Research and analysis

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

Updated 8 August 2024

Summary

This report is intended to provide statistics related to the prevalence, risk factors, diagnosis, and treatment of HIV in South West England in 2022. It is one of 9 annual regional reports produced by the UK Health Security Agency (UKHSA) using data sourced through 3 agency surveillance systems: the HIV and AIDS New Diagnoses Database (HANDD), the HIV and AIDS Reporting System (HARS), and the GUMCAD STI Surveillance System. This report includes trend data from HANDD since 2013, from HARS since 2017, and from GUMCAD since 2018.

HIV remains an important public health problem in the South West, although many regional indicators have improved throughout the preceding 10 years. As of 2022, the South West had the lowest rate of new HIV diagnoses out of all English regions, and the second lowest diagnosed prevalence rate, at 1.3 diagnoses  per 1,000 residents aged 15 to 59 years.

The number of new diagnoses among UK-born residents, gay and bisexual men who have sex with men (GBMSM), and residents without previous diagnoses abroad have consistently decreased between 2013 and 2022. Between 2021 and 2022, an increase in HIV diagnoses was observed among black African residents and residents having sex between men and women, particularly 25 to 44 year olds. The majority of these individuals reported a history of previous diagnosis abroad and are likely to have known of or managed their HIV status before receiving their first diagnosis in the UK.

Within the South West, rates of new diagnoses in the Bristol metropolitan area, including in the City of Bristol, South Gloucestershire, and North Somerset, were significantly lower than the overall regional rate. However, the City of Bristol is still considered a region with high diagnosed HIV prevalence (more than 2 per 1,000 residents), alongside Bournemouth, Christchurch, and Poole. Rates of new HIV diagnosis were higher than the regional rate in Swindon and Bournemouth, Christchurch, and Poole.

Testing coverage improved at specialist sexual health services (SHSs) between 2021 and 2022 after declining during the COVID-19 pandemic. Identification, initiation, and continuation of pre-exposure prophylaxis (PrEP) at specialist SHSs was particularly effective for GBMSM and women only having sex with women (WOSW), with an estimated more than 70% of GBMSM and WOSW attendees in need of PrEP being provided the relevant care. In contrast, less than half of heterosexual men and heterosexual and bisexual women estimated to be in need of PrEP were provided with treatment while attending specialist SHSs in 2022.

New diagnoses

In 2022, an estimated 180 South West residents were newly diagnosed with HIV, accounting for 5% of new diagnoses in England. This represents a rise of 31% from 2021. 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 South West residents (3.2 per 100,000) was below that of England in 2022 (6.7 per 100,000).

In 2022, 29% of all new diagnoses in South West residents were in GBMSM, compared to 48% in 2021 and 56% in 2013. The number of GBMSM residents in the South West newly diagnosed with HIV was 66% lower than in 2013. Of the GBMSM newly diagnosed with HIV, 61% were white and 45% were UK-born.

Heterosexual contact was the largest infection route for new diagnoses in South West residents in 2022 (59%). Infections in African-born persons accounted for 67% of all heterosexually acquired cases in 2022 (n=60), compared to 32% (n=31) in 2013. Infections in UK-born persons accounted for 18% of all heterosexually acquired cases in 2022.

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

Black Africans represented 43% of all newly diagnosed South West residents in 2022, compared to 19% in 2021 and 12% in 2013. A small proportion of new diagnoses in 2022 were in black Caribbeans (3%).

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

Late diagnoses

Reducing late HIV diagnoses is one of the indicators in the Public Health Outcomes Framework. People who are diagnosed late have a tenfold increased risk of mortality within 1 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 West residents with HIV are diagnosed late (49% from 2020 to 2022, compared to 43% in England), as defined by a CD4 count of less than 350 cells per cubic millimetre (cells/mm³) at diagnosis.

In the South West, heterosexuals were more likely to be diagnosed late (65% of males, 53% of females) than GBMSM (41%). By ethnic group, black Africans were more likely to be diagnosed late than the white population (55% and 50% respectively).

People living with diagnosed HIV

The 5,413 people living with diagnosed HIV in the South West in 2022 was 4% higher than 2021 and 56% higher than 2013. This increase is partly due to the effectiveness of HIV treatment, which has reduced the number of deaths from HIV.

The prevalence rate of diagnosed HIV in the South West in 2022 was 1.3 per 1,000 residents aged 15 to 59 years. This was lower than the 2 per 1,000 observed in England as a whole. In the South West, 2 local authorities had a diagnosed HIV prevalence in excess of 2 per 1,000 population aged 15 to 59 years in 2022, which is the threshold for expanded HIV testing. They were Bournemouth, Christchurch and Poole (2.6) and the City of Bristol (2.5).

The 2 most common probable routes of transmission for South West residents living with diagnosed HIV in 2022 were sex between men (53%) and sex between men and women (43%).

In 2022, 35% of those living with diagnosed HIV in the South West were aged between 35 and 49 years, and 54% were aged 50 years and over (up from 34% in 2013). Males represented 73% of South West residents living with diagnosed HIV in 2022 and females represented 27%.

In 2022, 73% of South West residents living with diagnosed HIV were white and 17% were black Africans. However, due to the relative sizes of the white and black African populations the rate per 1,000 population aged 15 to 59 years was much higher in black Africans (21 per 1,000) than in the white population (1 per 1,000).

Continuum of HIV care

In England, excluding London, in 2022, 98% of HIV diagnosed residents were receiving anti-retroviral treatment. Of these, 98% were virally suppressed (viral load below 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 South 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) 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 with the highest being among people living with HIV who inject drugs (8%, CrI 1% to 27%), heterosexual women who are not black African (8%, 6% to 12%), and heterosexual men who are not black African (7%, 4% to 20%).

HIV testing

A total of 36,412 people were tested in specialist SHSs in the South West in 2022, a decrease of 53% since 2018. The proportion of clients at SHSs who were provided with HIV testing in the South West was 46%, which compares to 48% across England. HIV testing coverage in specialist SHSs in the South West is higher in men (66%) than women (37%), and highest in GBMSM (82%).

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, 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 would be required

PrEP

In 2022, 8% of HIV-negative South West residents accessing SHSs in England were defined as having a PrEP need, among whom 69% initiated or continued PrEP. Of those with PrEP need, 88% had this need identified at a clinical consultation. Among GBMSM, the group with greatest need, these proportions were: 77%, 73% and 89%.

Consistent use of PrEP can be an efficacious and effective intervention to prevent HIV acquisition. Despite PrEP being routinely available through specialist SHS, awareness, accessibility and uptake of primary prevention initiatives is variable for different population groups. Addressing this disparity is key to HIV prevention.

HIV Action Plan

The 2022 to 2025 HIV Action Plan, jointly developed by the Office for Health Improvement and Disparities and UKHSA, aims to reduce HIV transmission by 80%, and HIV related and preventable deaths and AIDS by 50% between 2019 and 2025. This will be achieved by:

• ensuring equitable access and uptake of HIV prevention programmes

• scaling up HIV testing in line with national guidelines

• optimising rapid access to treatment and retention in care

• improving the quality of life for people living with HIV

• addressing stigma

While there has been considerable progress towards ending HIV transmission in the UK, the interim ambitions of the HIV Action Plan were adversely impacted by COVID-19. To ensure the goals are reached, a number of prevention areas need to be prioritised. These include:

• PrEP access for all

• scaling up of partner notification

• increasing HIV testing among heterosexual men and women

• improving retention to care and monitoring inequalities in all aspects of HIV prevention

The further ambition to achieve zero new HIV infections, AIDS and HIV-related deaths in England by 2030 will require significant improvement in diagnoses for heterosexuals and black Africans.

HIV prevention messages

The 2022 to 2025 HIV Action Plan (jointly developed by the Office for Health Improvement and Disparities and UKHSA) aims to reduce HIV transmission by 80%, and HIV related and preventable deaths and AIDS by 50% between 2019 and 2025 (1). To ensure these goals are reached, a number of prevention areas need to be prioritized. These include:

• PrEP access for all who need it

• increasing HIV testing among heterosexual men and women

• 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. For those testing HIV negative, it provides access to PrEP. For those testing positive, it provides life-saving treatment which also prevents onward transmission. Everyone should have an STI screen, including an HIV test, on at least an annual basis, if having condomless sex with new or casual partners. GBMSM should have tests for HIV and STIs annually, or every 3 months if having condomless sex with new or casual partners.

HIV PrEP is available for free from specialist SHS and can be used to reduce an individual’s risk of acquiring HIV. Consistent use of PrEP can be an efficacious and effective intervention to prevent HIV acquisition. Despite PrEP being routinely available through specialist SHS, awareness, accessibility and uptake of primary prevention initiatives is variable for different population groups (1).

HIV PEP can be used to reduce the risk of acquiring HIV following some sexual exposures. PEP is available for free from most specialist SHS and most emergency departments.

Symptoms due to HIV and AIDS may not appear for many years, and people who are unaware of their infection may not feel themselves to be a risk to others. Prevention messages should reinforce that anyone can acquire HIV regardless of age, gender, ethnicity, sexuality, or religion, and it is important to challenge assumptions about who is at risk of HIV.

People living with diagnosed HIV infection who are on treatment and have an undetectable viral load are unable to pass on the infection to others during sex. This is known as ‘Undetectable = Untransmittable’ or ‘U=U’.

Stigma, anxiety and depression experienced by people with HIV affect their ability to seek healthcare, engage in treatment and remain in care (2). Reducing stigma in healthcare services will encourage people from seeking the healthcare services they need.

Specialist SHS are free and confidential. They offer:

• testing and treatment for HIV and STIs

• condoms

• vaccination

• HIV PrEP and PEP

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

Charts, tables and maps

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

Source: UKHSA, HANDD.

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

Figure 1 is a bar chart showing the rates of new HIV diagnoses by English region for the year 2022. Rates have been calculated per 100,000 residents and are not age-restricted, with the overall rate for England (6.7) represented as a horizontal line.

The South West had the lowest rate of diagnoses in England in 2022 (3.2) while London had the highest (15.5), followed by Yorkshire and the Humber (6.5) and the East Midlands (6.1). Yellow lines reflect 95% confidence intervals.

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

Source: UKHSA, HANDD.

Note: The number of new diagnoses will depend on accessibility of testing as well as infection and transmission. HIV diagnosed prevalence (rate per 1,000 aged 15 to 59 years as per NICE testing guidelines). Lower diagnosed prevalence less than 2, high diagnosed prevalence 2 to 5, Extremely high diagnosed prevalence more than 5. 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 rates of new HIV diagnosis in 2022, per 100,000 residents, among upper-tier local authorities (UTLAs) in South West England. Rates have not been age-restricted. HIV diagnoses in the UTLAs have been compared to the regional rate (3.2), which is depicted as a dashed horizontal line. Diagnoses for Cornwall and the Isles of Scilly have been combined to preserve data confidentiality conventions related to the small population of the Isles of Scilly.

Rates of new HIV diagnoses in Swindon (7) and Bournemouth, Christchurch, and Poole (7) were significantly higher than the regional rate in 2022.

Rates in the Bristol metropolitan area, including the City of Bristol (1), South Gloucestershire (1), and North Somerset (0.5), were significantly lower than the regional rate.

The overall prevalence of HIV diagnoses in the South West, including both existing and new diagnoses, is considered low (fewer than 2 per 100,000 residents aged 15 to 59) for all UTLAs except for Bournemouth, Christchurch, and Poole and the City of Bristol 

Figure 3. New HIV diagnoses and deaths, the South West, 2013 to 2022

Source: UKHSA, HANDD.

Note: The number of new diagnoses will depend on accessibility of testing as well as infection and transmission. Numbers may rise as we receive more reports and more information. This will impact on interpretation of trends in more recent years. New HIV diagnoses are shown by UK region of residence at diagnosis. Deaths are shown by UK region of death, which in some instances may not be the same as UK region of residence at diagnosis. Region of death may not be known for all deaths, particularly for those in the most recent years. Numbers for these years should be interpreted as minimum numbers (deaths reported and allocated to a region of death to date) and not as a trend.

Figure 3 is a line graph showing the annual counts of new HIV diagnoses and deaths among residents of South West England between 2013 and 2022. The line representing new HIV diagnoses indicates a general decrease in annual HIV diagnoses from 2013 to 2021, followed by an uptick to 180 new diagnoses in 2022.

The number of deaths  among HIV-positive individuals in the South West has remained fairly static within the preceding 10 year period, although there are limitations to these figures which may underestimate the true number of deaths (see note).

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

Source: 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 representing the total annual number of new diagnoses of HIV among residents of South West England. Within this population, the proportion of individuals who had been previously diagnosed abroad is shaded in blue and white, while the proportion of those receiving an HIV diagnosis for the first time in the United Kingdom are shaded in solid blue. In 2022, 51.1% of new HIV diagnoses in the South West occurred among individuals with a pre-existing diagnosis abroad. This represents a 40% increase from 2021 (36.5%). In contrast, the number of newly diagnosed residents with no prior foreign diagnosis history remained relatively constant between 2021 (81) and 2022 (82).

Figure 5. New HIV diagnoses by probable route of acquiring HIV (adjusted for missing route information), South West residents, 2013 to 2022

Source: 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 5 is a line graph displaying annual counts of new HIV diagnoses among residents of South West England from 2013 to 2022, structured by 3 estimated probable transmission routes: sex between men (SBM), sex between men and women (SBMW), and other infection routes. Counts have been subdivided further between the total count of new HIV diagnoses, represented with a solid line, and a count restricted to those not previously diagnosed abroad (NPDA), represented by a dashed line.

Estimated transmission routes are determined through a risk hierarchy  which reflects what we know about the epidemiology and prevalence of HIV in different communities. If an individual belongs to multiple exposure categories, they will be assigned the route with the greatest presumed risk. For example, a man who has reported a history of injection drug use­ – but who also reports having sex with men – will be assigned to the ‘sex between men’ group, rather than the ‘other’ group.

Annual counts of new HIV diagnoses for all transmission pathways fell or remained constant between 2013 and 2021, with a particular decline in diagnoses between 2019 and 2021. Between 2021 and 2022, the number of diagnoses among the SBMW group increased by 89% to 107 cases, surpassing the number of SBM diagnoses. 56% of the individuals in the SBMW group in 2022 were previously diagnosed with HIV abroad, as compared to 11% in 2013.

The ‘other’ transmission route category includes diagnoses from 2013 to 2022 related to intravenous drug use, mother-to-child transmission, healthcare settings, blood, and blood products. Diagnosis outside of SBM and SBMW pathways, within these groups, occurred infrequently in the last ten years, with fewer than 10 diagnoses recorded for each of the 3 subcategories in 2022. 

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

Source: UKHSA, HANDD.

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

Figure 6 is a pyramid graph displaying the number of new HIV diagnoses among residents of South West England in 2022, organised by age group and gender. More diagnoses were recorded among 25 to 34 year old males (35) than any other subgroup, followed by 35 to 44 year old females (31) and 25 to 34 year old females (25). 39.2% of new HIV diagnoses were observed in females in 2022, in comparison to 22.5% in 2013.

Figure 7. Number of new HIV diagnoses by ethnic group (adjusted for missing ethnic group information), South West residents, 2013 to 2022

Source: 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 7 is a line graph displaying the annual counts of new HIV diagnoses by ethnic group among residents of South West England between 2013 and 2022. Counts have been subdivided further between the total count of new HIV diagnoses for each ethnicity, represented by a solid line, and a count restricted to those NPDA, represented by a dashed line.

From 2013 to 2021, the greatest number of new HIV diagnoses were recorded among white residents. In 2022, more diagnoses were recorded among black African residents than white residents or those of other ethnicities. The number of new HIV diagnoses has decreased or remained constant among white and other ethnic groups, regardless of prior diagnosis abroad, since 2013. New HIV diagnosis counts among black African populations were relatively constant between 2013 and 2021. In 2022, the estimated count of new HIV diagnoses among black African individuals with previous diagnoses abroad increased from 14 to 51.

Figure 8. Number of new HIV diagnoses by world region of birth (adjusted for missing world region of birth information), South West residents, 2013 to 2022

Source: 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 8 is a line graph displaying the annual counts of new HIV diagnoses by world region of birth among residents of South West England between 2013 and 2022. Counts have been subdivided further between the total count of new HIV diagnoses for each region, represented by a solid line, and a count restricted to those NPDA, represented by a dashed line.

From 2013 to 2019, the greatest number of new HIV diagnoses were recorded among UK-born residents. In 2022, more diagnoses were recorded among residents born in Africa than those born in the UK or in all other regions combined. The number of new HIV diagnoses has decreased or remained stable among residents born outside of Africa, regardless of prior diagnosis abroad, since 2013. New HIV diagnosis counts among residents born in Africa were relatively constant between 2013 and 2021. In 2022, the estimated count of new HIV diagnoses among African-born residents with previous diagnoses abroad increased from 19 to 58.  

Figure 9. Percentage of new HIV diagnoses, by local authority of residence, that were diagnosed late, South West, aged 15 years and over, 2020 to 2022 (see footnote on interpreting trends)

Source: UKHSA, HANDD, HARS.

Note: 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 MSM are less likely to be diagnosed late.

Figure 9 is a bar chart showing the percentages of new HIV diagnoses that were diagnosed late among South West residents, by UTLA, between 2020 and 2022. The overall percentage for the South West (49%) is represented as a dashed horizontal line. The markings in yellow represent 95% confidence intervals. Diagnoses for Cornwall and the Isles of Scilly have been combined to preserve data confidentiality conventions related to the small population of the Isles of Scilly.

The UTLA with the highest proportion of late HIV diagnoses in 2020 to 2022 was Bath and North East (100%), followed by North Somerset (67%) and Gloucestershire (63%). The UTLAs with the lowest proportions of late HIV diagnoses in 2022 were Dorset (31%), Bournemouth, Christchurch and Poole (34%), and Somerset (38%). Due to the small overall number of late diagnoses (119), trends and comparisons between the percentages of late diagnoses in any UTLA should be interpreted with caution.

Figure 10a. Percentage and number of new HIV diagnoses by probable route of infection that were diagnosed late, South West residents, aged 15 years and over, 2020 to 2022

Source: UKHSA, HANDD, HARS.

Note: 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). A comparable figure for the injecting drug use exposure group has been withheld to preserve data privacy conventions surrounding the small numbers of new diagnoses within this transmission group.

Figure 10a is a bar chart showing the proportions of South West residents aged 15 or older within each probable HIV transmission group that were diagnosed late between 2020 and 2022. The markings in yellow represent 95% confidence intervals.

The greatest proportion of late diagnoses was reported among men with a history of heterosexual sexual content (65%) while the lowest proportion was reported among GBMSM (41%).

Figure 10b. Percentage and number of new HIV diagnoses by ethnic group that were diagnosed late, South West residents, aged 15 years and over, 2020 to 2022

Source: UKHSA, HANDD, HARS.

Note: 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 and black African ethnic groups—a figure for the black Caribbean ethnic group has been withheld on the basis of data privacy conventions surrounding the small number of new diagnoses within this group.

Figure 10b is a bar chart showing the proportions of South West residents aged 15 or older within the white and black African ethnic groups that were diagnosed late between 2020 and 2022. The markings in yellow represent 95% confidence intervals.

55% of new HIV diagnoses among black African residents were made late between 2020 to 2022, in comparison to 50% among white residents.

Figure 11. Percentage of new HIV diagnoses that were diagnosed late by probable route of infection and year of first UK HIV diagnosis, South West residents, aged 15 years and over, 2013 to 2022

Source: UKHSA, HANDD, HARS.

Note: 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 11 is a line graph displaying the annual percentages of HIV diagnoses which were made late from 2013 to 2022, among South West residents aged 15 or older who were diagnosed in the UK. These percentages have been subdivided according to estimated route of transmission.

The proportions of diagnoses made late within the SBM and SBMW groups have remained relatively constant in the preceding 10 year period. Since 2013, individuals in the SBMW group have been proportionally more likely to receive a late HIV diagnosis in the South West in comparison to GBMSM.

Figure 12. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by UKHSA region, 2022

Source: UKHSA, HARS.

Figure 12 is a bar chart showing the prevalence of diagnosed HIV per 1,000 residents aged 15 to 59 years by English statistical region in 2022. Yellow markers indicate 95% confidence intervals.

In 2022, the regions with the highest diagnosed prevalence rates were:

• London (5.3)

• the North West (2.0)

• the West Midlands (1.9)

The regions with the lowest diagnosed prevalence rates were:

• the North East (1.2)

• the South West (1.3)

• Yorkshire and the Humber (1.6).

The prevalence rate of HIV in London in 2022 was over twice the rate of any other region in England.

Figure 13. Number of residents living with diagnosed HIV and accessing care, the South West, 2013 to 2022

Source: UKHSA, HARS.

Figure 13 is a line graph displaying the annual number of diagnosed HIV-positive residents of South West England who have accessed HIV-related care. Everyone living with diagnosed HIV in the UK can access care for free, so this number acts as a proxy for the number of living with diagnosed HIV. 

The number of residents accessing care has steadily risen every year between 2013 and 2022, and increased by 4.7% between 2021 and 2022, to a total of 5,413 residents.

Figure 14. Number of residents living with diagnosed HIV and accessing care by probable route of transmission (adjusted for missing route information), the South West, 2022

Source: UKHSA, HARS.

Figure 14 is a bar chart depicting counts of South West residents accessing care for diagnosed HIV in 2022 by their probable route of transmission group.

This figure shows that the vast majority of South West residents living with diagnosed HIV in 2022 are estimated to have acquired HIV through sex between men (2,844) or sex between men and women (2,306), although a small number of residents are assumed to have contracted HIV through injection drug use (118), mother to child transmission (75), or other transmission pathways (70).

Figure 15. Percentage of residents with diagnosed HIV who are accessing care in each age group, the South West, 2013 and 2022

Source: UKHSA, HARS.

Figure 15 is a bar chart showing the age distribution of South West residents accessing care for diagnosed HIV, compared between 2013 and 2022.

In 2013, the greatest proportion of HIV care access was reported among residents aged 35 to 49 (47%), followed by those aged 50 or older (34%) and those aged 25 to 34 (10%).

By 2022, the majority (54%) of residents accessing HIV care in the South West were aged 50 or older, while 35 to 49 year olds represented 35% of those accessing care and 25 to 34 made up 10%.

Figure 16. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 by ethnic group, the South West, 2022

Source: UKHSA, HARS.

Figure 16 is a bar chart showing the prevalence rates of diagnosed HIV per 1,000 South West residents aged 15 to 59 in 2022, sorted by ethnic group. Yellow markings indicate 95% confidence intervals.

The highest rate of diagnosed HIV was observed in the black African group (21.2), more than triple the rate of the group with the second highest prevalence, other black residents (6.5). The lowest rates of diagnosed HIV were observed among the white (0.7) and Asian (0.9) ethnic groups.

Figure 17. Rate of HIV diagnoses per 100,000 population by Index of Multiple Deprivation decile, the South West, 2022

Source: UKHSA, HARS.

Figure 17 is a bar chart showing the prevalence rates of diagnosed HIV per 100,000 South West residents in 2022, sorted by Index of Multiple Deprivation (IMD) decile. Yellow markings indicate 95% confidence intervals. Rates have not been age-restricted.

In 2022, the highest rates of diagnosed HIV were observed within the most deprived (1.6) and second most deprived (1.7) IMD deciles. The lowest rates of diagnosed HIV were observed within the least (0.5) and the next 2 least deprived (0.7) deciles.

Figure 18. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years  by local authority, the South West, 2022

Source: UKHSA, HARS.

Figure 18 is a bar chart showing the prevalence rates of diagnosed HIV per 1,000 South West residents aged 15 to 59 years in 2022, sorted by UTLA. Yellow markings indicate 95% confidence intervals. The regional prevalence rate (1.3) is indicated by a horizontal dashed line. Data for Cornwall and the Isles of Scilly have been combined to preserve data security conventions related to the small population of the Isles of Scilly.

In 2022, the UTLAs with the highest prevalence rates of diagnosed HIV were:

• Bournemouth, Christchurch and Poole (2.6)

• the City of Bristol (2.5)

• Torbay (1.9)

The UTLAs with the lowest rates were:

• Wiltshire (0.8)

• Cornwall and the Isles of Scilly (0.9)

• Devon (0.9)

Rates for Bournemouth, Christchurch, and Poole, the City of Bristol, Torbay, Swindon, and Plymouth were significantly higher than the regional rate, while rates for Wiltshire, Cornwall and the Isles of Scilly, Devon, North Somerset, Dorset, Somerset, Bath and North East Somerset, and Gloucestershire were significantly lower than the regional rate.

Figure 19. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by local authority, the South West, 2022

Source: UKHSA, HARS.

Figure 19 is a map of UTLAs in South West England shaded according to the prevalence rates of diagnosed HIV per 1,000 residents aged 15 to 59 years in 2022. Data for Cornwall and the Isles of Scilly have been combined to preserve data security conventions related to the small population of the Isles of Scilly. No UTLA in the region reported a prevalence rate higher than 5 per 1,000 residents.

Figure 20. The continuum of HIV care, 2022

Source: UKHSA and HARS, Multi-Parameter Evidence Synthesis (MPES) model.

Figure 20 is a chart illustrating that England surpassed all Joint United Nations Programme on HIV/AIDS (UNAIDS) 90:90:90 HIV care continuum targets in 2022. The 90:90:90 targets were issued by UNAIDS in the 2016 Political Declaration on HIV and AIDS, with the intention of eliminating HIV/AIDS as a public health problem globally by 2030.

To meet its 90:90:90 targets, a country must successfully diagnose at least 90% of those living with HIV. Of those diagnosed, 90% must receive treatment, and of those receiving treatment, 90% must have suppressed viral loads.

In 2022, 95% of those living with HIV in England outside London are estimated to know their status.

Of this population, 98% are known to have obtained treatment for HIV, and of those accessing care, 98% are known to have suppressed viral loads.

In total, this means that 91% of those living with HIV in England outside London are estimated to have suppressed viral loads, and cannot pass on the virus to sexual partners, even those not using PrEP or condoms .

Figure 21. HIV test coverage by population group, South West residents, 2018 to 2022

Source: UKHSA, GUMCAD.

Figure 21 is a line graph showing the proportion of eligible attendees at specialist SHSs in the South West who accepted a HIV test from 2018 to 2022, subdivided by gender and GBMSM status. An eligible attendee is defined as a patient attending a 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 in the South West declined among all gender and sexuality groups between 2018 and 2021 before recovering in 2022. However, the total number of eligible attendees at SHS declined during the same time period, from 119,913 in 2018 to 79,317 in 2022.

In 2022, the highest proportion of testing coverage was recorded among GBMSM (82%), followed by males including GBMSM (66%).

Less than half of eligible females (37%) received HIV testing services at SHSs in 2022.

Between 2021 and 2022, testing coverage improved by 10.5% among GBMSM, by 16.3% among all males, by 9.5% among females, and by 10.0% for all SHS attendees.

This figure does not include HIV tests performed outside of specialist SHS settings, including online consultations and British Association for Sexual Health and HIV (BASHH) Level 1 clinics. These providers are not mandated to offer an HIV test to everyone, and may not consistently code and report HIV test outcomes to UKHSA. 

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

Source: UKHSA, GUMCAD.

Gender or sexual orientation	2018	2019	2020	2021	2022	% change 2018 to 2022	% change 2021 to 2022
Heterosexual men	33,669	34,406	20,199	15,939	17,958	-47%	13%
GBMSM	8,277	10,342	9,349	10,668	10,795	30%	1%
Subtotal (men)	44,988	48,246	31,368	28,866	31,471	-30%	9%
Hetero/bisexual women	45,900	49,368	34,584	30,759	31,361	-32%	2%
Women who only have sex with women	262	367	519	445	368	40%	-17%
Subtotal (women)	50,297	54,219	37,094	33,843	34,754	-31%	3%
Total (all genders)	96,006	103,416	69,366	65,539	73,142	-24%	12%

Table 1 displays the number of South West residents tested for HIV at all SHSs, including specialist SHSs, between 2018 and 2022. These counts have been organised by gender and sexual behaviour group. Residency information for consultations in this figure may be less robust than for specialist SHS. The proportion of HIV testing via online services has increased rapidly since the COVID-19 pandemic.  

Between 2018 and 2022, overall HIV testing coverage decreased by 24%. Testing counts dropped significantly for all subgroups other than WOSW in 2020, during the first year of the COVID-19 pandemic. Declines in testing coverage between 2018 and 2022 were particularly notable among heterosexual men (−47%) and heterosexual and bisexual women (−32%), while improvements in coverage were observed between GBMSM (+30%) and WOSW (+40%). Between 2021 and 2022, testing coverage increased for all subgroups other than WOSW (−17%).

Figure 22. HIV PrEP need and initiation or continuation in residents attending specialist SHSs, the South West, 2022

Source: UKHSA, GUMCAD.

Figure 22 is a bar chart displaying the percentages of South West residents attending specialist SHSs in 2022 who required, initiated, or continued a course of HIV PrEP, organized by sexual behaviour group. The first column in each group shows the percentages of specialist SHS attendees estimated to be in need of PrEP through clinical and other information. The second column shows the percentage of individuals in need of PrEP who were identified and consulted by their specialist SHS. The third column shows the percentage of those in need of PrEP who initiated or continued a course of treatment in 2022.

PrEP need is identified on an individual basis by specialist SHSs. An individual may be determined as in need of PrEP through a combination of factors, including their clinical, demographic, or behavioural backgrounds.

In 2022, GBMSM were the group with the highest proportional need for PrEP (77%), followed by WOSW (9%), heterosexual men (2%), and heterosexual and bisexual women (below 1%). However, specialist SHSs were more effective at identifying PrEP need among WOSW (94%) than GBMSM (89%), and a greater proportion of WOSW in need of PrEP initiated or continued treatment (89%) in comparison to GBMSM (73%).

Although the greatest absolute number of new HIV diagnoses in the South West were reported among those having sex with men and women, a small proportion of the total population of this risk group was estimated to be in need of PrEP in 2022. Less than half of heterosexual and bisexual women (36%) and heterosexual men (37%) attending specialist SHSs who were estimated to be in need of PrEP initiated or continued treatment in 2022.

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 HARS which captures information at every attendance for HIV care.

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. Confidence intervals presented in the text are produced by Bayesian analysis.

The Office for National Statistics midyear 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, and the counts have not been adjusted. 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, this means 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.

Several figures have been redacted from this report to protect the data privacy of individuals who may be identifiable from small numbers within our data extracts. Please contact Field Services South West ([email protected]) to inquire about accessing further granular information surrounding patient demographics.

  Further information

See Sexual and Reproductive Health Profiles for more information on a whole range of sexual health indicators.

See Sexual health, reproductive health and HIV in England: a guide to local and national data for more information on local sexual health data sources.

 Annual epidemiological spotlight on STIs in South West: 2022 data

Local authorities have access to additional HIV and STI intelligence via the Data Exchange and the HIV and STI web portal. They should also have received a set of tables containing HIV data specific to their authority. They should contact [email protected] if they do not have access to this information.

About the Field Service

The Field Service was established in 2018 as a national service comprising geographically dispersed multi-disciplinary teams integrating expertise in Field Epidemiology, Real-time Syndromic Surveillance and Public Health Microbiology to strengthen the surveillance, intelligence, and response functions of UKHSA.

You can contact your local Field Service team at [email protected].

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

Acknowledgements

We would like to thank the following:

• local sexual health and HIV clinics for supplying the HIV data
• Institute of Child Health
• UKHSA Centre for Infectious Disease Surveillance and Control (CIDSC) HIV and STI surveillance teams for collection, analysis and distribution of data

References

1. Department of Health and Social Care UK ‘Towards Zero: An action plan towards ending HIV transmission, AIDS and HIV-related deaths in England 2022 to 2025’ UK Government White Paper, 2022

2. Aghaizu A, Martin V, Kelly C, Kitt H, Farah A, Latham V, Brown AE, 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’ UKHSA December 2023