Research and analysis

Annual epidemiological spotlight on HIV in the East of England, 2022 data

Updated 1 October 2024

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Summary

HIV remains an important public health problem in the East of England.

In 2022, the East of England had the fourth highest rate of new HIV diagnoses in England of 6 per 100,000, compared to the England rate of 7 per 100,000.

By local authority: Luton, Peterborough, Milton Keynes, Bedford, and Cambridgeshire all have rates higher than both the regional and national average. Luton has the highest rate in the region with 14 new HIV diagnoses per 100,000.

There was an increase observed in the number of new infections of HIV via heterosexual contact, which made up 69% of all new HIV diagnoses in the East of England in 2022, and among individuals of black African ethnicity, which made up 48% of new infections by ethnicity.

Of new HIV diagnoses in the East of England, 38% had previously been diagnosed abroad – up 116% from 2021. Nationally, a 69% increase among those previously diagnosed abroad was observed.

Late diagnosis of HIV remains an important issue in the East of England. Between 2020 and 2022, 46% of new HIV diagnoses were late in the region compared to 43% in England. 62% of heterosexual males were diagnosed late between 2020 and 2022, as well as 43% of heterosexual females and 40% of gay, bisexual, and other men who have sex with men (GBMSM).

HIV testing remains crucial for early diagnosis and treatment of HIV and for reducing HIV transmission. In the East of England, over 98,600 people were tested in specialist sexual health services (SHSs) in 2022, however this is a 13% decrease since 2018 and testing will have been impacted by the COVID-19 pandemic. Compared to 2021, overall testing in SHSs increased by 12%.

Note: Paediatric data from the Integrated Screening Outcomes Surveillance System (ISOSS) and the Children’s HIV and AIDS Reporting System (CHARS) were not available at the point of publication. As a result, data for the age group under 15 are not available and data for 16 to 24 years may be underreported.

New diagnoses

In 2022, an estimated 379 East of England residents were newly diagnosed with HIV, accounting for 10% of new diagnoses in England. This represents a rise of 24% 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 East of England residents (6 per 100,000) was below that of England in 2022 (7 per 100,000).

In 2022, 28% of all new diagnoses in East of England residents were in GBMSM (compared to 40% in 2021 and 39% in 2013). The number of GBMSM residents in the East of England newly diagnosed with HIV (107, adjusted for missing information) was 37% lower than in 2013. Of the GBMSM newly diagnosed with HIV 49% were white and 39% were UK-born.

Heterosexual contact was the largest infection route for new diagnoses in East of England residents in 2022 (69%). Infections in African born persons accounted for 72% of all heterosexually acquired cases in 2022 (n=127), compared to 56% (n=113) in 2013. Infections in UK born persons accounted for 14% of all heterosexually acquired cases in 2022.

Injecting drug use accounted for 1% of new diagnoses in East of England residents.

Black Africans represented 48% of all newly diagnosed East of England residents in 2022 (compared to 25% in 2021 and 30% in 2013). A small proportion of new diagnoses in 2022 were in black Caribbeans (2%).

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 ten-fold risk of mortality within one year of diagnosis compared to those diagnosed promptly and they have increased healthcare costs.

It is of particular concern that a large proportion of East of England residents with HIV are diagnosed late (46% from 2020 to 2022, compared to 43% in England), as defined by a CD4 count of less than 350 cells/mm3 at diagnosis.

In the East of England, heterosexuals were more likely to be diagnosed late (62% of males, 43% of females) than GBMSM (40%). By ethnic group, black Africans were more likely to be diagnosed late than the white population (48% and 46% respectively).

People living with diagnosed HIV

The 8,076 people living with diagnosed HIV in the East of England in 2022 was 4% higher than 2021 and 38% higher than 2013. This increase is partly due to the effectiveness of HIV treatment, which has reduced the number of deaths from HIV.

The diagnosed prevalence rate of HIV in the East of England in 2022 was 2 per 1,000 residents aged 15 to 59 years. This was lower than the 2 per 1,000 observed in England as a whole (small differences may be hidden by rounding). Twelve local authorities in the East of England 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:

  • Bedford (2.4)
  • Harlow (2.6)
  • Hertsmere (2.1)
  • Luton (3.8)
  • Milton Keynes (3.3)
  • Norwich (2.2)
  • Peterborough (2.4)
  • Southend-on-Sea (3)
  • Stevenage (3)
  • Thurrock (2.4)
  • Watford (2.3)
  • Welwyn Hatfield (2.2)

The two most common probable routes of transmission for East of England residents living with diagnosed HIV in 2022 were sex between men and women (63%) and sex between men (33%).

In 2022, 38% of those living with diagnosed HIV in the East of England were aged between 35 and 49 years, and 51% were aged 50 years and over (up from 27% in 2013). Males represented 59% of East of England residents living with diagnosed HIV in 2022 and females represented 41%.

In 2022, 47% of East of England residents living with diagnosed HIV were white and 40% were black Africans. However, due to the relative sizes of the white and black African populations the rate per 1,000 population aged 15 to 59 years was much higher in black Africans (23 per 1,000) than in the white population (1 per 1,000).

Continuum of HIV care

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

For East of England 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 proportion undiagnosed among people living with HIV who inject drugs (8%, CrI 1% to 27%), non-black African heterosexual women (8%, 6% to 12%), and non-black African heterosexual men (7%, 4% to 20%).

HIV testing

A total of 36,312 people were tested for HIV in specialist SHSs in the East of England in 2022, a decrease of 60% since 2018. The HIV testing coverage at specialist SHSs in the East of England was 41%, which compares to 48% across England. HIV testing coverage in specialist SHSs in the East of England is higher in men (59%) than women (32%), and highest in GBMSM (63%).

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 two reasons for this. Firstly, online, and other non-specialist SHSs are not mandated by the British Association of Sexual Health and HIV (BASHH) to offer an HIV test to everyone. Secondly, these services may not code and report the outcome of an HIV test in their GUMCAD submissions.

Since 2020, the proportion of HIV testing which takes place through online services has risen sharply. As a consequence, clients may not be fully coded in relation to HIV testing if they were referred to online testing following triage by a specialist SHS or they were referred to specialist SHS following online testing (where further testing, treatment or care was required).

PrEP

In 2022, 7% of HIV-negative East of England residents accessing SHSs in England were defined as having a PrEP need, among whom 68% initiated or continued PrEP. Of those with PrEP need, 83% had this need identified at a clinical consultation. Among GBMSM, the group with greatest need, these proportions were: 63%, 70% and 83%. Consistent use of PrEP can be an efficacious and effective intervention to prevent HIV acquisition. Despite PrEP being routinely available through specialist SHS, awareness, accessibility and uptake of primary prevention initiatives is variable for different population groups. Addressing this disparity is key to HIV prevention.

HIV Action Plan

The 2022 to 2025 HIV Action Plan (jointly developed by the Office for Health Improvement and Disparities and UKHSA) aims to reduce HIV transmission by 80%, and HIV related and preventable deaths and AIDS by 50% between 2019 and 2025. This will be achieved by ensuring equitable access and uptake of HIV prevention programmes; scaling up HIV testing in line with national guidelines; optimising rapid access to treatment and retention in care; improving the quality of life for people living with HIV and addressing stigma.

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

  • PrEP access for all
  • scaling up of partner notification
  • increasing HIV testing among heterosexual men and women
  • improving retention to care and monitoring inequalities in all aspects of HIV prevention

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

HIV Prevention Messages

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

  • PrEP access for all who need it
  • increasing HIV testing among heterosexual men and women
  • rapid access to treatment and care

Using condoms consistently and correctly protects against HIV and other STIs such as chlamydia, gonorrhoea, and syphilis. They can also be used to prevent unplanned pregnancy.

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

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

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

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

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

Specialist SHS are free and confidential. They offer:

  • testing and treatment for HIV and STIs
  • condoms
  • vaccination
  • HIV PrEP and PEP

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

Charts, tables and maps

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

Sources: UKHSA, HANDD.

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

Figure 1 is a column chart outlining the rate of new HIV diagnoses per 100,000 population for all ages in the year 2022. Each UKHSA region is represented by its own column with 95% confidence intervals and the overall England rate (6.7 per 100,000) is represented as a line.

The East of England (pale blue) has the fourth highest rate of all UKHSA regions (5.7) but is below the overall England rate. The East of England’s upper confidence interval does not cross the overall England rate.

London is the region with the highest rate of new HIV diagnoses (15.5), which is above the overall England rate with a lower confidence interval that does not cross over the England rate.

The Yorkshire and Humber and East Midlands regions have new HIV diagnoses rates below the overall England rate, but their upper confidence interval crosses the overall England rate.

The rate of new HIV diagnoses for the South East, West Midlands, North West, North East and South West regions are all rate lower than the overall England rate and with lower confidence intervals that do not cross the England rate. The region with the lowest rate is the South West (3.2).

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

Sources: UKHSA, HANDD.

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

Note 2: 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 3: the colour coding does not relate to new diagnosis but to the data in the diagnosed prevalence section later.

Figure 2 is a column chart outlining the rate of new HIV diagnoses per 100,000 population for all ages in the year 2022. Each Upper Tier Local Authority (UTLA) in the East of England is represented by its own column with 95% confidence intervals and the overall East of England rate (5.7 per 100,000) is represented as a line.

The UTLAs are also separated by their status as a high (green) or lower (pale blue) HIV diagnosed prevalence area. Green bars represent high diagnosed prevalence areas, which are:

  • Luton
  • Peterborough
  • Milton Keynes
  • Bedford
  • Thurrock
  • Southend-on-Sea.

Blue bars represent lower diagnosed prevalence areas, which are:

  • Cambridgeshire
  • Hertfordshire
  • Essex
  • Norfolk
  • Suffolk
  • Central Bedfordshire

Luton has the highest rate of new HIV diagnoses in the East of England (14.0). Luton, Peterborough, and Milton Keynes all have rates higher than the regional rate and all with lower confidence intervals that do not cross over the regional rate.

Bedford, Cambridgeshire, and Hertfordshire all have rates higher than the regional rate, but all have lower confidence intervals that do cross the regional rate.

Thurrock, Essex, Norfolk, Suffolk, Southend-on-Sea, and Central Bedfordshire all have rates lower than the regional rate, but only Suffolk and Central Bedfordshire have upper confidence intervals that do not cross the regional rate. The UTLA with the lowest rate of new HIV diagnoses is Central Bedfordshire (3.0)

Figure 3. New HIV diagnoses and deaths, the East of England, 2013 to 2022

Sources: UKHSA, HANDD.

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

Note 2: Numbers may rise as we receive more reports and more information. This will impact on interpretation of trends in more recent years. New HIV diagnoses are shown by UK region of residence at diagnosis. Deaths are shown by UK region of death which in some instances may not be the same as UK region of residence at diagnosis. Region of death may not be known for all deaths, particularly for those in the most recent years. Numbers for these years should be interpreted as minimum numbers (deaths reported and allocated to a region of death to date) and not as a trend.

Figure 3 is a line chart outlining the number of new HIV diagnoses (teal line) and deaths among HIV-diagnosed residents in the East of England (light blue line). Data is shown by year from 2013 to 2022.

The number of new HIV diagnoses decreased from 2014 to 2020. However, since the COVID-19 pandemic in 2020, new HIV diagnoses have been increasing with 379 diagnoses made in 2022.

Deaths among those diagnosed with HIV has seen an overall increase since 2017 with 75 deaths reported in 2022. This coincides with the National HIV Mortality Review that led to improved reporting of deaths. Additional deaths due to COVID-19 would have also been reported since the Pandemic.

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

Sources: UKHSA, HANDD.

Note 1: The number of new diagnoses will depend on accessibility of testing as well as infection and transmission. Numbers may rise as further reports are received and more information is obtained. This is more likely to affect more recent years, particularly 2022.

Figure 4 is an area line chart outlining the trend in the number of new HIV diagnoses among East of England residents by whether they had previously been diagnosed abroad (white and teal checkered) or not (solid teal) by year from 2018 to 2022.

The proportion of new HIV diagnoses among individuals who had previously been diagnosed abroad versus those who had not remained relatively stable from 2018 to 2021. Between these years both groups followed similar trends.

However, in 2022 there was an increase in the number of new HIV diagnoses among individuals previously diagnosed abroad (116% increase from 2021) whilst the number of new HIV diagnoses that had not been previously diagnosed abroad had a slight decrease (2% decrease from 2021).

Sources: UKHSA, HANDD.

NPDA: Not previously diagnosed abroad.

Note 1: Numbers may rise as further reports are received and more information is obtained. This is more likely to affect more recent years, particularly 2022.

Note 2: The number of new diagnoses will depend on accessibility of testing as well as infection and transmission.

Figure 5a is a line chart outlining the trend in the number of new HIV diagnoses among East of England residents by probable route of infection and by year from 2013 to 2022. Probable infection routes have been separated for all HIV diagnosed in solid lines and those not previously diagnosed abroad in dashed lines.

The number of new diagnoses likely due to sex between men and women (pale blue lines) saw an overall decrease in number between 2014 and 2021 for both all diagnoses and those not previously diagnosed abroad. However, in 2022 there was a sharp increase in number with 260 new HIV diagnoses likely due to sex between men and woman among all new HIV diagnoses made. The number of new diagnoses among those not previously diagnosed abroad also saw an increase in 2022 (147), but on a smaller scale, suggesting there was a higher increase among those who had been previously diagnosed abroad.

The number of new diagnoses likely due to sex between men (teal lines) has been decreasing overall since 2016 for both all new diagnoses (107 in 2022) and among those not previously diagnosed abroad (84 in 2022).

The number of new diagnoses likely due to other probable routes of infection (blue lines) has been decreasing since 2019 for both all new diagnoses (13 in 2022) and among those not previously diagnosed abroad (5 in 2022).

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

Sources: UKHSA, HANDD.

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

Figure 5b is a line chart outlining the trend in the number of new HIV diagnoses among East of England residents by other probable route of infections and by year from 2013 to 2022.  Paediatric data from the Integrated Screening Outcomes Surveillance System (ISOSS) and the Children’s HIV and AIDS Reporting System (CHARS) were not available at the point of publication. As a result, data in the above chart may be affected. In 2022, there were small numbers of new HIV diagnoses among other probable infection routes with 5 mother-to-child infections (pale blue line), 4 injecting drug use (teal line), and 2 other (which includes transmission via blood or tissue shown by the blue line).

The number of new HIV diagnoses likely due to injecting drug use has decreased from 15 to 4 new diagnoses between 2019 and 2022.

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

Sources: UKHSA, HANDD.

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

Figure 6a is a pyramid chart outlining the number of new HIV diagnoses among East of England residents by age group and gender in 2022 (males in teal, females in pale blue).  Paediatric data from the Integrated Screening Outcomes Surveillance System (ISOSS) and the Children’s HIV and AIDS Reporting System (CHARS) were not available at the point of publication. As a result, data for the age group under 15 are not available and shown as 0’s in the chart.  Data for 16 to 24 years may also be underreported.

Among males, the 25 to 34 age group had the highest number of new diagnoses (65) followed by those aged 35 to 44 (57).

Among females, the 35 to 44 age group had the highest number of new diagnoses (65) followed by 25 to 34 (39).

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

Sources: UKHSA, HANDD.

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

Figure 6b is a pyramid chart outlining the number of new HIV diagnoses among East of England residents by sex between men probable route of exposure (pale blue) versus all other exposures (teal) for 2022.

Among new HIV diagnoses likely due to sex between men, those aged 25 to 34 had the highest number of new infections (37) followed by those aged 35 to 44 (28).

Among new HIV diagnoses likely due to all other exposure routes, those aged 35 to 44 had the highest number of new infections (24) followed by those aged 45 to 54 (22) and 25 to 34 (20).

Sources: UKHSA, HANDD.

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

Figure 7a is a line chart outlining the number of new HIV diagnoses among East of England residents whose likely route of infection was sex between men by age group and year from 2013 to 2022.

Across most age groups there has been a decrease in the number of new HIV diagnoses from 2013 to 2022, excluding those aged 35 to 44 (yellow line) where there were 28 new HIV diagnoses in both 2013 and 2022.

From 2020 to 2022, the number of new HIV diagnoses increased for those aged 25 to 34 (beige line), 35 to 34 (yellow line), and 15 to 24 (pink line). There was a decrease among those aged 45 to 54 (teal line) and 55 to 64 (purple line).

In 2022, the age group with the highest number of new diagnoses was 25 to 34 (37), followed by 35 to 44 (28), 15 to 24 (12), 45 to 54 (9), and 55 to 64 (2).

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 7b is a line chart outlining the number of new HIV diagnoses among East of England residents whose likely route of infection was sex between men and women by age group and year from 2013 to 2022.

Overall, decreasing trends were observed across age groups until 2021. In 2022, all age groups saw an increase in the number of new HIV diagnoses.

In 2022, the age group with the highest number of new diagnoses was 35 to 44 (yellow line: 82), followed by 25 to 34 (beige line: 54), 45 to 54 (teal line: 47), 55 to 64 (purple line: 26), and 15 to 24 (pink line: 7).

Sources: UKHSA, HANDD.

NPDA: Not previously diagnosed abroad.

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 chart outlining the number of new HIV diagnoses among East of England residents by white (teal), black African (pale blue), and all other ethnic groups (blue) from 2013 to 2022. The ethnic groups have been separated for all HIV diagnoses in solid lines and those not previously diagnosed abroad in dashed lines.

There has been an overall decrease in the number of new diagnoses made among those of white ethnicity, for both all diagnoses and those not previously diagnosed abroad. In 2022, there were 109 new HIV diagnoses among those of white ethnicity, 94 of which had not previously been diagnosed abroad.

Among those of black African ethnicity, there was a decreasing trend from 2014 to 2021. However, in 2022 a sharp increase was observed for all new diagnoses and a smaller increase in those who had not previously been diagnosed abroad – suggesting the increase among those of black African ethnicity is driven by those who had previously been diagnosed abroad. In 2022, there were 182 new HIV diagnoses among those of black African ethnicity, 82 of which had not previously been diagnosed abroad.

Among those of all other ethnic groups, there has been an overall increasing trend in the number of new diagnoses since 2017. In 2022, there were 88 new HIV diagnoses among those of all other ethnic groups, 60 of which had not previously been diagnosed abroad. 

Sources: UKHSA, HANDD.

NPDA: Not previously diagnosed abroad.

Note 1: Numbers may rise as further reports are received and more information is obtained. This is more likely to affect more recent years, particularly 2022.

Note 2: The number of new diagnoses will depend on accessibility of testing as well as infection and transmission.

Figure 9 is a line chart outlining the number of new HIV diagnoses among East of England residents by world region of birth from 2013 to 2022. The world regions have been separated for all HIV diagnoses in solid lines and those not previously diagnosed abroad in dashed lines.

There has been an overall decrease in the number of new diagnoses made among those born in the UK (teal lines), for both all diagnoses and those not previously diagnosed abroad. In 2022, there were 80 new HIV diagnoses among those of white ethnicity, 76 of which had not previously been diagnosed abroad.

Among those born in Africa (pale blue line), there was a decreasing trend from 2014 to 2021. However, in 2022 a sharp increase was observed for all new diagnoses and a smaller increase in those who had not previously been diagnosed abroad – suggesting the increase among those born in Africa is driven by those who had previously been diagnosed abroad. In 2022, there were 196 new HIV diagnoses among those born in Africa, 94 of which had not previously been diagnosed abroad.

Among those born in all other world regions (blue lines), there was an overall gently increasing trend in the number of new diagnoses between 2013 and 2019, but since then and until 2022, the number of new diagnoses has fluctuated. In 2022, there were 103 new HIV diagnoses among those born in all other world regions, 67 of which had not previously been diagnosed abroad. 

Sources: UKHSA, HANDD, HARS.

Note 1: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count of under 350 cells/mm3.

Note 2: The underlying population will impact on the proportion diagnosed late, for example GBMSM are less likely to be diagnosed late.

Figure 10 is a column chart outlining the percentage of new HIV diagnoses that were diagnosed late among East of England local authority of residence between 2020 and 2022. Each East of England upper tier local authority is represented by a column with 95% confidence intervals and the overall percentage of late diagnoses for the East of England region (46.3%) is represented by a dashed line.

Peterborough has the highest percentage of late diagnosis (62%), followed by:

  • Bedford (60%)
  • Central Bedfordshire (57%)
  • Cambridgeshire (53%)
  • Milton Keynes (52%)
  • Essex (50%)

All of these local authorities have a late diagnosis percentage higher than the regional figure.

Luton and Suffolk have the lowest percentage of late diagnosis (36% each), followed by:

  • Hertfordshire (38%)
  • Southend-on-Sea (41%)
  • Thurrock (44%)
  • Norfolk (45%)

All local authorities have confidence intervals that cross the regional percentage of late HIV diagnosis.

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

Sources: UKHSA, HANDD, HARS.

Note 1: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count under 350 cells/mm3. Proportions are only shown for the sex between men, heterosexual contact (males), heterosexual contact (females) and injecting drug use exposure groups and are withheld for any of these categories if they contain fewer than 5 late diagnoses.

Figure 11a is a column chart outlining the percentage and number of new HIV diagnoses that were diagnosed late by probable route of infection among East of England residents between 2020 and 2022. Each probable route of infection is represented by a column with 95% confidence intervals.

Males with heterosexual contact had the highest percentage of late diagnosis (62%, n=68), followed by females with heterosexual contact (43%, n=63), sex between men (40%, n=70) and injecting drug use (40%, n=4).

The lower confidence interval for males with heterosexual contact cross the confidence intervals for females with heterosexual contact and injecting drug use, but not sex between men.

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

Sources: UKHSA, HANDD, HARS.

Note 1: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count under 350 cells/mm3. Proportions are only shown for the white, black African and black Caribbean ethnic groups and are withheld for any of these ethnic group categories if they contain fewer than 5 late diagnoses.

Figure 11a is a column chart outlining the percentage and number of new HIV diagnoses that were diagnosed late by ethnic group among East of England residents between 2020 and 2022. Each probable ethnic group is represented by a column with 95% confidence intervals.

50% of new diagnoses among those of black Caribbean ethnicity were diagnosed late, but this equates to 5 individuals diagnosed late. 48% of new diagnoses among those of black African ethnicity were diagnosed late (63 individuals) and 46% of new diagnoses among those of white ethnicity (113 individuals).

Confidence intervals for all three ethnic groups included cross each other.

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

Sources: UKHSA, HANDD, HARS.

Note 1: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count  under 350 cells/mm3.

Figure 12 is a line chart outlining the percentage of new HIV diagnoses that were diagnosed late by probable route of exposure and year of first HIV diagnosis among East of England residents between 2013 and 2022.

The percentage of late diagnoses of new HIV diagnoses among men and women with heterosexual contact (pale blue line) was relatively stable until 2022, where a decrease was observed. In 2022, 43% of new HIV diagnoses among men and women with heterosexual contact were diagnosed late.

The percentage of late diagnoses of new HIV diagnoses among men who have sex with men (teal line) had an increasing trend between 2013 and 2018, a decrease in 2019 and 2020, but had since increased again. In 2022, 42% of new HIV diagnoses among men who have sex with men were diagnosed late.

The percentage of late diagnoses of new HIV diagnoses among all other probable infection routes (blue line) has fluctuated since 2018. In 2022, 100% of new HIV diagnoses among all other probable infection routes were diagnosed late.

Figure 13. Age distribution of new HIV diagnoses that were diagnosed late by year of first UK HIV diagnosis, East of England residents, aged 15 years and over, 2013 to 2022 [note 1]

Sources: UKHSA, HANDD, HARS.

Note 1: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count under 350 cells/mm3.

Figure 13 is a line chart outlining the percentage of new HIV diagnoses that were diagnosed late by age group and year of first HIV diagnosis among East of England residents between 2013 and 2022.

Late diagnosis among those aged 35 to 44 (yellow line) has been increasing since 2019 and in 2022 was the age group with the highest percent of late diagnosis (36%)

Among those aged 45 to 54, late diagnosis had been increasing since 2018 but a steep reduction was then observed in 2022 - now 20%.

Among those aged 55 and over, late diagnoses had been decreasing since 2018 but then increased to 20% in 2022.

Among those aged 25 to 34, late diagnosis has decreased overall since 2018 but has been relatively stable since 2020 - now 19%.

Those aged 15 to 24 have historically had the lowest percentage of late diagnosis across the age groups, late diagnosis in this group decreased from 2018 to 2020, but has since increased to 6% in 2022.

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

Sources: UKHSA, HARS.

Figure 14 is a column chart outlining the diagnoses HIV prevalence per 1,000 aged 15 to 59 by UKHSA region of residence in 2022.

The East of England had the fifth highest prevalence (1.7) compared to other regions, with London having the highest (5.3) and the North East the lowest (1.2)

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

Sources: UKHSA, HARS.

Figure 15 is a line chart outlining the number of East of England residents living with diagnosed HIV and accessing care by year from 2013 to 2022.

The number of individuals diagnosed with HIV and accessing care has been increasing steadily, from 5,838 in 2013 to 8,076 in 2022.

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

Sources: UKHSA, HARS.

Figure 16 is a column chart outlining the number of East of England residents living with diagnosed HIV and accessing care by probable route of infection in 2022.

The highest number of individuals living with HIV and accessing care are among heterosexual men and women (5,048), followed by men who have sex with men (2,679), mother to child transmission (165), injective drug use (127), and blood/healthcare worker grouped with 58 individuals.

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

Sources: UKHSA, HARS.

Figure 17 is a column chart outlining the number of East of England residents living with diagnosed HIV and accessing care by age group comparing 2013 data (teal columns) to 2022 (pale blue columns).

In 2022, of individuals living with HIV and accessing care:

  • 0% were aged under 15 years
  • 2% were 15 to 24 years
  • 9% were 25 to 34 years
  • 38% were 35 to 49 years
  • 51% were 50 years and over

Compared to 2013 data, there was a higher percentage of individuals living with HIV and accessing care in 2022 among those aged 50 and over only (27% in 2012, compared to 51% in 2022). This could be an indication of improved treatment and outcomes for those diagnosed with HIV.

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

Sources: UKHSA, HARS.

Figure 18 is a column chart outlining the diagnosed HIV prevalence per 1,000 by ethnic group among East of England residents in 2022. Each ethnic group is represented by a column with 95% confidence intervals.

The highest prevalence was observed among those of black African ethnicity (22.9), followed by black other/unspecified (6.3), black Caribbean (3.6), other/mixed (1.4), Asian (0.7) and white (0.7).

The confidence intervals for black African, black other/unspecified, and black Caribbean do not cross the other ethnic groups.

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

Sources: UKHSA, HARS.

Figure 19 is a column chart outlining the rate of HIV diagnoses per 100,000 by Index of Multiple Deprivation (IMD) among East of England residents in 2022. Each IMD decile is represented by a column with 95% confidence intervals with IMD decile 1 being most deprived and 10 being least deprived.

The data shows higher rates of HIV diagnosis among those most deprived compared to those least deprived, ranging from 2.4 per 100,000 among those in IMD decile 1 to 0.6 among those in IMD decile 10.

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

Sources: UKHSA, HARS.

Figure 20 is a column chart outlining the diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by East of England upper tier local authority of residence in 2022. Each local authority is represented by a column with 95% confidence intervals. The prevalence for the East of England region (1.7) is represented by a dashed line.

Luton is the East of England local authority with the highest prevalence (3.78), followed by:

  • Milton Keynes (3.29)
  • Southend-on-Sea (3.05)
  • Peterborough (2.44)
  • Thurrock (2.42)
  • Bedford (2.38)

All of these local authorities have a diagnosed HIV prevalence higher than the region and all have lower confidence intervals that do not cross over the regional prevalence.

Hertfordshire’s diagnosed HIV prevalence is similar to the region’s at 1.78, whilst Central Bedfordshire (1.48), Essex (1.40), Cambridgeshire (1.39), Norfolk (1.28), and Suffolk (1.18) all have diagnosed HIV prevalence below the region and with upper confidence intervals that do not cross the regional prevalence.

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

Sources: UKHSA, HARS.

Figure 21 is a heat map outlining the diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by East of England upper tier local authority of residence in 2022. Each local authority has been grouped into very high (5.0 and above), high (2.0 to 4.9), low (1.0 to 1.9) and very low (under 1.0) prevalence areas.

The East of England has no upper tier local authorities with very high or very low prevalence.

Luton, Milton Keynes, Southend-on-Sea, Peterborough, Thurrock, and Bedford all have high diagnosed HIV prevalence.

Hertfordshire, Central Bedfordshire, Essex, Cambridgeshire, Norfolk, and Suffolk all have low diagnosed HIV prevalence.

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

Sources: UKHSA, HARS.

Figure 22 is a heat map outlining the diagnosed HIV prevalence per 1,000 residents (all ages) by middle super output area (MSOA) of East of England residents in 2022. Each MSOA has been grouped into prevalence bandings:

  • 10.0 and above
  • 5.0 to 9.9
  • 2.0 to 4.9
  • 1.0 to 1.9
  • under 1.0

Pockets of higher diagnosed HIV prevalence (2.0 and above) were observed mostly within the region’s cities and large towns. Rurals parts of the region mostly had prevalence between 0.0 and 1.9.

There were no MSOAs in the region with a prevalence higher than 10.0, but Luton and Milton Keynes had pockets of prevalence between 5.0 and 9.9.

Figure 23. The continuum of HIV care, 2022

Source: UKHSA, HARS (MPES model).

Figure 23 is a column chart outlining the progress to the UNAIDs 90:90:90 targets in all areas of England outside of London.

The UNAIDS 90:90:90 targets state that 90% of people living with HIV should be diagnosed, 90% of those diagnosed should be on treatment, and 90% of those on treatment should be virally suppressed. This equates to, of all people living with HIV, 90% should be diagnosed, 81% should be on treatment, and 73% should be virally suppressed.

The areas of England outside of London exceeded these targets in 2022 with 95% of people living with HIV having a diagnosis, 98% of those diagnosed on treatment, and 98% of those on treatment being virally suppressed. This equates to, of all people living with HIV, 95% are diagnosed, 93% are on treatment, and 91% are virally suppressed.

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

Sources: UKHSA, GUMCAD.

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

Figure 24 is a line chart outlining the trend in HIV testing coverage at specialist SHS by population group among East of England residents between, from 2018 to 2022. The population groups included are all individuals (teal line), males (red line), females (blue line), and GBMSM (yellow line).

Since 2020 and the COVID-19 pandemic, HIV testing coverage has decreased among all population groups.

In 2022, the highest coverage was among GBMSM at 63% (down from 90% in 2018), followed by males at 59% (down from 81% in 2018), and then females at 32% (down from 57% in 2018). Overall HIV testing coverage in SHS was 41% (down from 67% in 2018).

It is important to note there has been an increase in online testing since the COVID-19 pandemic, which are not included in SHS HIV testing coverage data.

Table 1: People tested for HIV by population group, East of England residents attending all SHSs, 2018 to 2022

Gender/sexual orientation 2018 2019 2020 2021 2022 % change 2018 to 2022 % change 2021 to 2022
Heterosexual men 41,734 40,790 21,738 22,695 27,017 −35% 19%
GBMSM 9,919 11,593 11,066 14,521 15,115 52% 4%
Subtotal (men) 52,178 53,143 33,487 38,144 43,413 −17% 14%
Hetero/bisexual women 59,139 59,339 38,163 42,874 46,410 −22% 8%
WOSW 546 580 527 611 607 11% −1%
Subtotal (women) 60,170 60,787 39,289 44,215 47,988 −20% 9%
Total (all genders) 113,709 115,698 74,674 88,101 98,649 −13% 12%

Source: UKHSA, GUMCAD.

WOSW: women who only have sex with women

Table 1 outlines the number and percentage change of people tested for HIV in specialist SHSs by gender/sexual orientation and year among East of England residents from 2018 to 2022. Gender/sexual orientations included are heterosexual mean, GBMSM, all men, heterosexual/bisexual women, WOSW, all women, and all individuals in total.

In 2022, compared to 2018, all gender/sexual orientation groups had a decrease in the number of HIV tests – except for GBMSM and WOSW, for which both saw an increase.

Between 2018 and 2022, heterosexual men saw the largest percentage decrease of 35%, followed by heterosexual/bisexual women (22% decrease), all women (20% decrease), and all men (17% decrease). Among individuals in total, there was a 13% decrease in the number of HIV tests between 2018 and 2022. However, GBMSM saw a 52% increase and WOSW an 11% increase.

Between 2021 and 2022, all gender/sexual orientation groups had an increase in the number of HIV tests – except for WOSW.

Heterosexual men saw a 19% increase, followed by:

  • all men (14% increase)
  • all women (9% increase)
  • heterosexual/bisexual women (8% increase)
  • GBMSM (4% increase).

WOSW had a 1% decrease. Among individuals in total, there was a 12% increase in the number of HIV tests between 2021 and 2022.

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

Sources: UKHSA, GUMCAD.

Figure 25 is a column chart outlining the percentage of HIV pre-exposure prophylaxis (PrEP) total need (dark teal column), identified need (teal column), and whether PrEP has been initiated/continued (light teal column) by sexual orientation among East of England resident attending specialist sexual health services (SHS) in 2022. The sexual orientations included are GBMSM, heterosexual/bisexual women, heterosexual mean, and WOSW.

For GBMSM 63% have a PrEP need, 83% of the those with a need were identified, and 70% had PrEP initiated or continued.

For heterosexual/bisexual women 1% have a PrEP need, 73% of the those with a need were identified, and 48% had PrEP initiated or continued.

For heterosexual men 2% have a PrEP need, 68% of the those with a need were identified, and 42% had PrEP initiated or continued.

For WOSW 11% have a PrEP need, 95% of the those with a need were identified, and 66% had PrEP initiated or continued.

Information on data sources

  • HIV and AIDS New Diagnoses and Deaths (HANDD) collects information on new HIV diagnoses, AIDS at diagnosis and deaths among people diagnosed with HIV. Information is received from laboratories, specialist SHSs, GPs and other services where HIV testing takes place in England, Wales and Northern Ireland. The Recent Infection Testing Algorithm (RITA) and CD4 surveillance scheme are linked to HANDD to assess trends in recent and late diagnoses. Data is deduplicated across regions and therefore figures may differ from country-specific data.
  • The Survey of Prevalent HIV Infections Diagnosed (SOPHID) began in 1995 and was a cross-sectional survey of all adults living with diagnosed HIV infection who attend for HIV care in England, Wales and Northern Ireland. SOPHID collected information about the individual’s place of residence along with epidemiological data including clinical stage and antiretroviral therapy (ART). In 2015, SOPHID reporting in England was replaced by the HIV and AIDS Reporting System (HARS) which captures information at every attendance for HIV care.
  • Date of data extract: November 2023. Updates to HANDD and SOPHID/HARS made after this date will not be reflected in this report.
  • Confidence intervals for rates in the figures have been calculated to the 95% level using the Byar’s method; confidence intervals for percentages have been calculated to the 95% level using the Wilson Score method. Confidence intervals presented in the text are produced by Bayesian analysis.
  • ONS mid-year estimates for 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 are the unadjusted counts as reported. Where charts are displaying adjusted data, this is indicated in the chart title.
  • The denominators for all percentages exclude records for which information was unknown. For example, when calculating the proportion of new diagnoses where probable route of infection was sex between men, new diagnoses where route of infection was known would be used as the denominator.

All analyses in this report are residence-based and reflect the patient’s place of residence at diagnosis.

Numbers may change as more information becomes available to assign area of residence to cases and historical data is refreshed accordingly.

Further information

Local authorities have access to additional HIV and STI intelligence via the Data Exchange and the HIV and STI web portal. They should also have received a set of tables containing HIV data specific to their authority. They should contact FES.NorthWest@ukhsa.gov.uk 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 FS team at eoe.stihiv@ukhsa.gov.uk.

If you have any comments or feedback regarding this report or the Field Service, contact eoe.stihiv@ukhsa.gov.uk

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. December 2023, UK Health Security Agency
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