Official Statistics

HIV testing, PrEP, new HIV diagnoses and care outcomes for people accessing HIV services: 2024 report

Updated 1 October 2024

The annual official statistics data release covers data to end of December 2023.

The data focuses on England (UK data provided where available) and activity in 2023 and changes since 2022 and 2019 (as a baseline year for HIV Action Plan). Data for 2023 was not available for all 4 nations of the UK and more complete data for Scotland and Wales is published by Public Health Scotland and Public Health Wales, respectively.

This report is accompanied by data tables, slide sets, and Sexual and Reproductive Health Profiles which provide further breakdowns of data by demographic groups.

Main points

HIV testing

The main findings are:

• the number of people tested in all sexual health services (SHSs) rose by 8% between 2022 and 2023, a substantial recovery to 96% of the testing levels in 2019
• compared to 2019, there was a 10% (from 615,653 to 555,507) and 22% (414,550 to 324,835) decrease in the number of heterosexual and bisexual women and heterosexual men tested in 2023, respectively, but a 34% increase (150,413 to 201,732) in the number of gay, bisexual and other men who have sex with men (GBMSM) tested
• between 2022 and 2023 the HIV testing rate rose by 11%
• in 2023, the testing rate was highest among GBMSM at 52,255 per 100,000, compared to 1,894 and 3,106 per 100,000 among heterosexual men and heterosexual and bisexual women, respectively
• the number of heterosexual people of black African ethnicity tested increased from 55,453 in 2019 to 61,072 in 2023, while positivity remained stable between 0.3% and 0.4%, which may be indicative of ongoing transmission
• equivalent figures for GBMSM were 150,413 to 201,732 in 2023 with a fall in positivity from 0.5% in 2019 to 0.2% in both 2022 and 2023, suggesting there may have been a fall in transmission overall, which has not been sustained into 2023
• in 2023, 936 people were reported by specialist SHSs as a contact following HIV partner notification, 84% (785) of these were tested, amongst whom 4.6% (36) were positive – both the number of people who attended following HIV partner notification and the proportion tested have increased from 2022 to 2023

HIV pre-exposure prophylaxis (PrEP)

The main findings are:

• since pre-exposure prophylaxis (PrEP) was commissioned by the NHS in autumn 2020, the number of people taking PrEP has increased annually
• in 2023, 10.1% (132,299 of 1,313,780) of HIV negative people accessing specialist SHSs in England had a PrEP need
• 85.2% (94,026 of 110,338) of GBMSM who had a PrEP need, had that need identified compared to 60.8% (2,935 of 4,826) in heterosexual men and 62.2% (3,090 of 4,969) in heterosexual and bisexual women in 2023
• in 2023, initiation or continuation of PrEP among those with a PrEP need was highest in GBMSM at 75.4% (83,210 of 110,338) compared to 39.0% (1,884 of 4,826) in heterosexual men and 40.9% (2,034 of 4,969) in heterosexual and bisexual women

New HIV diagnoses

The main findings are:

• there were 6,008 HIV diagnoses in England (including those previously diagnosed abroad) in 2023, an increase of 51% from 3,975 in 2022 and of 56% from 3,859 in 2019
• in 2023, 53% (3,198 of 6,008) of diagnoses were reported to UKHSA as being previously diagnosed abroad
• the number of diagnoses first made in England is likely overestimated by between 253 and 436 people, due to data quality issues – based on viral suppression at diagnosis, country of birth, and year of arrival, these people are more likely to be previously diagnosed abroad but not reported by clinics as such:
  • most of these people fit the profile of those previously diagnosed abroad: black African women diagnosed outside of London and trends in new diagnoses first made in England among this group should be interpreted with caution while UKHSA continue to work with clinics to resolve this issue

New HIV diagnoses among those first diagnosed in England

The main findings are:

• the number of HIV diagnoses first made in England increased by 15% from 2,451 in 2022 to 2,810 in 2023
• the contribution of opt-out bloodborne viruses (BBVs) testing in an emergency department (ED) setting on the rise in new diagnoses first made in England will be presented in the next HIV Action Plan monitoring and evaluation framework report (to be published in December 2024)

Among men exposed through sex between men

The main findings are:

• following a decline in recent years in the number of diagnoses in England among men exposed through sex between men, the number of diagnoses rose by 7% (761 in 2022 to 811 in 2023)
• in 2023, men of an ethnic minority group (excluding white ethnic minorities) accounted for 33% (266 of 811) of diagnoses among men exposed through sex between men; specifically accounting for 40% (127 of 321) of those living in London and 28% (139 of 490) among those living outside of London
• there was a 7% rise in diagnoses in ethnic minority men (excluding white ethnic minorities) (248 to 266) compared to a 3% rise in white men (446 to 461) in 2023

Among people exposed through sex between men and women

The main findings are:

• the number of new diagnoses first made in England rose by 36% (445 in 2022 to 605 in 2023) among men exposed through sex with women and by 30% (602 to 780) among women exposed through sex with men
• this increase largely occurred among people living outside of London: 51% increase (from 286 to 432) among men and 44% increase (413 to 595) among women; compared to 9% increase (159 to 173) among men and 2% decrease (189 to 185), among women living in London
• this rise disproportionately affected people of black African ethnicity (64% from 420 in 2022 to 688 in 2023); this figure may be overestimated by potential mis-categorisation of people previously diagnosed abroad
• the number of people of white ethnicity newly diagnosed rose by 3% (301 to 310) in 2023

Previously diagnosed abroad

The main findings are:

• in 2023, 53% (3,198 of 6,008) of people diagnosed in England were reported as previously diagnosed abroad, compared to 38% (1,524 of 3,975) in 2022 and 27% (1,058 of 3,859) in 2019, this is a 110% increase from 1,524 in 2022 and a 202% rise from 1,058 in 2019
• the number of people who were previously diagnosed abroad rose by 154% (from 594 in 2022 to 1,509 in 2023) among women exposed through sex with men, compared to a 151% (272 to 683) and 38% (409 to 566) increase among men exposed through sex with women, and men exposed through sex between men, respectively
• the rise was largely in areas outside of London (135% increase from 1,123 in 2022 to 2,635 in 2023) compared to inside London (40% increase from 401 to 563)
• most people were rapidly tested and linked to care; 92% and 96% within 1 and 3 months of their England diagnosis, respectively
• viral load information was available for 3,048 of the 3,198; overall, 70% (2,125 of 3,048) of those with a reported viral load were virally suppressed within a month of their diagnosis in England indicative of access to HIV treatment abroad; those with undetectable viral load cannot pass on HIV to sexual partners

Late HIV diagnoses

The main findings are:

• the number of late diagnoses among those first diagnosed in England with a CD4 count reported (CD4 count below 350 cells per cubic millimeter (mm³) of blood within 91 days of diagnosis, excluding those with evidence of recent infection) with HIV increased by 3% from 896 in 2022 to 923 in 2023
• the increase in the number of late diagnoses since 2022 is largely among people of black ethnicity (40% increase from 259 to 362)
• people first diagnosed in England in 2022 at a late stage were 10 times more likely to die (deaths due to all causes among people with HIV) within a year of their diagnosis, compared to people who were diagnosed promptly (33 versus 4 deaths, respectively)

Outcomes of people living with diagnosed HIV and accessing HIV care

The main findings are:

• in 2023, 100,063 people were accessing HIV care in England
• the age profile of those receiving HIV care in 2023 continues to reflect an aging population living with HIV with over half aged 50 years and over, 51% (50,666 of 100,063) in 2023 compared to 27% (19,950 of 74,216) in 2013
• treatment coverage in adults accessing care in England remained at 98% (98,395 of 99,931)
• overall, 98% (90,942 of 93,099) of people living with diagnosed HIV in England in 2023 (with a reported viral load) were virally suppressed and therefore unable to pass on the virus to a sexual partner

Summary of main messages

The HIV Action Plan for England, published in 2021, sets an ambition to reduce HIV transmission by 80% between 2019 and 2025. The HIV Action Plan monitoring and evaluation framework, published later in 2024 will provide greater insight on HIV Action Plan ambitions, progress towards ending HIV transmission, and include metrics related to incidence, undiagnosed infection and transmissible levels of virus.

This report shows that the number of people first diagnosed with HIV in England has risen in 2023 and there is further evidence of widening inequalities. For both GBMSM and heterosexual adults, this rise has disproportionately affected ethnic minority groups. Further provision of services is needed that are accessible to diverse key populations and culturally competent.

Overall testing rates increased substantially since 2022 but have not fully recovered to testing rates observed in 2019 for some demographic groups. The increasing levels of testing and fall in positivity over the past 5 years may be suggestive of an overall fall in HIV transmission in GBMSM, but not a continued reduction. The rise in HIV testing together with a higher and sustained positivity in black African heterosexuals may be suggestive of ongoing transmission. However, this number could also be affected by changing patterns of migration with a recent rise in people diagnosed with HIV abroad arriving in England. The contribution of opt-out BBVs testing in an ED setting on the rise in new diagnoses first made in England will be presented in the next HIV Action Plan monitoring and evaluation framework report (to be published in December 2024).

Access to PrEP has been increasing on an annual basis since 2020. However, inequalities in access remain ongoing with unmet needs by specific exposure groups.

For the first time, over half of all HIV diagnoses were made among those previously diagnosed abroad. Most people have evidence of existing treatment in the form of viral suppression (see the definition in the Appendix) within a month of their England diagnosis and are rapidly linked to care in England ensuring good clinical outcomes and prevention of onward transmission. It is clear that services need resilience to ensure appropriate and accessible capacity for recently arrived populations. The rising number of late diagnoses, particularly among black African populations demonstrates an urgent need to improve access to testing and the full implementation of HIV testing guidelines.

For those diagnosed and linked to services, HIV care remains excellent with 98% of people with diagnosed HIV treated and 98% of those on treatment are virally suppressed. People with diagnosed HIV are aging, with over half aged 50 years and over in 2023 compared to a quarter ten years ago. This highlights the need for joined up health and social care services to meet the needs of the ageing population.

HIV testing in sexual health services

HIV testing is an important component of prevention and is undertaken in various settings such as sexual health services, emergency care departments, primary and secondary care, and community settings. This section describes HIV testing undertaken in sexual health services (SHSs) in England. Data relating to testing in other settings will be published in the HIV Action Plan monitoring and evaluation framework.

A negative HIV test result provides an opportunity to access PrEP and health advice, while a positive result leads to essential HIV care and treatment. Treated individuals with an undetectable viral load can live a healthy and long life and cannot transmit HIV to sexual partners, even without condoms or PrEP.

Number of people tested

Following a 30% drop in the number of people tested for HIV at SHSs from 1,325,994 in 2019 to 927,251 in 2020 due to COVID-19 disruptions, there continues to be a year-on-year increase with 1,269,944 people tested in 2023. Overall, there has been an 8% increase in the number of people tested in all SHSs between 2022 and 2023 (1,171,837 to 1,269,944). This shows a substantial recovery to 96% of the testing levels observed in 2019.

Testing can occur at specialist SHSs providing Level 3 STI-related care (genitourinary medicine clinics) and non-specialist SHSs providing Level 2 STI-related care (split into online testing providers and non-specialist SHSs excluding online providers, which includes sexual and reproductive health services). For more information relating to service levels see Appendix B of the British Association for Sexual Health and HIV’s Standards for the Management of STIs.

Between 2022 and 2023, the number of people tested in specialist SHSs rose by 21% (573,581 to 691,519). In non-specialist services excluding online providers, the number of people tested increased by 13% (20,261 to 22,840) whereas figures for non-specialist online testing providers decreased slightly (4%, 577,995 to 555,585). Between 2019 and 2023 there has been a decrease in the number of people tested at non-specialist SHSs excluding online (65%, 65,250 to 22,840). However, during this time, the number of people tested by online providers has increased by 117% (255,492 to 555,585).

In 2023, 48% (607,627 of 1,269,944) of all HIV testing at SHSs was undertaken through people ordering a test online, rather than receiving a test in person at a SHS (Figure 1). In comparison, in 2019, 19% (256,717 of 1,325,994) of all HIV testing at SHSs was undertaken through people ordering a test online.

Figure 1. Proportion of people tested for HIV at all SHSs by consultation medium (face-to-face and online), England, 2019 to 2023

Source: Data from routine returns to the GUMCAD STI Surveillance System (HIV testing in England of the accompanying data tables).

In 2023, 201,732 GBMSM had an HIV test, the highest number ever reported, 34% higher than the 150,413 tested in 2019, and 4% higher than the 194,552 tested in 2022. In heterosexual and bisexual women, an 8% increase was reported between 2022 and 2023 (514,488 to 555,507), 90% of 2019 testing levels (615,653). Testing in heterosexual men increased by 13% to 324,835 in 2023 compared to 287,081 in 2022, 78% of 2019 testing levels (414,550) (Figure 2).

Figure 2. Number of attendees tested for HIV at all SHSs by gender identity and sexual orientation, England, 2019 to 2023

Source: Data from routine returns to the GUMCAD STI Surveillance System (HIV testing in England of the accompanying data tables).

Overall, testing in London increased by 8% between 2022 and 2023 (413,755 to 445,655), exceeding 2019 levels (430,853). The equivalent figures outside London were a 9% increase (719,593 to 782,840), and 90% of 2019 testing levels (867,297) (Figure 3).

In 2023, testing among GBMSM living in London continued to exceed that seen in 2019 (68,969), rising from 89,719 in 2022 to 96,929 in 2023 (Figure 3). Outside London, after increasing from 78,468 in 2019 to 98,234 in 2022, the number remained relatively stable at 97,960 in 2023 (Figure 3). In contrast, testing in heterosexual and bisexual women and heterosexual men, both inside and outside London, remains below 2019 levels, despite year-on-year increases since 2020 (Figure 4). For heterosexual and bisexual women, testing in 2023 corresponds to 98% of 2019 testing levels in London (196,591 of 199,969) and 84% outside of London (340,336 of 405,018). Similarly, testing in 2023 for heterosexual men living in London was 89% of 2019 levels (115,745 of 130,523) and 72% (199,095 of 276,203) for heterosexual men living outside of London.

Figure 3. Number of GBMSM tested for HIV and proportion positive at all SHSs, London and outside London, 2019 to 2023

Source: Data from routine returns to the GUMCAD STI Surveillance System (HIV testing in England of the accompanying data tables).

Figure 4. Number of heterosexual and bisexual women and heterosexual men tested for HIV and proportion positive at all SHSs, London and outside London, 2019 to 2023

Source: Data from routine returns to the GUMCAD STI Surveillance System (HIV testing in England of the accompanying data tables).

HIV positivity within SHSs

New diagnoses data in the Yorkshire and Humber region in 2023 (and in England) was affected by a data quality issue. This has now been resolved and the data in this report has been updated. Therefore, the data in this report may not match the equivalent data in other publications.

The proportion of tests that were positive in all SHSs remained stable from 0.09% (1,003 of 1,171,837) in 2022 to 0.09% (1,191 of 1,269,944) in 2023 compared with 0.12% in 2019 (1,553 of 1,325,994). A similar trend was seen in heterosexual and bisexual women (0.04%; 191 of 514,448 in 2022 as compared to 0.05%; 259 of 555,507 in 2023) and heterosexual men (0.07%; 190 of 287,081 in 2022 as compared to 0.08%; 262 of 324,835 in 2023), compared with 0.05% (293 of 615,653) in heterosexual and bisexual women and 0.08% (325 of 414,550) in heterosexual men in 2019. The number of GBMSM testing each year has risen from 150,413 in 2019 to 201,732 in 2023. This, coupled with an overall decline in the proportion testing positive (0.5% in 2019 to 0.2% in both 2022 and 2023) suggests that there may be a reduction in transmission in the community which has not been sustained into 2023. The proportion testing positive in 2023 is 2.5 times higher in GBMSM than heterosexual men (0.2% as compared to 0.08%).

The number of white GBMSM tested rose from 113,764 in 2019 to 151,323 in 2023, while positivity decreased from 0.5% to 0.2%. Among GBMSM of black ethnicity the number of tests rose from 5,374 to 8,301 while positivity fell from 1.0% to 0.5% testing positive. Equivalent figures were 10,262 to 17,871 tested, 0.6% to 0.4% testing positive and 9,930 to 16,392 tested, 0.9% to 0.4% positive among GBMSM of Asian and other or mixed ethnicity respectively.

The number of black African heterosexuals testing rose from 55,453 in 2019 to 61,072 in 2023 while the positivity rate has remained stable at 0.3% to 0.4%, which may be indicative of ongoing transmission. Equivalent figures for white heterosexuals are 704,729 to 605,781 and 0.02% to 0.04%, respectively.

In 2023, HIV positivity in all SHS in England was higher for individuals born in high HIV prevalence countries (HPCs) compared to other non-UK countries. Among men born in HPCs, the positivity was 0.7%, and 0.8% for women, compared to 0.3% in men and 0.1% for women born in other non-UK countries. Positivity for men born in HPCs has increased from 0.4% in 2019 to 0.7% in 2023, with a similar trend seen in women (0.7% in 2019 to 0.8% in 2023).

HIV testing rate

HIV testing rate in all (specialist and non-specialist) SHSs in England increased by 11% between 2022 and 2023 (2,488 to 2,771 per 100,000 population) exceeding the testing rate observed in 2019 (2,733 per 100,000). In 2023, testing rate was highest among GBMSM (52,255 per 100,000) and lowest among heterosexual men (1,894 per 100,000). Among heterosexual and bisexual women, testing rate was 3,106 per 100,000 in 2023. The testing rate is calculated using the total number of tests taken in a year, so people testing multiple times within a year will result in an increased rate.

HIV testing rates in all SHSs have not returned to pre-pandemic levels in younger individuals. From 2019 to 2023, there was a 22% decrease in the testing rate in those aged 15 to 24 years (8,049 to 6,303 per 100,000 population) (Figure 5). In contrast there was an increase in the HIV testing rate from 2019 to 2023 in all other ages, by:

• 10% in 25 to 34 years (7,840 to 8,648 per 100,000)
• 24% in 35 to 49 years (2,739 to 3,408 per 100,000)
• 16% in 50 to 64 (767 to 886 per 100,000)
• 14% in 65 years and over (124 to 141 per 100,000)

Figure 5. HIV testing rate at all SHSs by age group, England, 2019 to 2023

Source: Data from routine returns to the GUMCAD STI Surveillance System (HIV testing in England of the accompanying data tables).

HIV test uptake

Overall, three-quarters of attendees at specialist SHSs in England who were offered an HIV test received a test in 2023 (76%, 691,519 of 908,153). Between 2019 and 2023, over 90% GBMSM in specialist SHS who were offered a test had a test compared to over 80% in heterosexual men (Figure 6). However, test uptake remains consistently lower in women, with 65% of heterosexual and bisexual women tested in 2023. 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. However, test uptake in heterosexual and bisexual women has decreased from 69% in 2019 to 65% in 2023.

Figure 6. HIV testing uptake among those offered testing at specialist SHS, by gender identity and sexual orientation, England, 2019 to 2023

Source: Data from routine returns to the GUMCAD STI Surveillance System (HIV testing in England of the accompanying data tables).

Partner notification

In 2023, a total of 936 people were reported by specialist SHSs as a contact following partner notification, a 10% increase from 842 in 2022. Of these, 84% (785 of 936) were tested and amongst those 4.6% (36 of 785) were newly diagnosed with HIV in 2023. This is an improvement on the previous year, with 78% of those who attended following partner notification tested in 2022. In 2019, 1,487 people were reported by specialist SHSs as a contact following partner notification, among these 91% (1,351 of 1,487) were tested and among these 4.4% (59 of 1,351) were newly diagnosed with HIV. Therefore, the number of people attending following partner notification, and the proportion tested among those is below levels seen in 2019.

By gender identity and sexual orientation, the largest group of people who were reported as attending following partner notification were GBMSM (35%, 324 of 936). Heterosexual men accounted for the largest number of new diagnoses among contacts (33%, 12 of 36), followed by GBMSM (28%, 10 of 36) and heterosexual and bisexual women (22%, 8 of 36).

HIV pre-exposure prophylaxis (PrEP)

HIV pre-exposure prophylaxis (PrEP) is an important component of prevention strategies, involving the administration of antiretroviral medications to HIV negative individuals to significantly reduce the risk of HIV acquisition. Coding and reporting of PrEP activity by SHSs through their routine STI surveillance submissions have improved since the start of routinely commissioned PrEP in 2020. The PrEP data reported by SHSs in 2023 may therefore more accurately represent the uptake of PrEP among SHS attendees than the data reported in previous years.

In 2023, 1,313,780 HIV negative individuals attended specialist SHSs (excluding those seeking reproductive care only) in England, an increase from 1,260,365 in 2022 and 1,182,518 in 2021. Of the HIV negative attendees in 2023, 10.1% (132,299) were defined as having a PrEP need (at high risk of acquiring HIV; definition in Appendix) compared to 9.7% (121,699) in 2022 and 7.4% (88,028) in 2021. PrEP need was highest in GBMSM at 70.3% (110,338 of 156,997) in 2023, compared to 1.8% (4,826 of 267,689) in heterosexual men and 0.8% (4,969 of 647,165) in heterosexual and bisexual women (Figure 7).

Among those defined as having a PrEP need in 2023, 83.9% (110,970) had that need identified compared to 83.3% (101,391) in 2022 and 79.6% (70,038) in 2021. The proportion of GBMSM who had their PrEP need identified was 85.2% (94,026 of 110,338) in 2023 compared to 62.2% (3,090 of 4,969) in heterosexual and bisexual women. There was a slight decrease among heterosexual men from 62.2% (2,679 of 4,305) in 2022 to 60.8% (2,935 of 4,826) in 2023 (Figure 7).

In 2023, 73.0% (96,562) of people defined as having a PrEP need, initiated or continued PrEP an increase from 71.2% (86,616) in 2022 and 69.8% (61,473) in 2021 (Figure 7). Among GBMSM with PrEP need, 75.4% (83,210 of 110,338) initiated or continued PrEP in 2023, compared to 39.0% (1,884 of 4,826) in heterosexual men and 40.9% (2,034 of 4,969) in heterosexual and bisexual women (Figure 7).

Figure 7. Proportion of people with a PrEP need identified (by initiation status) or not identified among people defined as having a PrEP need by gender identity and sexual orientation, England, 2021 to 2023

Source: Data from routine returns to the GUMCAD STI Surveillance System (HIV pre-exposure prophylaxis (PrEP) need and use in England of the accompanying data tables).

HIV post-exposure prophylaxis (PEP)

In 2023, 8,222 people received HIV post-exposure prophylaxis (PEP) at an SHS. This is a 6% decrease in HIV PEP provision relative to 2022 (8,706) and represents a 32% decrease compared with 2019 (12,078). Between 2019 and 2023, the percentage decrease was 38% (7,939 to 4,945) among GBMSM, 34% (1,562 to 1,035) among heterosexual men and 45% (1,772 to 981) among heterosexual and bisexual women. Whilst most of the decrease in PEP provision from 2022 to 2023 was seen in heterosexual and bisexual women (11%, 1,104 to 981) and GBMSM (2%, 5,028 to 4,945), HIV PEP provision increased slightly in heterosexual men (6%, 973 to 1,035). Between 2022 and 2023, there was a 12% decrease (3,780 to 3,329) in PEP provision among people of any gender or sexual orientation of white British ethnicity and a 19% increase (456 to 544) among those of black African ethnicity.

New HIV diagnoses

Overall trends of new HIV diagnoses

In 2023, there were 6,402 HIV diagnoses in the UK excluding Northern Ireland; this was a 46% rise from 4,379 in 2022 and a 49% rise from 4,286 in 2019. In England, there were 6,008 HIV diagnoses in 2023 (Figure 8). This was a 51% rise from 3,975 in 2022 and a 56% rise from 3,859 in 2019.

Figure 8. HIV diagnoses, AIDS at diagnosis, and all-cause deaths in people with HIV, England, 2003 to 2023

Source: Data from routine returns to the HIV and AIDS Reporting System (HARS) (New HIV diagnoses, AIDS, deaths and people in care in England of the accompanying data tables).

HIV diagnosis by country of first diagnosis

Since 2015, UKHSA and its predecessors have been able to categorise HIV diagnoses according to whether they were first diagnosed in England or previously diagnosed abroad (see definition in Appendix); (of those living in England who were newly diagnosed, less than 0.5% were first diagnosed in another nation of the UK so are referred to as ‘first diagnosed in England’). Together with trends in HIV test positivity, HIV diagnoses first made in England are used as a proxy for HIV transmission to evaluate the success of HIV prevention activities. While it is important that people previously diagnosed abroad are rapidly linked to care and treatment following UK arrival, diagnosis trends in this population do not reflect HIV transmission in England.

In England, over half (53%, 3,198 of 6,008) of the diagnoses in 2023 were known to have been previously diagnosed abroad (Figure 9). This is a 110% rise from 1,524 in 2022 and a 202% rise from 1,058 in 2019. The remaining 47% (2,810) of diagnoses in 2023 were first made in England, a rise of 15% from 2,451 in 2022 but comparable to the 2,801 in 2019. This is the first time the number and proportion of diagnoses previously made abroad have exceeded those first made in England.

Figure 9. HIV diagnoses by country of first diagnosis including adjustments [note 1] for potential misallocation of location of first diagnosis, England, 2015 to 2023

Source: Data from routine returns to the HIV and AIDS Reporting System (HARS) (New HIV diagnoses, AIDS, deaths and people in care in England of the accompanying data tables).

Note 1: The dotted lines represent the number of new diagnoses by country of first diagnosis after adjusting for the 253 people who were reported as first diagnosed in England but were likely previously diagnosed abroad based on being born abroad.

Due to data quality issues, it is likely that the number of people first diagnosed in England is overestimated. To minimise this, UKHSA contacted individual reporting sites with the greatest increase in numbers of people first diagnosed in England to verify and correct the data. Subsequently, a provisional adjustment found around 253 people reported as first diagnosed in England were likely previously diagnosed abroad. This is because they were born abroad, arrived in the UK within 2 years of diagnosis and were virally suppressed within one month of England diagnosis. In most cases, people will become virally suppressed within one to 6 months after initiating ART. Having a viral load below 200 copies of HIV per millilitre of blood within a month of diagnosis therefore suggests prior initiation of ART. We show the impact of this data quality issue in Figure 9 only, all other analyses are focused on data as reported to UKHSA.

An additional 183 people were born abroad but had no information reported about year of arrival or viral load. The overestimation of those first diagnosed in England will therefore not exceed a maximum of 436. Figure 9 shows the number of diagnoses first made in England and previously diagnosed abroad, and the provisional adjustment (plus or minus 253). UKHSA are continuing to work with clinics to improve data quality.

The 253 people who reported as first diagnosed in England, but were born abroad, diagnosed within 2 years of arriving in England, and being virally suppressed within a month of diagnosis, indicative of a previous diagnosis abroad, have a similar demographic the profile to those previously diagnosed abroad. Most were exposed through sex between men and women (49% women and 17% men). Just under two-thirds (61%) were black African, and 81% lived outside of London (Figure 10). By comparison, among people reported as being previously diagnosed abroad, 47% were women exposed through sex with men, 21% were men exposed through sex with women, 63% were black African, and 82% were living outside of London.

Figure 10. Number of people categorised as first diagnosed in England who were born abroad, diagnosed within 2 years of arrival and virally suppressed within one month of their England diagnosis, by residence, 2019 to 2023

Source: Data from routine returns to the HIV and AIDS Reporting System (HARS) (New HIV diagnoses, AIDS, deaths and people in care in England of the accompanying data tables).

The adjustment mentioned above has not been applied since further work is needed to audit and verify information relating to country of diagnosis. The data presented throughout this report is as reported to UKHSA. Data relating to people first diagnosed in England should be interpreted with caution, particularly in relation to black African people exposed though sex between men and women living outside of London.

Diagnoses first made in England

As reported to UKHSA, the number of HIV diagnoses first made in England increased by 15% from 2,451 in 2022 to 2,810 in 2023 (Figure 9).

In 2023, nearly half (49%; 1,386 of 2,810) of all new diagnoses first made in England were among people exposed through sex between men and women (Figure 11). Specifically, 28% (780 of 2,810) of new diagnoses first made in England were among women exposed through sex with men and 22% (605 of 2,810) were among men exposed through sex with women.

Less than a third (29%; 811 of 2,810) of new diagnoses first made in England were among men exposed through sex between men, 2% (47 of 2,810) were among people exposed by injecting drug use, 1% (41 of 2,810) were among people exposed by vertical transmission, and 1% (15 of 2,810) were among people exposed through blood products. Probable route of exposure was not reported for 18% (506 of 2,810) of those first diagnosed in England in 2023.

There were 9 HIV diagnoses among trans and gender-diverse people in 2023 in England.

Figure 11. New HIV diagnoses among people first diagnosed in England by probable route of exposure, England, 2019 to 2023

Source: Data from routine returns to the HIV and AIDS Reporting System (HARS) (New HIV diagnoses, AIDS, deaths and people in care in England of the accompanying data tables).

Among those first diagnosed in England in 2023, 1% (15 of 2,810) were aged 14 years and under, 8% (234 of 2,810) were aged between 15 and 24 years, 70% (1,962 of 2,810) were aged between 25 and 49 years, and 21% (599 of 2,810) were aged 50 years and over. The number of diagnoses has decreased for all age groups since 2019 except those aged between 25 and 49 years which has increased by 7% (from 1,842 to 1,962). The greatest decrease was among those aged 14 years and under (35% decrease from 23 to 15), followed by those aged between 15 and 24 years (25% decrease from 312 to 234), and those aged 50 years and over (4% decrease from 624 to 599).

In the past 10 years, the number of new diagnoses first made among people living outside London has exceeded the number among those living in London (Figure 12). In 2023 this gap widened as the number of diagnoses first made in England among people living outside of London increased by 25% from 1,459 in 2022 to 1,830 in 2023 but decreased by 1% among those living in London (992 in 2022 to 980 in 2023).

Figure 12. New HIV diagnoses first made in England by residence in or outside London, England, 2019 to 2023

Source: Data from routine returns to the HIV and AIDS Reporting System (HARS) (New HIV diagnoses, AIDS, deaths and people in care in England of the accompanying data tables).

Just under two-thirds (61%, 1,723 of 2,810) of people first diagnosed in England in 2023 were born outside the UK (region of birth was not recorded for people). From 2022 there was an increase of 52% among those born outside the UK, from 1,133 to 1,723. By comparison, 29% (806 of 2,810) of diagnoses first made in England were among those born in the UK, and there was only a 20% increase among this group from 674 in 2022 to 806 in 2023 (Figure 13).

Figure 13. New HIV diagnosis first made in England by birth in the UK or outside the UK, 2019 to 2023

Source: Data from routine returns to the HIV and AIDS Reporting System (HARS) (New HIV diagnoses, AIDS, deaths and people in care in England of the accompanying data tables).

Diagnoses first made in England among men exposed through sex between men

Despite a trend in recent years towards a decline in the number of diagnoses in England among men exposed through sex between men, in 2023 the number increased by 7% from 761 in 2022 to 811 in 2023 (Figure 11). Nevertheless, this represents a 35% decrease since 2019 (from 1,242 to 811).

Over half (57%, 461 of 811) of men exposed through sex between men were of white ethnicity, among whom there was a slight increase (3%) in diagnoses from 446 in 2022 to 461 in 2023. By comparison, there was a 7% increase in diagnoses among men of all other ethnic groups combined (excluding white ethnic minorities) (248 to 266) who made up 33% (266 of 811) of diagnoses among men exposed through sex between men. Specifically, the greatest increase (42%) in diagnoses from 2022 to 2023 was among men of black ethnicity, from 55 in to 78 (Figure 14).

Figure 14. New HIV diagnoses among men exposed through sex between men, first diagnosed in England by ethnicity, 2019 to 2023

Source: Data from routine returns to the HIV and AIDS Reporting System (HARS) (New HIV diagnoses, AIDS, deaths and people in care in England of the accompanying data tables).

Nearly half (48%, 388 of 811) of the men exposed through sex between men were born in the UK, and 49% (397 of 811) were born outside the UK. Specifically, 14% (113 of 811) were born in Europe, 14% (110 of 811) in Asia, and 12% (94 of 811) in Latin America and the Caribbean. Since 2022, there has been a greater increase in diagnoses among those born outside the UK (28% increase from 310 to 397), though there was still a 21% increase among those born in the UK (from 321 to 388). The highest increases were among those born in Africa (49% from 45 to 67), Latin America and the Caribbean (47% from 64 to 94), and Asia (21% from 91 to 110).

The recent rise in HIV diagnoses among men exposed through sex between men is largely among those living in London, with a 16% rise from 276 in 2022 to 321 in 2023 (Figure 15). By comparison, the number of diagnoses rose by 1% among those living outside London from 485 in 2022 to 490 in 2023 (Figure 16).

Among those living in London, a greater increase in diagnoses was seen among people of an ethnic minority (excluding white ethnic minorities) (20% increase from 106 to 127) than people of white ethnicity (5% increase from 137 to 144), who accounted for 40% (127 of 321) and 45% (144 of 321) of those living in London, respectively. The greatest increase specifically, was among those of black ethnicity (28% increase from 25 to 32) followed by those of Asian ethnicity (25% increase from 32 to 40).

There was an increase in the number of diagnoses for all age groups among men exposed through sex between men and living in London, except for those aged 65 years and over who saw a decrease from 3 to 2. The increase was highest among those aged 15 to 24 years (24% increase from 42 to 52).

Among those living outside of London, there was a 2% decrease (142 to 139) in people of an ethnic minority (excluding white ethnic minorities) compared to a 3% increase (309 to 317) in people of white ethnicity, who made up 28% (139 of 490) and 65% (317 of 490) of diagnoses among men exposed through men living outside London, respectively.

Among men exposed through sex between men, living outside of London, of an ethnic minority (excluding white ethnic minorities), there was an increase in diagnoses from 2022 to 2023 was among people of black ethnicity (53% increase from 30 to 46) but a decrease among those of Asian ethnicity (18% from 65 to 53) and those of other or mixed ethnicity (15% from 47 to 40).

Among those living outside of London, the greatest increase between 2022 and 2023 was among people aged between 50 and 64 years (17% increase from 60 to 70), but in contrast to those living in London, there was a decrease (25% from 85 to 64) among those aged between 15 and 24 years among those living outside of London.

Figure 15. New HIV diagnoses among people first diagnosed in England by probable route of exposure among those living in London, England, 2019 to 2023

Source: Data from routine returns to the HIV and AIDS Reporting System (HARS) (New HIV diagnoses, AIDS, deaths and people in care in England of the accompanying data tables).

Figure 16. New HIV diagnoses among people first diagnosed in England by probable route of exposure among those living outside London, England, 2019 to 2023

Source: Data from routine returns to the HIV and AIDS Reporting System (HARS) (New HIV diagnoses, AIDS, deaths and people in care in England of the accompanying data tables).

Diagnoses first made in England among people exposed through sex between men and women

The following section include data as reported to UKHSA. Due to data quality issues, particularly data relating to women outside of London and first diagnosed in England is likely to be overestimated and should be interpreted with caution.

The number of new diagnoses first made in England among people exposed through sex between men and women increased by 32% from 1,048 in 2022 to 1,386 in 2023, accounting for 49% (1,386 of 2,810) of new diagnoses made in England in 2023 (Figure 11).

Among men exposed through sex with women, the number of new diagnoses first made in England increased by 36% (445 in 2022 to 605 in 2023). The equivalent increase among women exposed through sex with men was 30% (602 in 2022 to 780 in 2023).

Among those exposed through sex between men and women, the increase in new diagnoses was largely among people living outside of London: there was a 51% increase in new diagnoses outside of London among men (286 to 432) and a 44% increase among women (413 to 595) (Figure 16). The diagnoses among men and women living in London increased by 9% (159 in 2022 to 173 in 2023) among men but decreased by 2% (189 in 2022 to 185 in 2023) among women (Figure 15).

Among people exposed through sex between men and women of white ethnicity there was an increase of 9 diagnoses from 2022 to 2023 (3% increase, from 301 to 310). By comparison there was a 45% increase among people of all other ethnic groups combined (excluding white ethnic minorities), from 649 to 942. Specifically, the greatest increase was among those of black African ethnicity (64% increase from 420 to 688), followed by a 60% increase (20 in 2022 to 32 to 2023) among those of black Caribbean ethnicity, 43% increase (40 in 2022 to 57 to 2023) among those of other black ethnicities, and 10% increase (from 68 in 2022 to 75 to 2023) among those of Asian ethnicity. The only decrease in diagnoses by ethnic group was among those of other or mixed ethnicity (11% decrease from 101 to 90).

Diagnoses previously made abroad

This section uses data as reported to UKHSA. In 2023, of the 6,008 diagnoses in England in 2023, 53% (3,198) were previously diagnosed abroad. This compares to 38% (1,524 of 3,975) in 2022 and 27% (1,058 of 3,859) in 2019. Of the 3,198 people previously diagnosed abroad and subsequently diagnosed in England in 2023, 2,054 (64%) had arrived in England in 2023 and 739 (23%) had arrived in England in 2022.

In 2023, 72% (2,308 of 3,198) of those previously diagnosed abroad reported Africa as their region of birth. Specifically, 50% (1,592 of 3,198) of those previously diagnosed abroad reported Eastern Africa as their region of birth followed by 22% (716 of 3,198) who reported other areas of Africa, and 8% each for those who reported Asia (267 of 3,198) and Latin America and the Caribbean (245 of 3,198) as their region of birth.

Diagnoses previously made abroad are unlikely to reflect HIV acquired in England. Most people were rapidly linked to care shortly after their England arrival, ensuring good health outcomes and preventing onward HIV transmission. In 2023, 92% of adults previously diagnosed abroad were linked to care in England within one month of their England diagnosis and 96% within 3 months. Furthermore, provisional analysis indicates that 70% (2,125 of 3,048) of those with viral load information available were virally suppressed within a month of their diagnosis in England, indicating access to antiretroviral therapy (ART) abroad prior to arrival in England.

Nearly half (47%) of those previously diagnosed abroad in 2023 were women exposed though sex with men (154% increase from 594 in 2022 to 1,509 in 2023), 21% were men exposed through sex with women (151% increase from 272 in 2022 to 683 in 2023), and 18% were men exposed through sex with men (38% increase from 409 in 2022 to 566 in 2023) (Figure 17).

Among those previously diagnosed abroad in 2023, 63% were black African (2,023 of 3,198), 10% were white (314 of 3,198), 8% were mixed or other (261 of 3,198), and 7% were Asian (210 of 3,198).

The majority of people of black African ethnicity who were previously diagnosed abroad were men (25%; 501 of 2,022) and women (59%; 1,192 of 2,022) exposed through sex between men and women. Meanwhile, most people of white and Asian ethnicity previously diagnosed abroad were exposed through sex between men, at 53% (166 of 314) and 63% (132 of 210), respectively.

Figure 17. New HIV diagnoses among people previously diagnosed abroad by probable route of exposure, England, 2019 to 2023

Source: Data from routine returns to the HIV and AIDS Reporting System (HARS) (New HIV diagnoses, AIDS, deaths and people in care in England of the accompanying data tables).

Diagnoses previously made abroad among people living outside of London increased by 135% from 2022 to 2023 (1,123 to 2,635), accounting for 82% of all diagnoses previously made abroad in England in 2023 (2,635 of 3,198) (Figure 18). Specifically, there was a 154% increase (from 433 to 1,100) among those living in the Midlands and East of England, a 123% increase (from 363 to 809) among those living in the South of England, and a 122% increase (from 327 to 726) among those living in the North of England.

People living in London account for the remaining 18% of diagnoses previously made abroad (563 of 3,198), among whom there was only a 40% increase in number of diagnoses from 401 in 2022 to 563 in 2023.

Figure 18. New HIV diagnoses among people previously diagnosed abroad by centre of residence, England, 2019 to 2023

Source: Data from routine returns to the HIV and AIDS Reporting System (HARS) (New HIV diagnoses, AIDS, deaths and people in care in England of the accompanying data tables).

Late HIV diagnosis and presentation

Late HIV diagnoses among people first diagnosed in England

A late HIV diagnosis is defined as having a CD4 count below 350 cells per mm³ of blood within 91 days of diagnosis and no evidence of a recent infection (full definition of late HIV diagnosis in the Appendix). In 2023, 80% (2,413 of 3,023) of adults who received a diagnosis first made in the UK had a CD4 count reported within 91 days of diagnosis (82% [2,286 of 2,795] in England). The median CD4 count within 91 days of diagnosis among adults first diagnosed in England in 2023 was 367 cells per mm³, an increase from 350 cells per mm³ in 2022.

The number of late diagnoses among those first diagnosed in England with a CD4 count within 91 days of diagnosis increased by 3% from 896 in 2022 to 923 in 2023. Although the proportion of diagnoses made late decreased from 45% (896 of 1,980) to 40% (923 of 2,286), this is likely an underestimation due to mis-categorisation of people first diagnosed in England and should be interpreted with caution.

The highest proportions of late diagnoses were among people aged 50 years and over (53% for those aged 50 to 64 years, 55% for those aged 65 years and over), men exposed through sex with women (51%), people of black ethnicity (44%), Asian ethnicity (43%) (Figures 19a to 19e).

The increase in the number of late diagnoses since 2022 is largely among people of black ethnicity (40% increase from 259 to 362). Meanwhile, there was a decrease in both the number of late diagnoses and the proportion of diagnoses made late among other ethnic groups.

The number of late diagnoses increased among men exposed through sex with women (16% increase from 223 to 259), and women exposed through sex with men (5% increase from 251 to 263). The respective proportions diagnosed late decreased from 60% (223 out of 374) in 2022 to 51% (259 out of 512) in 2023 among men, and from 49% (251 out of 508) to 42% (263 out of 632) among women (Figure 19d).

However, both the number and proportion of late diagnoses decreased among men exposed through sex between men (6% decrease from 233 to 220; proportion decreased from 36% [233 of 651] to 31% [220 of 715]), and those exposed through injecting drug use (33% decrease from 24 to 16; proportion decreased from 67% [24 of 36] to 52% [16 of 31]).

The number of late diagnoses increased among those living outside London (7% increase from 553 to 594) and decreased among those living in London (4% decrease from 343 to 329), though the proportions decreased both outside London (from 48% [553 of 1,162] to 41% [594 of 1,455]) and inside London (from 42% [343 of 818] to 40% [from 329 of 831]) (Figure 19e).

People aged between 15 and 24 years were the only age group to have an increased proportion of late diagnoses from 2022 (28%; 54 out of 191) to 2023 (31%; 64 out of 209) but the number of late diagnoses increased for people aged between 15 and 49 years (9% increase from 611 to 669).

Figure 19a. Number and proportion of people diagnosed late by age, 2021 to 2023

Figure 19b. Number and proportion of people diagnosed late by ethnicity, 2021 to 2023

Figure 19c. Number and proportion of people diagnosed late by gender identity, 2021 to 2023

Figure 19d. Number and proportion of people diagnosed late by probable route of exposure, 2021 to 2023

Figure 19e. Number and proportion of people diagnosed late by region, 2021 to 2023

Source: Data from routine returns to the HIV and AIDS Reporting System (HARS) (New HIV diagnoses, AIDS, deaths and people in care in England of the accompanying data tables).

Those first diagnosed late in England in 2022 were 10 times more likely to die (deaths due to all causes) within a year of their diagnosis, compared to those who were diagnosed promptly (33 versus 4 deaths, respectively). This was higher than in 2021 whereby those diagnosed late were 6 times more likely to die within a year of diagnosis compared to those diagnosed promptly (31 versus 6 deaths, respectively).

Among those diagnosed late in England the highest mortality rates were amongst those aged 65 years and over (3 deaths, 71 per 1,000), those aged between 50 and 64 years (16 deaths, 66 per 1,000), those exposed by injecting drug use (1 death, 42 per 1,000), and those living outside of London (22 deaths, 40 per 1,000) (Figures 20a to 20e).

Among those diagnosed promptly in England in 2022, the highest mortality rates were among those exposed through injecting drug use (1 death, 83 per 1,000) and those aged 65 and over (1 death, 38 per 1,000).

Figure 20a. One-year all-cause mortality (per 1,000) among adults newly diagnosed with HIV, by diagnosis stage and age group, England, 2022

Figure 20b. One-year all-cause mortality (per 1,000) among adults newly diagnosed with HIV, by diagnosis stage and ethnic group, England, 2022

Figure 20c. One-year all-cause mortality (per 1,000) among adults newly diagnosed with HIV, by diagnosis stage and gender identity, England, 2022

Figure 20d. One-year all-cause mortality (per 1,000) among adults newly diagnosed with HIV, by diagnosis stage and probable route of exposure, England, 2022

Figure 20e. One-year all-cause mortality (per 1,000) among adults newly diagnosed with HIV, by diagnosis stage and region of residence, England, 2022

Source: Data from routine returns to the HIV and AIDS Reporting System (HARS) (New HIV diagnoses, AIDS, deaths and people in care in England of the accompanying data tables).

Late presentation among people previously diagnosed abroad

The number of people who had been previously diagnosed abroad that presented late (see definition in Appendix) when subsequently diagnosed in England increased from 233 in 2022 to 422 in 2023, though the proportion decreased from 19% to 15% 2023 (Figure 20a to 20e).

HIV care outcomes

People living with diagnosed HIV and accessing care

In 2023, 100,063 people were accessing HIV care in England compared to 94,569 in 2022, and 91,551 in 2021. The age profile of those receiving HIV care continues to reflect an aging population living with HIV with over half (51%, 50,666 of 100,063) aged 50 years and older in 2023 compared to 27% (19,950 of 74,216) in 2013 (Figure 21).

There were 233 trans and gender diverse people accessing HIV care in England in 2023, compared to 230 in 2022.

Figure 21. Number of adults seen for HIV care by age, England, 2014 to 2023

Source: Data from routine returns to the HIV and AIDS Reporting System (HARS) (New HIV diagnoses, AIDS, deaths and people in care in England of the accompanying data tables).

Treatment coverage

Treatment coverage in adults accessing care in England remained stable at 98% from 2022 (92,731 of 94,423) to 2023 (98,395 of 99,931). This was 1 percentage point lower than the 99% treatment coverage in 2021 and 2020.

In 2023, treatment coverage was lowest among people aged 15 to 24 years (96% 1,589 of 1,649) (Figure 22) and ranged from 98% to 99% for all other age groups.

People exposed through sex between men and women and men exposed through sex between men, all had a treatment coverage of 99%. The lowest treatment coverage was among those exposed through injecting drug use (97%). Treatment coverage was consistently high, ranging from 98% to 99% among people with known ethnicity except among those of other black ethnicity who had a treatment coverage of 97%.

Figure 22. Treatment status of adults seen for HIV care, by age groups, 2023

Break shown with symbol in y-axis.

Source: Data from routine returns to the HIV and AIDS Reporting System (HARS) (New HIV diagnoses, AIDS, deaths and people in care in England of the accompanying data tables).

HIV viral load suppression

People living with HIV that are virally suppressed (who maintain an undetectable viral load) cannot pass on the virus to sexual partners, even without PrEP or condoms. This is known as Undetectable = Untransmittable (U = U).

Among people living with HIV in England with a reported viral load and taking ART, the proportion who were virally suppressed remained stable at 98% in 2023 (90,942 of 93,099) and 2022 (86,079 of 88,080). Viral suppression was equally high (98%) among men exposed through sex between men (40,216 of 40,888) and people exposed through sex between men and women (43,579 of 44,661) but lowest among people exposed through injecting drug use (93%, 1,125 of 1,213), and vertical transmission (91%, 1,573 of 1,720).

Only 91% (1,238 of 1,356) of people aged between 15 and 24 years were virally suppressed, with the proportion suppressed increasing with age and highest among people aged 65 years and over (99%; 8,829 of 8,921).

All-cause mortality

The total number of deaths due to all causes among people with HIV in the UK in 2023 was 775, with 658 of these occurring in England.

In England, this represents a 5% increase from the 626 deaths in 2022. However, the number of deaths in 2023 still exceeds those in 2019, before the COVID-19 pandemic, by 18% (658 in 2023 versus 560 in 2019).

The average age of death has increased from 55 years (range: 19 to 89 years) in 2019 to 57 years (range: 22 to 94 years) in 2023.

Since 2022, there has been a 26% increase in the number of deaths among people of black ethnicity (137 to 172), a 21% increase among people of mixed or other ethnicity (24 in 2022 to 29 in 2023), and a 13% increase among people of Asian ethnicity (16 to 18).

However, the rate of deaths per 1,000 people accessing care for HIV remained relatively stable from 2022 to 2023 among those of black ethnicity (4.1 to 4.6 deaths per 1,000), other or mixed ethnicity (3.8 to 4.2 deaths per 1,000), and Asian ethnicity (3.6 to 3.8 deaths per 1,000).

By contrast, among people of white ethnicity both the number of deaths decreased (3% from 406 to 396) and the rate decreased (8.5 to 8.2 deaths per 1,000).

Appendix

Gender identity

Gender identity reporting began in 2015 and is as reported by the clinic. Data relating to men or boys includes trans men and boys and data relating to women includes trans women and girls unless otherwise indicated that data relating to trans and gender-diverse people has been shown separately. Where gender identity information is not reported, gender at birth is used in the graphs. ‘Trans’ data relate to all those who identify with a different gender to that assigned at birth. This includes trans men, trans women, and gender diverse (genderqueer, non-binary, other gender and prefer not to say).

HIV testing: levels of sexual health services

Sexual health services (SHS) include the following:

• SHSs providing specialist (Level 3) and non-specialist (Level 2) STI related care – these services may also provide SRH care as an integrated service
• online services providing non-specialist (Level 2) STI-related care

Specialist SHS refers to genitourinary medicine (GUM) and integrated GUM or sexual and reproductive health (SRH) services. Non-specialist SHS refers to SRH services, young people’s services, internet-based services, termination of pregnancy services, pharmacies, outreach and general practice, and other community-based settings.

Further details on the levels of sexual healthcare provision are provided in Appendix B of the British Association for Sexual Health and HIV (BASHH) Standards for the Management of STIs.

Pre-exposure prophylaxis (PrEP)

Data is sourced from the GUMCAD STI Surveillance System which includes comprehensive data on people accessing specialist SHSs.

2021 data represent the first full year of data for routine NHS provision of PrEP at specialist (Level 3) SHSs providing STI related care. There is likely to be under reporting and inconsistent use of PrEP surveillance codes reported through the GUMCAD STI Surveillance System in 2021. These data quality issues should be considered when interpreting trends in PrEP service provision. UKHSA is actively working with service providers to support PrEP reporting and the quality of coding. All data will be updated on an annual basis.

The data presented in this report relate to consultations between January 2021 and December 2023, with a 12-month lookback period for each consultation. These measures therefore represent a less conservative approach to measuring PrEP need and initiation or continuation of PrEP to account for under-reporting of PrEP eligibility codes.

More details of the indicators below are described in the PrEP monitoring and evaluation framework, and a phased approach to publication of PrEP data is taking place. This year, UKHSA has published data for 3 indicators listed below.

1. Determining PrEP need (indicator 1.1)

Definition: Proportion of all HIV negative individuals accessing specialist SHSs with PrEP need, that is at substantial risk of HIV acquisition and will benefit from receiving PrEP.

Numerator: The number of HIV negative individuals accessing specialist SHSs with PrEP need.

Denominator: The number of HIV negative individuals accessing specialist SHS​s.

2. PrEP need identified (indicator 1.1.1)

Definition: Proportion of all HIV negative individuals with estimated PrEP need (indicator 1.1) who had this need identified.

Numerator: The number of HIV negative individuals accessing specialist SHSs with PrEP need identified.

Denominator: The number of HIV negative individuals accessing specialist SHSs with PrEP need (numerator of indicator 1.1).

3. Initiation or continuation of PrEP among those with need (indicator 1.1.2)

Definition: Proportion of all HIV negative individuals with estimated PrEP need (indicator 1.1) who started or continued PrEP.

Numerator: The number of HIV negative individuals accessing specialist SHSs who started or continued PrEP​.

Denominator: The number of HIV negative individuals accessing specialist SHSs with PrEP need (numerator of indicator 1.1).

Late diagnoses corrected for recency of infection

The definition of late HIV diagnosis currently used in the UK is a CD4 count below 350 cells per mm³ of blood within 91 days of diagnosis, excluding those with evidence of recent infection. This evidence is either a negative test within the 24 months prior to their first positive HIV test, or the result of a Recent Infection Testing Algorithm (RITA), which combines serological recency test results with clinical data.

Late presentation

This follows the same definition as late diagnosis but applies to people who were previously diagnosed abroad, using CD4 count taken within 91 days of subsequent diagnosis in England.

Viral suppression

This refers to people with a viral load count below or equal to 200 copies per millilitre.

Acknowledgements

Amina Addow, Adamma Aghaizu, Shaun Bera, Daniel Bradshaw, Norah O Brien, Alison Brown, Erna Buitendam, Cuong Chau, Nicholas Cooper, Monica Desai, Tamara Đjuretić, Joan Ekajeh, Kevin Fenton, Amal Farah, Anu Fasanya, Kate Folkard, Susan Hopkins, Clare Humphreys, Carole Kelly, Hannah Kitt, Tobi Kolawole, James Lester, Clare Macdonald, Neil Mackay, Sema Mandal, Veronique Martin, Hamish Mohammed, Janice Morgan, Debbie Mou, Gary Murphy, Kedeen Okumu-Camerra, Temitope Omisore, Shahin Parmar, Sonia Rafeeq, Mary Ramsay, Natasha Ratna, Rachel Roche, John Saunders, Victoria Schoemig, Ammi Shah, Deborah Shaw, Katy Sinka, Georgina Wilkinson.

Suggested citation

Hannah Kitt, Ammi Shah, Cuong Chau, Kedeen Okumu-Camerra, Shaun Bera, Victoria Schoemig, Neil Mackay, Tobi Kolawole, Natasha Ratna, Veronique Martin, Tamara Đjuretić, Alison Brown. HIV testing, PrEP, new HIV diagnoses and care outcomes for people accessing HIV services: 2024 report. The annual official statistics data release (data to end of December 2023). October 2024, UK Health Security Agency, London

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