Research and analysis

Annual epidemiological spotlight on HIV in London: 2022 data

Updated 8 August 2024

Summary

HIV remains an important public health problem in London.

This report aims to provide key intelligence about HIV in London. For a broader context see UKHSA’s national HIV report (1).

In 2022, an estimated 38,680 people were living with HIV in London (95% credible interval (CrI) 38,060 to 39,330). This was 39% of all people living with HIV in England and includes both diagnosed and undiagnosed people.

New diagnoses

In 2022, an estimated 1,363 London residents were newly diagnosed with HIV, accounting for 36% of new diagnoses in England. This represents a rise of 17% 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 London residents (15 per 100,000) was above that of England in 2022 (7 per 100,000).

In 2022, 48% of all new diagnoses in London residents were in gay, bisexual and other men who have sex with men (GBMSM) (compared to 51% in 2021 and 61% in 2013). The number of GBMSM resident in London newly diagnosed with HIV (650, adjusted for missing information) was 58% lower than in 2013. Of the GBMSM newly diagnosed with HIV 52% were white and 18% were UK born.

Heterosexual contact was the most common infection route for new diagnoses in London residents in 2022 (49%). Infections in Africa-born persons accounted for 53% of all heterosexually acquired cases in 2022 (n=207), compared to 57% (n=450) in 2013. Infections in UK-born persons accounted for 18% of all heterosexually acquired cases in 2022.

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

Black Africans represented 20% of all newly diagnosed London residents in 2022 (compared to 22% in 2021 and 23% in 2013). A small proportion of new diagnoses in 2022 were in black Caribbeans (3%).

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

Late diagnoses

Reducing late HIV diagnoses is one of the indicators in the Public Health Outcomes Framework (2). A late diagnosis is defined as a CD4 count of less than 350 cells per cubic millimeter (cells/mm³) at diagnosis. CD4 cells are a type of white blood cell. Their concentration indicates the health of an immune system. People who are diagnosed late have a tenfold increased 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 London residents with HIV are diagnosed late (39% from 2020 to 2022, compared to 43% in England).

In London, heterosexuals were more likely to be diagnosed late (60% of males, 56% of females) than GBMSM (29%). By ethnic group, black Africans were more likely to be diagnosed late than the white population (60% and 30% respectively).

People living with diagnosed HIV

The 37,267 people living with diagnosed HIV in London in 2022 was 1% higher than 2021 and 11% higher than 2013. This increase is partly due to the effectiveness of HIV treatment, which has significantly reduced the number of deaths from HIV.

The diagnosed prevalence rate of HIV in London in 2022 was 5 per 1,000 residents aged 15 to 59 years. This was higher than the 2 per 1,000 observed in England as a whole. Thirty-two local authorities in London 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 (3). The only local authority in London with a diagnosed prevalence below this level was Kingston upon Thames (2.0).

The 2 most common probable routes of transmission for London residents living with diagnosed HIV in 2022 were sex between men (51%) and sex between men and women (45%).

In 2022, 36% of those living with diagnosed HIV in London were aged between 35 and 49 years, and 51% were aged 50 years and over (up from 27% in 2013). Males represented 70% of London residents living with diagnosed HIV in 2022 and females represented 29%.

In 2022, 46% of London residents living with diagnosed HIV were white and 31% 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 (16 per 1,000) than in the white population (3 per 1,000).

Continuum of HIV care

In London in 2022, 98% of HIV diagnosed residents were receiving anti-retroviral treatment. Of these, 97% were virally suppressed (which means they viral load of fewer than 200 copies/ml) and were very unlikely to pass on HIV, even if having sex without condoms (untransmissible virus). This compares to 99% in England as a whole receiving antiretroviral therapy (ART) and 98% of these virally suppressed.

For London 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 3.7% (CrI 2.8% to 5.0%) of people living with HIV in London were undiagnosed. This equates to an estimated 1,425 (CrI 1,073 to 1,957) undiagnosed people.

Of those living with HIV in London, it is estimated that 3% (Crl 2% to 5%) of GBMSM are undiagnosed (600 men, Crl 400 to 1,000) and 4% (Crl 3% to 6%) of heterosexuals (800 people, CrI 600 to 1,100), including 400 black Africans. In London, the proportion undiagnosed varied by exposure group with the highest proportion undiagnosed among people living with HIV who inject drugs (7%, CrI 1% to 24%), non-black African heterosexual women (7%, 5% to 9%), and non-black African heterosexual men (5%, 3% to 13%).

HIV testing

A total of 156,355 people were tested for HIV in specialist sexual health services (SHSs) in London in 2022, a decrease of 46% since 2018. The HIV testing coverage at specialist SHSs in London was 54% (of eligible attendees), which compares to 48% across England. HIV testing coverage in specialist SHSs in London is higher in men (68%) than women (42%), and highest in GBMSM (73%).

Some HIV tests are performed in settings other than at SHSs. These include tests done through online consultations. It is not currently possible to include these in the HIV testing coverage measure. There are 2 reasons for this. Firstly, online and other non-specialist SHSs are not mandated by the British Association of Sexual Health and HIV (BASHH) to offer an HIV test to everyone. Secondly, these SHSs may not code and report the outcome of an HIV test in their GUMCAD submissions.

Since 2020, the proportion of HIV testing which takes place through online services has risen sharply (1). As a consequence, clients may not be fully coded in relation to HIV testing if they were referred to online testing following triage by a specialist SHS or they were referred to specialist SHS following online testing (where further testing, treatment or care was required).

Pre-exposure prophylaxis (PrEP)

In 2022, 17% of HIV-negative London residents accessing SHSs in England were defined as having a PrEP need, among whom 78% initiated or continued PrEP. Of those with a PrEP need, 83% had this need identified at a clinical consultation. Among GBMSM, the group with greatest need, these proportions were: 70%, 79% and 84%.

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 acquired immunodeficiency syndrome (AIDS) by 50% between 2019 and 2025 (4). This will be achieved by:

• ensuring equitable access and uptake of HIV prevention programmes
• scaling up HIV testing in line with national guidelines
• optimising rapid access to treatment and retention in care
• improving the quality of life for people living with HIV and addressing stigma

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

HIV prevention messages

In order to ensure that the HIV Action plan goals of reducing HIV transmission, AIDS and deaths are reached, a number of prevention areas need to be prioritised, these include PrEP access for all who need it, increasing HIV testing among heterosexual men and women, and rapid access to treatment and care.

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

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

HIV PrEP 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 (5). HIV post-exposure prophylaxis (PEP) can be used to reduce the risk of acquiring HIV following some sexual exposures. PEP is available for free from most specialist SHS and most emergency departments.

Symptoms due to HIV and AIDS may not appear for many years (6), and people who are unaware of their infection may not feel themselves to be a risk to others (7). 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’ (8).

Stigma, anxiety and depression experienced by people with HIV affect their ability to seek healthcare, engage in treatment and remain in care (9). Reducing stigma in healthcare services will encourage people in seeking the healthcare services they need.

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

Charts, tables and maps

For the following charts, tables and maps, the number of new diagnoses will depend on accessibility of testing as well as infection and transmission.

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

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

Figure 1 is a column chart showing new HIV diagnosis rates by English region for the year 2022. Rates are per 100,000 population and are not age-restricted. The overall England rate (6.7) is represented as a solid horizontal line.

The chart shows that London not only has the highest new HIV diagnosis rate of all English regions (15.5) but that its rate is more than twice that of the region with the next highest rate (the North West with 6.5). London’s population is more ethnically and socio-economically diverse than other regions and also has a younger age distribution.

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

Source: UKHSA, HANDD

HIV diagnosed prevalence is measured as 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.

The colour coding on the chart does not relate to new diagnosis but to the data in the diagnosed prevalence section later.

Figure 2 is a column chart showing new HIV diagnosis rates by London local authority for the year 2022. LAs are shown in descending order in relation to their new HIV diagnosis rate. Rates are per 100,000 population and are not age-restricted. The overall London rate (15.5) is represented as a dashed horizontal line.

The colour coding of the columns is designed to help relate new HIV diagnosis rates to the diagnosed prevalence for each local authority. A column that appears towards the left of the chart but has a mid-teal or pale blue colour may indicate a local authority where diagnosis rates are increasing in relation to historical rates for that local authority. Brent is an example of such an local authority. By contrast, a column that appears towards the right of the chart but has a dark blue colour may indicate that diagnosis rates are decreasing in relation to those seen in the past.

The chart shows that new HIV diagnosis rates tend to be higher in inner London local authorities such as Westminster, which has the highest rate (53), Kensington and Chelsea (35) and Lambeth (35). The lowest rates are found in local authorities in outer London: Havering (4), Sutton (5) and Bexley (5). Inner London local authorities tend to have more diverse populations and higher levels of deprivation than those in Outer London.

Figure 3. New HIV diagnoses and deaths, London, 2013 to 2022

Source: UKHSA, HANDD

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 showing the trend in number of new HIV diagnoses and deaths in HIV-diagnosed London residents between the years 2013 (2,526 new HIV diagnoses) and 2022 (1,363).

The new HIV diagnosis line shows the number of diagnoses broadly static between 2013 and 2015. A fall was seen from that year on, slowing in 2017. There was a large fall in the COVID pandemic year 2020. In 2021, the first half of which was also affected by pandemic related restrictions, diagnoses remained at the level seen in 2020. However, in 2022 a rise was seen for the first time since 2014.

Deaths began to rise in 2017. However, this coincides with improved ascertainment of deaths as a result of the National HIV Mortality Review. Additional deaths due to COVID-19 were also reported during the pandemic. Deaths tend to be subject to a greater reporting delay than diagnoses. It is important to aware of this when interpreting the number of deaths currently reported for the most recent year. 

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

Source: UKHSA, HANDD

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

Figure 4 is an area chart. It displays the trend in new HIV diagnoses in London residents between 2018 and 2022 by whether the person had been previously diagnosed abroad or not. The solid-shaded area represents new HIV diagnoses where there had been no prior diagnosis abroad and the pattern-shaded area above it represents the additional portion of diagnoses where a prior diagnosis abroad was recorded. Identifying patients who have been previously diagnosed abroad has become an issue of increasing importance as access to testing and treatment has improved worldwide. Including those previously diagnosed abroad in all analyses can lead to distortions in our understanding of which groups remain exposed to the greatest risk of transmission in the UK. The chart shows that the proportion of London residents newly diagnosed with HIV who were previously diagnosed abroad has fallen slightly over the 5-year period from 29% in 2018 (467 new HIV diagnoses) to 27% in 2022 (369). However, the proportion for 2022 was a rise of 3 percentage points from 24% in 2021 (276).

Figure 5a. New HIV diagnoses by probable route of acquiring HIV (adjusted for missing route information), London residents, 2013 to 2022 [note 1]

Source: UKHSA, HANDD. NPDA means 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.

Figure 5a is a line chart showing the trend in new HIV diagnoses by probable transmission route, grouped as sex between men, sex between men and women and other acquisition routes from 2013 to 2022. HIV exposure categories are arranged in a risk hierarchy. This hierarchy reflects what we know about transmission risk and the prevalence of HIV in different communities. If people have multiple exposures, they are allocated to the group highest in the risk hierarchy. For example, a woman who reported sex with men and with women would be allocated to the sex between men and women group, while a man who reported sex between men and injecting drug use would be allocated to the sex between men group.

Numbers have been adjusted for missing transmission route allocation. Diagnoses where this information is unknown have been proportionately allocated to the 3 transmission groups. For each group an additional dashed line shows the trend when people known to have been previously diagnosed abroad are excluded.

New HIV diagnoses have declined in all groups over the 10-year period, but the decline has been most pronounced in those who probably acquired HIV via sex between men, a decrease of 58% (or 72% if those previously abroad are excluded). The number of new HIV diagnoses in this group fell from 1,548 in 2013 to 650 in 2022 (or from 1,463 to 415 if those previously diagnosed abroad are excluded). The impact of excluding those previously diagnosed abroad tends to be largest for this group. This group did see a rise when 2022 is compared to 2021 but it was small: 9% (or 2% when those with a prior diagnosis abroad are excluded).

For those who probably acquired HIV via sex between men and women, the number of new HIV diagnoses fell by 26% from 892 in 2013 to 664 in 2022 (or by 33% from 821 to 553 if those previously diagnosed abroad are excluded). However, this group has seen a marked upturn in diagnoses in the most recent years and in 2022 it returned to being the most commonly reported HIV transmission route for the first time since 2008. The rise in this group when 2022 is compared to 2021 was 25% (or 21% when those with a prior diagnosis abroad are excluded). Moreover, when those with a prior diagnosis abroad are excluded, it becomes apparent that the renewed rising trend started earlier in this group, beginning in 2020, the year most affected by pandemic disruptions.

The number of people probably acquiring HIV from non-sexual routes remained low over the ten-year period, declining from 86 in 2013 to 49 in 2022 (or from 68 to 26 if those previously diagnosed are excluded).

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

Source: UKHSA, HANDD.

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

The chart shows that the number of new HIV diagnoses in London residents whose probable route of HIV acquisition belonged to any of these subcategories remained low and declining throughout the ten-year period. Rises were seen for the injecting drug use and mother-to-child transmission groups in 2022 compared to 2021 but these need to be interpreted with caution given the small numbers involved.

The most common ‘other’ HIV transmission route subcategory in both 2013 and 2022 was mother-to-child with 33 new HIV diagnoses. By 2022 the number of new HIV diagnoses in this subcategory had fallen to 15 and all were in people born abroad. However, due to changes in paediatric surveillance, data on those aged less than 15 years at diagnosis was unavailable this year. In all 4 years prior to 2022, the number of diagnoses in Londoners aged less than 15 years at diagnosis who were believed to have acquired HIV via mother-to-child transmission was between 1 and 4.

All 3 subcategories had fewer than twenty new HIV diagnoses in 2022. 

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

Source: UKHSA, HANDD. This year, data is unavailable for people aged under 15 years.

Figure 6a is a pyramid chart showing the number of new HIV diagnoses by age group and gender in 2022. For males, the 25 to 34 year age group had by far the largest number of new HIV diagnoses (393). This group also contained the largest number of diagnoses for females (101). However, for females the difference between different age groups (other than those aged less than 25 years) was not so marked. Data for those aged less than 15 years was not available this year due to changes in paediatric HIV surveillance.

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

Source: UKHSA, HANDD.

Figure 6b is a pyramid chart showing the number of new HIV diagnoses by age group and probable route of HIV acquisition for males aged 15 to 64 years in 2022. For those who probably acquired HIV via sex between men (GBMSM) the 25 to 34 year group accounted for the highest number of new HIV diagnoses (213), while for those whose HIV acquisition was by any other route it was the 35 to 44 year group (62). Non-GBMSM tended to be older at diagnosis than GBMSM. The side of the pyramid representing GBMSM is considerably affecting by skewing, with each age group above the 25 to 34 year group markedly smaller than the one below it. A similar progression is not seen for non-GBMSM. For non-GBMSM, the 3 age groups spanning ages 24 years to 54 years are quite similar in size.

Figure 7a. Number of new HIV diagnoses probably acquired through sex between men by age group and year of first UK HIV diagnosis, London residents aged 15 to 64 years, 2013 to 2022 [note 1]

Source: UKHSA, HANDD.

Figure 7a is a line chart showing the number of new HIV diagnoses by age group for GBMSM London residents aged 15 to 64 years from 2013 to 2022. Diagnoses in those aged between 15 and 64 years accounted for an average of 99% diagnoses in GBMSM Londoners over the 10-year period. The final points on the lines correspond to the bars on the left hand side of figure 6b.

Diagnoses in 2021 fell for all age groups both in relation to 2013, the first year in the trend period and for older age groups in relation to the previous year.

However, allowing within the context of falling numbers, over the ten-year trend period, 2 age groups have increased as a proportion of all GBMSM new HIV diagnoses in those aged 15 to 64 years each year. The first is the 25 to 34 year group which accounted for 43% of diagnoses in 2013 (620) and 49% in 2022 (213). The proportional increase in this group was associated with GBMSM who were born abroad. More than half of non-UK-born GBMSM Londoners who were diagnosed with HIV in 2022 were aged 25 to 34 years. The other age group that saw a proportional increase was the 55 to 64 year age group which accounted for 3% of diagnoses in 2013 (45) and 4% in 2022 (18). The proportional increase in this older age group was associated with UK-born GBMSM. For London residents in this GBMSM sub-group, more than 1 in 10 of those newly diagnosed in 2022 were aged 55 to 64 years.

For all transmission groups, differences in age at diagnosis between UK-born and non-UK-born individuals are to be expected as migrants tend to be younger working-age people.

Figure 7b. Number of new HIV diagnoses probably acquired through sex between men and women by age group (in years) and year of first UK HIV diagnosis, London residents aged 15 to 64 years, 2013 to 2022 [note 1]

Source: UKHSA, HANDD.

Figure 7b is a line chart showing the number of new HIV diagnoses by age group for heterosexual London residents aged 15 to 64 years from 2013 to 2022. Bisexual women are also included. Diagnoses in those aged between 15 and 64 years accounted for an average of 96% of diagnoses in heterosexual Londoners over the 10-year period.

Diagnoses fell for all age groups other than the oldest age group (55 to 64 years) when 2022 is compared to 2013, the first year of the trend period. Decreases of over 50% were seen for 3 age groups: 15 to 24 years (a fall of 69%), 25 to 34 (a fall of 56%) and 35 to 44 years (a fall of 53%). The 55 to 64 year age group experienced a rise of 47% however.

As with GBMSM, falling numbers overall mask proportional changes in the size of different age groups. When 2022 is compared to the previous year rises are seen for all age groups other than the 15 to 24 year group, with the largest proportional rise being seen for the 45 to 54 year group (34%). There has been a noticeable shift towards a higher median age at diagnosis for those who acquire HIV via sex between men and women. This may be an effect of people acquiring HIV at an older age but age at diagnosis may also rise due to delays in a person being diagnosed. Increases in the proportion diagnosed who belong to older age groups were seen in both UK-born and non-UK-born heterosexual Londoners. 

Figure 8. Number of new HIV diagnoses by ethnic group (adjusted for missing ethnic group information), London residents, 2013 to 2022 [note 1]

Source: UKHSA, HANDD. NPDA means not previously diagnosed abroad.

Figure 8 is a line chart showing the number of new HIV diagnoses by ethnic group from 2013 to 2022. The white and black African ethnic groups are represented as distinct categories. All other ethnic groups are grouped into a single category. As with the probable route of infection line chart there is a pair of lines for each ethnic category shown, one showing all new HIV diagnoses and one showing the number once those previously diagnosed abroad are excluded.

All 3 of the categories show a declining trend, especially the white group. This group is the most common ethnic group over the 10-year period with 1,324 new HIV diagnoses in 2013 decreasing by 57% to 572 in 2022 (or from 1,226 to 431 excluding those previously diagnosed abroad). New HIV diagnoses in the black African group fell by 51% from 574 in 2013 to 279 in 2022 (or from 538 to 185 excluding those previously diagnosed abroad) and the category representing all other ethnic groups decreased by 19% from 628 in 2013 to 512 in 2022 (or from 588 to 378 excluding those previously diagnosed abroad). This category is very heterogenous. The recent upturn in new diagnoses in 2022 compared to 2021 affected those in the other ethnic groups category most (a 21% rise) and those in the black African group least (an 8% rise).

Probable route of HIV acquisition and ethnic group are associated to some extent. Around 4 in 10 Londoners diagnosed in 2022 who acquired HIV via sex between men and women identified themselves as black African, while more than half of GBMSM identified themselves as white. This should be borne in mind when interpreting trends for either variable.

Black Africans were the group most likely to have been born abroad (9 in 10 black Africans diagnosed between 2013 and 2022) while people in the white group were least likely (nearly two-thirds). Changes in migration patterns should be considered when interpreting decreases or increases in new HIV diagnoses in different ethnic groups.

Figure 9. Number of new HIV diagnoses by world region of birth (adjusted for missing world region of birth information), London residents, 2013 to 2022 [note 1]

Source: UKHSA, HANDD. NPDA means not previously diagnosed abroad.

Figure 9 is a line chart showing the number of new HIV diagnoses by world region of birth from 2013 to 2022. The UK and Africa are represented as distinct categories. All other world regions of birth are grouped into a single category. Again, there is a pair of lines for each category shown, one for all new HIV diagnoses and another showing diagnoses excluding those in people previously diagnosed abroad.

All 3 categories show a declining trend. New HIV diagnoses in those born in the UK decreased from 778 to 248 between 2012 and 2022. This category, as might be expected, is less impacted by the exclusion of those previously diagnosed abroad: the number of new HIV diagnoses becomes 760 for 2013, falling to 238 in 2022. This group was the least affected by the recent upturn in new HIV diagnoses. It saw a rise of 6% between 2021 and 2022.

For those born in Africa the number of diagnoses fell from 607 to 452 (or from 555 to 342 excluding those previously diagnosed abroad). Although West Africa was the most commonly reported African sub-region of birth for African-born Londoners diagnosed between 2013 and 2022, almost 50 different African countries of birth were reported over the 10-year period. The rise associated with the recent upturn in new HIV diagnoses was 12% between 2021 and 2022 for this group.

The largest category over the 10-year period was the highly heterogenous group representing all other world regions of birth other than the UK or Africa. The number of diagnoses for this category decreased from 1,140 to 673. This group was also the one most impacted by the exclusion of those previously diagnosed abroad, particularly in the middle of the 10-year period. Removing those diagnoses the number of new HIV diagnoses was 1,037 in 2013, falling to 404 in 2022. Countries in South America and Europe made up the 5 most commonly reported countries of birth for Londoners in this group who were diagnosed with HIV between 2013 and 2022. Excluding those with a prior diagnosis abroad results in smaller numbers but does not change the countries that make up this list. This group was the most affected by the recent upturn in new HIV diagnoses with a 17% rise between 2021 and 2022.

Table 1. Number of new HIV diagnoses by ethnic group and whether born abroad, London residents with no prior diagnosis abroad, 2018 to 2022 [note 1]

Ethnic group	UK-born	Born abroad	Unknown country of birth
White	542	770	605
Black African	67	673	97
Black Caribbean	61	77	42
Black Other	39	85	49
Indian/Pakistani/Bangladeshi	38	123	37
Other Asian (including Chinese)	10	117	91
Mixed/Other	89	341	242
Unknown	86	187	624

Source: UKHSA, HANDD.

Table 1 shows that the relationship between ethnic group and whether a person newly diagnosed with HIV was born abroad. Data is for the 5-year period 2018 to 2022. Those with a prior diagnosis abroad are excluded. To make it clear that there are differences in completeness of ascertainment of country of birth for different ethnic groups, numbers in this table are not adjusted for missing information.

For black Africans, country of birth was known for 88% of those newly diagnosed with HIV with no prior diagnosis abroad. Of these, 91% of black Africans newly diagnosed with HIV were born abroad (673 new HIV diagnoses).

Country of birth was known for 68% of those in the white ethnic group. Of these, a smaller proportion were born abroad but it was still the majority (59% or 770 new HIV diagnoses).

For black Caribbeans, 77% had a known country of birth. This ethnic group had the lowest percentage born abroad: 56%, equating to 77 new HIV diagnoses.

The black other group was more similar to the black Caribbean than to the black African group: 72% had a known country of birth and of these 69% (85) were born abroad.

Asians have been separated into an Indian/Pakistani/Bangladeshi (IPB) group and a group containing all other Asians, including Chinese people. Country of birth was reported for 81% of the IPB group and of those 76% (123) had been born abroad. The other Asian group had the lowest proportion with a reported country of birth (58%) but where we did have this information 92% (117) were born abroad.

The remaining mixed/other group is extremely heterogenous. Country of birth was known for 64% of people in this category and of these 79% (341) had been born abroad.

The number of diagnoses in any group containing a large proportion of people who were born abroad is sensitive to changes in migration patterns over time. 

Figure 10a. New HIV diagnoses in GBMSM not previously diagnosed abroad by whether born abroad, London residents, 2013 to 2022

Source: UKHSA, HANDD.

Figure 10a is a line chart which displays new HIV diagnoses in GBMSM Londoners over the period 2013 to 2022 subdivided by whether born in the UK or abroad. It shows that, when we exclude GBMSM newly diagnosed with HIV who had been previously diagnosed abroad, people born abroad are still the largest sub-group (120 diagnoses or 70% of those with a known country of birth).

Figure 10b. New HIV diagnoses in heterosexuals not previously diagnosed abroad by whether born abroad: London residents, 2013 to 2022

Source: UKHSA, HANDD.

Figure 10b is a line chart which displays new HIV diagnoses in heterosexual Londoners over the period 2013 to 2022 subdivided by whether born in the UK or abroad. Unless otherwise stated, in this report the term ‘heterosexuals’ means people who are believed to have acquired HIV via sex between men and women. The chart shows that, when we exclude heterosexuals newly diagnosed with HIV who had been previously diagnosed abroad, people born abroad are still by far the largest group (215 diagnoses or 77% of those with a known country of birth).

Figure 11. Percentage of new HIV diagnoses that were diagnosed late, in London residents aged 15 years and over, by local authority of residence, 2020 to 2022 [note 2]

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

[Note 2] Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count of fewer than 350 cells/mm³. The underlying population will impact on the proportion diagnosed late, for example GBMSM are less likely to be diagnosed late.

Figure 11 is a column chart showing the percentage of HIV diagnoses for the period 2020 to 2022 that are estimated to have been made ‘late’ in relation to the time of acquisition by London local authority of residence. The categorisation of an HIV diagnosis as ‘late’ is based on CD4 count at diagnosis as this count tends to decline over time in people living with undiagnosed HIV. The chart and most of the other late diagnosis charts that follow it used 3 years’ data grouped together. This is to improve robustness given that only those new HIV diagnoses that meet the criteria described in the chart’s footnote can be included in the denominator.

The order of local authorities is different from that seen for new HIV diagnoses with outer London local authorities, such as Bexley (71%) and Kingston upon Thames (65%) having the highest percentages of late diagnoses. By contrast, at the other end of the chart we see Kensington and Chelsea with a late diagnosis percentage of 21%. Although the LAs at this end of the chart are mostly in inner London, which are subject to higher levels of deprivation and more diverse populations, there is also an association with the most common exposure groups for residents diagnosed with HIV. Local authorities with higher proportions of GBMSM tend to have lower late diagnosis percentages. This reflects greater awareness of HIV and higher testing rates for this group, compared to heterosexuals.

Figure 12a. Percentage and number of new HIV diagnoses that were diagnosed late, in London residents aged 15 years and over, by probable route of infection, 2020 to 2022 [note 3]

Source: UKHSA, HANDD, HARS.

[Note 3] Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count of fewer than 350 cells/mm³. 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 12a is a column chart. For each major exposure category, it shows the percentage of HIV diagnoses for the period 2020 to 2022 among London residents that are estimated to have been made late.

Men who probably acquired HIV via sex between men are least likely to be diagnosed late (29%). This reflects the higher testing rates and greater engagement with sexual health services seen for GBMSM. GBMSM resident in London are less likely to be diagnosed late than those resident in the rest of England (37%).

A late diagnosis was much more common for both men and women who probably acquired HIV through heterosexual sex, with men having an even higher percentage (60%) than women (56%). Some women may have additional opportunities to be diagnosed via antenatal services and this may partly explain some of the difference between men and women in this group. Heterosexuals resident in London (58%) are more likely to be diagnosed late than those resident in the rest of England (52%).

For those who probably acquired HIV via injecting drug use the percentage diagnosed late was 55%. The confidence interval for this group is much larger however as the number of new HIV diagnoses in this group was much smaller.

Figure 12b. Percentage and number of new HIV diagnoses that were diagnosed late, in London residents aged 15 years and over, by ethnic group, 2020 to 2022 [note 4]

Source: UKHSA, HANDD, HARS.

[Note 4] Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count of fewer than 350 cells/mm³. Proportions are withheld for any ethnic group category that contains fewer than 5 late diagnoses. IPB means Indian/Pakistani/Bangladeshi.

Figure 12b is a column chart. It is structured in the same way as figure 9a and shows percentages of HIV diagnoses made late by ethnic group for London residents for the period 2020 to 2022. When interpreting these percentages, it is important to note the association between having acquired HIV via sex between men and women and a late diagnosis, as some ethnic groups have a higher proportion of diagnoses in people who are believed to have acquired HIV via this route.

The white ethnic group had the lowest percentage of diagnoses made late (30%), while the black African group had the highest (60%) followed by the Indian/Pakistani/Bangladeshi (IPB) group (54%). It is important to note that the confidence intervals for ethnic groups with fewer diagnoses, for example, the Chinese ethnic group, are much wider than for those with more diagnoses.

Figure 13. Percentage of new HIV diagnoses that were diagnosed late, in London residents aged 15 years and over, by probable route of infection and year of first UK HIV diagnosis, 2013 to 2022 [note 5]

Source: UKHSA, HANDD, HARS.

[Note 5] Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count of fewer than 350 cells/mm³.

Figure 13 is a line chart showing trends in late diagnoses between 2013 and 2022 by exposure group in 3 categories: sex between men, sex between men and women and all other acquisition routes. Percentages in this chart are less robust as numbers in individual years are small and should be interpreted as indicative of broad trends only The chart shows that late diagnoses in those probably acquiring HIV through sex between men were lowest but started to rise after 2018, reaching 36% in 2021 (double the percentage in 2013, 18%).

For those probably acquiring HIV via heterosexual sex the percentage diagnosed late remained high throughout the period, rising slightly from 52% in 2013 to 55% in 2022, with a brief downturn in 2019, the last pre-pandemic year, when it dropped to 48%.

The trend for the other HIV acquisition routes was more variable as this group is heterogenous the number of new HIV diagnoses is low. The percentage of late diagnoses was similar at both ends of the 10-year period (51% in 2013 and 50% in 2022) but tended to fall in the first half of the period, reaching 29% in 2016, before rising, falling and then rising again in the final 2 years.

Figure 14. Percentage of new HIV diagnoses that were diagnosed late in GBMSM and heterosexuals by whether born in the UK, London, aged 15 years and over, 2020 to 2022 [note 5]

Source: UKHSA, HANDD, HARS.

Figure 14 is a column chart. For 2 exposure groups, GBMSM (those probably acquiring HIV through sex between men) and those probably acquiring HIV through sex between men and women, 2 columns are displayed. The first shows the percentage of UK-born London residents in each group that were diagnosed late, the second the percentage of London residents born abroad in each group that were diagnosed late. The data spans 3 years: 2020 to 2022.

For GBMSM there was little difference between those born in the UK and those born abroad (around a quarter of each group were diagnosed late). However, for those probably acquiring HIV via sex between men and women, the percentage diagnosed late was higher for those born abroad: 44% of UK-born heterosexuals and 58% of heterosexuals born abroad were diagnosed late.

Figure 15. Age distribution of new HIV diagnoses that were diagnosed late by year of first UK HIV diagnosis, London residents, aged 15 years and over, 2013 to 2022 [note 5]

Source: UKHSA, HANDD, HARS.

Figure 15 is a line chart showing the age distribution of those diagnosed late between 2013 and 2022. Unlike the previous late diagnosis charts the percentages indicate the proportion of late diagnoses that occurred within each age group, rather than showing the proportion within each group that were diagnosed late. Percentages in this chart are less robust as they are by single year and numbers are small when broken down by age group. They should be interpreted as indicative of broad trends only.

The proportion of those diagnosed late in the youngest age groups has remained broadly stable over the 10-year trend period. People aged 15 to 24 years accounted for 7% of those diagnosed late in 2013 and 6% in 2022, while those aged 25 to 34 years accounted for 27% of those diagnosed late in 2013 and 23% in 2022.

A large and sustained increase was seen in the oldest age group, those aged 55 years and older. Although there has been fluctuation between years the percentage of those diagnosed late in this age group has remained well above the 9% seen in 2013 and was 20% in 2022.

Median age at diagnosis was older for both GBMSM and heterosexuals when those diagnosed late were compared to all new diagnoses eligible for inclusion in the calculation (see chart footnote). For 2020 to 2022, for GBMSM, the median age at diagnosis for those diagnosed late was 35 years, compared to 33 for all newly diagnosed GBMSM who met the inclusion criteria. For heterosexuals for the same period, the median age at diagnosis for those diagnosed late was 46 years, compared to 44 for all newly diagnosed heterosexuals who met the inclusion criteria.

Figure 16. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by UKHSA region, 2022

Source: UKHSA, HARS.

Figure 16 is a column chart showing the prevalence of diagnosed HIV by English region for the year 2022. Rates are by 1,000 population and are restricted to those aged 15 to 59 years. The chart shows that London has a much higher rate (5.3) than any other English region. The region with the next highest rate is the North West, with a rate (2.0) less than half of London’s. As noted earlier, London has a population which is more diverse than other regions. It also has a younger age structure. In 2021, 46% of London’s population was aged 15 to 44 years compared to 37% for the rest of England.

Figure 17. Number of residents living with diagnosed HIV and accessing care, London, 2013 to 2022

Source: UKHSA, HARS.

Figure 17 is a line chart showing the number of Londoners living with diagnosed HIV who accessed HIV-related care in the years 2013 to 2022. As everyone living with diagnosed HIV in the UK can access care for free, this number acts as a proxy for the number of people living with diagnosed HIV. The line reflects changes in new HIV diagnoses, mortality in those living with diagnosed HIV and immigration patterns. It may also be affected by disruptions to care and changes in residence during the main pandemic year 2020. It shows that from 33,718 in 2013 the number reached a high of 37,188 in 2019, dropping down to 36,581 in 2020 before rising to a new peak of 37,267 in 2022.

Figure 18. Number of residents living with diagnosed HIV and accessing care by probable route of transmission (adjusted for missing route information), London, 2022

Source: UKHSA, HARS.

Figure 18 is a column chart which displays the number of Londoners living with diagnosed HIV and accessing care in 2022 by probable transmission route. It shows that people living with diagnosed HIV were overwhelmingly likely to have acquired HIV via sex, with 19,136 having probably acquired HIV through sex between men and 16,701 having probably acquired HIV through sex between men and women. By contrast, those who probably acquired HIV through vertical transmission (before or at birth or via breastfeeding), which was the next largest exposure group, numbered only 718 while those believed to have acquired HIV via injecting drug use numbered 514.

Figure 19. Percentage of residents with diagnosed HIV who are accessing care in each age group, London, 2013 and 2022

Source: UKHSA, HARS.

Figure 19 is a column chart which shows the percentage of Londoners living with diagnosed HIV and accessing care who belong to each age group. Two years are shown, 2013 and 2022. The chart shows an ageing cohort effect as, due to decreased transmission, fewer people receive a new HIV diagnosis and, due to effective treatment, fewer die prematurely.

In 2013 the largest age group was the 35 to 49 year group and only 27% were aged 50 years or older. By 2022, the 50 years or older group was the largest group, accounting for 51% of those living with diagnosed HIV. In both years fewer than 1% of those living with diagnosed HIV were aged under 15 years. The value for 2022 was too low to register on the chart but was not zero.

By 2022, the median age for those living with diagnosed HIV was around 50 years for almost all transmission groups (from 49 years for GBMSM to 52 years for heterosexuals and those who probably acquired HIV via injecting drugs). The exception was the group made up of those who probably acquired HIV via mother-to-child transmission. This group had a median age of 27 years.

Figure 20. Diagnosed HIV prevalence per 1,000 residents by ethnic group (all ages), London, 2022

Source: UKHSA, HARS.

Figure 20 is a column chart which shows the prevalence of diagnosed HIV by ethnic group for Londoners in 2022. Rates are per 1,000 population. They are not age-restricted as age-restricted denominator data was not available which means they are sensitive to differences in age distribution.

The ethnic group with the highest rate was the black African group (15.7). The white ethnic group had a rate of 3.4, but the white British population has an older age distribution than the other groups, which may cause the rate for the white group to be artificially depressed in relation to other groups.

Figure 21. Rate of HIV diagnoses per 100,000 population by Index of Multiple Deprivation decile, London, 2022

Source: UKHSA, HARS

Figure 21 is a column chart. It shows rates of diagnosed HIV prevalence for London residents by decile of deprivation for 2022. Deciles are calculated for England as a whole and patients are assigned on the basis of their lower super output area (LSOA) of residence. These rates are not age restricted.

The chart shows that the diagnosed prevalence rate for areas of London that fell into the most deprived decile (decile 1) was 6 times the rate for areas that fell into the least deprived decile. While not everyone who lives in an area of higher deprivation may be deprived, the differences seen suggest that people living with diagnosed HIV are also at higher risk of additional stresses relating to financial pressures. For some people these may have an impact on their ability to access HIV-related services.

Figure 22. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by local authority, London, 2022

Source: UKHSA, HARS.

Figure 22 is a column chart which displays the prevalence of diagnosed HIV by London local authority of residence. Rates are restricted to those aged 15 to 59 years and are by 1,000 population. As with the previous charts of this type, local authorities are shown in descending order. The pattern is similar to that seen for new HIV diagnoses: inner London local authorities with more diverse populations had higher rates while rates in outer London local authorities were lower. The highest rate was seen in Lambeth (12.2) and the lowest in Kingston upon Thames (1.95). This borough is the only local authority where the rate was below the 2 per 1,000 threshold, above which expanded testing is advised. Fifteen of London’s 33 local authorities had rates above the 5 per 1,000 threshold beyond which rates are considered to be very high and 4 had rates above 10 per 1,000.

Figure 23. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by local authority, London, 2022

Source: UKHSA, HARS.

Figure 23 is a map. It displays the same information as figure 16 but shows more clearly the difference in diagnosed prevalence in inner London local authorities compared to those in outer London. The map is shaded to show 4 rate bands, the highest of which is 5+ per 1,000 population aged 15 to 59 years. All inner London local authorities fall into this band other than Wandsworth, whereas in outer London only a minority of local authorities do: Haringey, Greenwich, Croydon and Newham. This reflects the greater diversity of inner London populations and also higher rates of deprivation.

Figure 24. Diagnosed HIV prevalence per 1,000 residents (all ages) by middle super outer area of residence London, 2022

Source: UKHSA, HARS.

Figure 24 is a map. It displays the prevalence of diagnosed HIV by London middle super output area (MSOA) of residence in 5 rate bands for the year 2022. Unlike the local authority level map, rates are not age restricted. This reflects the smaller size of an MSOA which is a geographical unit with populations of around 7,500. It shows that there are areas of inner London that have higher rates even than inner London as a whole. These are usually areas with large GBMSM populations. There are also areas of raised prevalence outside inner London. These include areas like the Thames Gateway area (the area that runs along either side of the river in outer east London) where relatively affordable housing built in the last couple of decades has attracted migrants from Africa and other parts of the world.

Figure 25. The continuum of HIV care, 2022

Source: UKHSA, HARS, MPES model.

Figure 25 shows the continuum of care for Londoners living with HIV in 2022. This shows the progress that London is making in relation to the UNAIDS 90-90-90 target and the higher 95-95-95 target (10). The chart consists of 4 columns with a y-axis which shows a percentage. A red line across each column shows the height that is needed for the column to meet the 90-90-90 UNAIDS target.

The first column represents all Londoners living with HIV, both diagnosed and undiagnosed and is therefore set to 100%. The second shows the percentage of those living with HIV who are diagnosed (96%), the third the percentage of those living with HIV who are diagnosed and on treatment (94%) and the fourth the percentage of those living with HIV who are diagnosed, on treatment and successfully virally suppressed (92%). If people are virally suppressed, they cannot transmit HIV to others.

The percentages and the column heights relate each group to the total number of those living with HIV. However, the UNAIDS target relates each group to the group that precedes it. In other words, 90% of those living with HIV should be diagnosed, 90% of those diagnosed should be on treatment and 90% of those on treatment should be virally suppressed. Therefore, between each column there is an arrow. This shows the relationship of each column to the one before it. The first arrow contains 96% as there is no difference: in both approaches the second column is looked at in relation to the first. The second arrow contains 98% as the 94% of those living with HIV who are on treatment are 98% of those who are diagnosed. The third arrow contains 97% as this is the percentage of those on treatment who are virally suppressed. This means that in 2022 London achieved 96-98-97, exceeding both the standard and higher UNAIDS targets.

Figure 26. HIV test coverage by population group, London residents, 2018 to 2022

Source: UKHSA, GUMCAD.

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

Figure 26 is a line chart displaying HIV test coverage for Londoners attending specialist sexual health services from 2018 to 2022 as percentage of eligible attendances. An attendance will not be eligible for inclusion in the denominator if a person is already known to be living with HIV. Four groups are shown: all residents, all men, all women and GBMSM. Throughout the 5-year period GBMSM had the highest coverage, although this declined from 88% in 2018 to 73% in 2022. Women had the lowest test coverage, and this also declined from 61% in 2018 to 42% in 2022. HIV test coverage for all men declined from 82% in 2018 to 68% in 2022.

Some HIV tests are performed in settings other than at specialist SHSs. These include tests done through online consultations. It is not currently possible to include these in the HIV testing coverage measure. There are 2 reasons for this. Firstly, online and other non-specialist SHSs are not mandated by the British Association of Sexual Health and HIV (BASHH) to offer an HIV test to everyone. Secondly, they may not code and report the outcome of an HIV test in their GUMCAD submissions. Women who become pregnant will be offered HIV testing as part of their antenatal screening. Tests done as part of antenatal screening are not included in this chart.

Table 2. People tested for HIV by population group, London residents attending all SHSs, 2018 to 2022

Gender and sexual orientation	2018	2019	2020	2021	2022	% change 2018 to 2022	% change 2021 to 2022
Heterosexual men	124,493	130,558	85,292	87,727	99,094	-20%	13%
GBMSM	60,485	70,639	65,767	73,119	87,298	44%	19%
Subtotal (men)	192,188	211,420	158,583	172,189	196,988	2%	14%
Heterosexual and bisexual women	186,981	202,394	156,273	168,859	180,016	-4%	7%
WOSW	1,333	2,371	2,646	4,714	6,638	398%	41%
Subtotal (women)	196,379	215,497	165,835	182,070	194,880	-1%	7%
Total	390,888	430,804	326,730	358,550	400,313	2%	12%

Source: UKHSA, GUMCAD.

Table 2 differs from the preceding figure in that it shows information about HIV testing for Londoners attending all sexual health services from 2018 to 2022, rather than specialist only. Numbers include people tested as a result of consultations via online services. Residence information for online consultations may be less robust than that for consultations in specialist SHS. The proportion of HIV tests via online services has increased rapidly since the pandemic. The table shows numbers of people tested for each year and proportional change from 2018 to 2022 and from 2021 to 2022. In addition to the overall total, numbers are provided by gender and, within gender, by sexual orientation.

The table shows that, while the proportion of men tested has remained roughly stable over the 5-year period at just under half of those with a known gender, this masks a decline in HIV tests in heterosexual men both in absolute numbers of men tested and compared to GBMSM. Absolute numbers of heterosexual men tested decreased from 124,493 in 2018 to 99,094 in 2022, a decline of 20%, but did increase by 13% from the 87,727 tests reported for 2021. Even allowing for a slight decrease in the percentage of men for whom sexual orientation was reported over the 5-year period (from 96% to 95%), the number of heterosexual men tested as a percentage of men with known sexual orientation decreased from 67% in 2018 to 53% in 2022.

For GBMSM the number reported for 2022 was the highest over the period of comparison: 87,298 GBMSM tested, a 44% rise on the 60,485 tests reported for 2018.

The number of women tested for HIV in 2022 was 194,880, similar to the 196,379 recorded for 2018, the start of the comparison period. The proportion of women for whom sexual orientation was reported remained stable at 96%. Where sexual orientation was known, the percentage of WOSW tested for HIV increased from 1% (1,333) in 2018 to 4% (6,638) in 2022, an increase of 398% over the comparison period. Whilst the number of those in this group who were tested was small in relation to the heterosexual and bisexual women group, it nevertheless partially masked a slight drop (4%) in the number of those tested in the heterosexual and bisexual women group (from 186,981 to 180,016) over the 5 years.

Figure 27. HIV pre-exposure prophylaxis (PrEP) need and initiation or continuation in residents attending specialist sexual health services (SHSs), London, 2022

Source: UKHSA, GUMCAD.

Figure 27 is a column chart showing information about PrEP need and use by gender and sexual orientation in 2022. The first column represents the percentage of London residents attending specialist SHSs who were determined to need PrEP based on clinical and other information. The second column shows the percentage of those in need in PrEP whose PrEP need was identified by the service and the third shows the percentage of those in need of PrEP for whom PrEP was initiated or continued. These 2 final columns for each group must be looked at in relation to the first column.

GBMSM had by far the highest need for PrEP (70%). Of these, 84% had their need identified and PrEP was initiated or continued for 79%. These proportions are slightly lower than for last year.

The group with the next highest level of need was women who only have sex with women, but the percentage was much lower (4%) and the absolute numbers for this group were also much lower than for any other group.

Figure 28. Lower and upper level estimates for the number of people living with HIV with transmissible levels of virus, London, 2022

Source: UKHSA, HARS.

Figure 28 is a pair of data visualisations showing the proportions of Londoners living with transmissible levels of HIV in 2022 by sub-category. Each chart, one of which shows lower-level estimates and the other upper level estimates, is a stacked bar chart.

The first chart, displaying lower-level estimates, shows that the lower level estimate of Londoners living with transmissible levels of HIV in 2022 was 6,317.

Of those, 1,400 were undiagnosed (first section of bar). This number is a point estimate from the Multi-Parameter Evidence Synthesis (MPES) model of undiagnosed infections (11).

A further 198 people were known to be newly diagnosed in 2022 but had no corresponding record of being seen for care during the year (second section of bar).

The third section of the bar shows there were 3,035 people who had not been seen for care in the 15 months to the end of 2022, but who had been seen for care in the 12 months prior to that and who had not been reported as having died.

The fourth section of the bar shows the number who were seen for care in 2022 but who were specified as not being on treatment. There were 777 Londoners in this category.

In the fifth and final section of the bar, a further 907 people were reported as in care and on treatment but not virally suppressed (with a viral load greater than or equal to 200 copies/ml of blood).

The second chart shows that the upper-level estimate of Londoners living with transmissible levels of HIV in 2022 was 10,696. This number is 4,379 higher than the lower estimate. The main difference in the composition of this chart, compared to the lower-level estimate chart, is the final section, which includes people who had been diagnosed with HIV and previously reported as London residents, but who were not seen for care over the 5 year period ending in 2022 (excluding those known to have died). This group (4,182 people) is excluded from the upper chart as it may include individuals who have left the UK or died but not been identified by the HIV surveillance system. There may also be some people have changed their personal identifiers so that new records are failing to be matched with existing ones for the individual.

Information on data sources

HANDD

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.

SOPHID

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

Confidence intervals for rates in the figures have been calculated to the 95% level using the Byar’s method; confidence intervals for percentages have been calculated to the 95% level using the Wilson Score method. Confidence intervals presented in the text are produced by Bayesian analysis.

ONS mid-year estimates for 2021 were used as a denominator for rates for 2022 by local authority of residence. ONS mid-year estimates for 2020 were used as a denominator for rates for 2022 by middle super output area of residence. ONS estimates of population by ethnic group for 2021 were used as a denominator for rates for 2022 by ethnic group.

The data behind charts showing absolute numbers may have been adjusted for missing information; however, unless stated otherwise, the numbers in the summary section are the numbers as reported, that is, unadjusted counts. Where charts are displaying adjusted data this is indicated in the chart title.

The denominators for all percentages exclude records for which information was unknown, this means that the proportion of new diagnoses where probable route of infection was sex between men would be calculated using new diagnoses for which route of infection was known as the denominator.

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

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

Further information

For further information on a whole range of sexual health indicators, see Sexual and Reproductive Health Profiles.

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

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

For the national HIV report 2022 data, see HIV testing, PrEP, new HIV diagnoses and care outcomes for people accessing HIV services: 2023 report.

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.seal@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 Field Service team at FES.SEaL@ukhsa.gov.uk

If you have any comments or feedback regarding this report or the Field Service, contact josh.forde@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 HIV and STI surveillance teams for collection, analysis and distribution of data

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