

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

Source: UKHSA, HARS.

Figure 22 is a South East map displaying the prevalence of diagnosed HIV by middle super output area (MSOA) of residence in five rate bands for the year 2022. Unlike the upper tier local authority level map, rates are not age restricted. This reflects the smaller size of an MSOA which is a geographical unit with populations of around 7,500. It shows more detailed areas of the South East that have higher rates.

Figure 23: The continuum of HIV care, 2022

Source: UKHSA, HARS, (MPES model).

Figure 23 shows the continuum of HIV care in England (bar London) in 2022. England achieved the UNAIDS 90-90-90 target; 95% of people living with HIV were being diagnosed, of those 93% were on treatment and 91% of those on treatment were virally suppressed.

Figure 24: HIV test coverage by population group, South East residents, 2018 to 2022

Source: UKHSA, GUMCAD.

The proportion of eligible attendees at specialist sexual health services (SHS) who accepted a HIV test. An eligible attendee is defined as a patient attending specialist SHS at least once during a calendar year. Patients known to be HIV positive, or for whom a HIV test was not appropriate, or for whom the attendance was related to Sexual and Reproductive Health (SRH) care only, are excluded.

Figure 24 shows the percentage HIV test coverage for South East residents accessing specialist SHS from 2018 to 2022. The graph shows a rise in HIV test coverage between 2021 and 2022 for females (40%) and all males (64%), and a fall in HIV test coverage in GBMSM (71%).

Table 1: People tested for HIV by population group, South 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 53,937 52,675 30,678 29,309 32,525 -40% 11%
GBMSM 14,218 16,427 15,097 17,767 17,719 25% 0%
Subtotal (men) 78,828 83,380 58,009 60,871 66,254 -16% 9%
Heterosexual and bisexual women 77,759 80,356 57,176 60,268 59,393 -24% -1%
WOSW 365 546 639 751 691 89% -8%
Subtotal (women) 97,633 105,782 77,523 81,248 83,661 -14% 3%
Total (all genders) 179,801 192,300 137,195 145,152 153,847 -14% 6%

Source: UKHSA, GUMCAD.

Table 1 shows the HIV test coverage by gender and sexual orientation from 2018 to 2022 from all Sexual Health Services. The 153,847 people in the South East tested for HIV in 2022 represents a 6% increase from 2021. However, this followed a 29% fall in testing between 2019 and 2020, and the number tested in 2022 remained 20% lower than in 2019. While there was a recovery in overall testing between 2021 and 2022, this was not seen equally across different demographic groups, with testing remaining stable in GBMSM, testing in heterosexual men increased by 11%, and testing in all women increasing by 3%. Testing in GBMSM in 2022 exceeded that seen in 2019 (8% increase). However, testing among women in 2022 remained 21% lower than in 2019, and testing among heterosexual men was 38% lower.

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

Source: UKHSA, GUMCAD.

In the chart, WOSW means women who only have sex with women

Figure 25 is a column chart showing information about PrEP need and use by gender and sexual orientation in 2022. The first column represents the percentage of South East residents attending specialist SHSs who were determined to be in need of PrEP based on clinical and other information. The second column shows the percentage of those in need of PrEP whose PrEP need was identified by the service and the third shows the percentage of those in need of PrEP for whom PrEP was initiated or continued. These two final columns for each group must be looked at in relation to the first column.

GBMSM had by far the highest need for PrEP (66%). Of these, 84% had their need identified and PrEP was initiated or continued for 71%.

The group with the next highest level of need was women who only have sex with women (WOSW), but the percentage was much lower (7%) and the absolute numbers for this group were also much lower than for any other group.

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

GUMCAD surveillance is a disaggregate reporting system which collects information about attendances and diagnoses at specialist (Level 3) and non-specialist (Level 2) sexual health services. Information about a patient’s area of residence is collected along with other variables. Date of data extract: 21 April 2023.

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 2020 were used as a denominator for rates for 2022.

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 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

Please access the online Sexual and Reproductive Health Profiles for further information on a whole range of sexual health indicators.

For more information on local sexual health data sources, see the UKHSA guide.

See the annual epidemiological spotlight on STIs in South East: 2022 data.

See the 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.

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  Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division teams for collection, analysis and distribution of data

References

  1. Shah A, Mackay N, Ratna N, Chau C, Okumu-Camerra K, Kolawole T, Martin V, Humphreys C, Brown A. HIV testing, PrEP, new HIV diagnoses and care outcomes for people accessing HIV services: 2023 report. The annual official statistics data release (data to end of December 2022). October 2023, UK Health Security Agency, London (viewed on 1 May 2024)
  2. UKHSA, Annual epidemiological spotlight on HIV in the South East: 2021 data.
  3. National AIDS Trust. Not PrEPared: barriers to accessing HIV prevention drugs in England. Available from: (viewed on 1 May 2024)
  4. 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.
  5. Sabin CA, Lundgren JD. The natural history of HIV infection. Curr Opin HIV AIDS. 2013 Jul;8(4):311-7. (viewed on 1 May 2024)
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