Research and analysis

Annual epidemiological spotlight on HIV in Yorkshire and Humber: 2022 data

Updated 8 August 2024

Applies to England

Summary

Interpreting epidemiological trends in human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) between 2019 and 2022 remains difficult due to the changes in HIV testing and access to sexual health and HIV services caused by the COVID-19 pandemic and followed by the mpox (monkeypox) outbreak (1). Although the number of people in England having an HIV test in sexual health services (SHSs) increased by 10% in 2022 compared to 2021 (1,155,551 in 2022 and 1,048,551 in 2021), the number remains lower than pre-pandemic levels (1).

HIV remains an important public health problem in Yorkshire and Humber. The rate of new HIV diagnoses increased 46% in 2022 compared to 2021. In 2022, Yorkshire and Humber had the highest rate of new HIV cases outside of London (6.5 new diagnoses per 100,000). Despite this, the prevalence of HIV in Yorkshire and Humber remains low at 1.6 per 1,000. Across the local authorities in Yorkshire and Humber, Leeds reported the highest rate of new HIV diagnoses (16 per 100,000), whilst Sheffield (11 per 100,000) and Hull (7 per 100,000) also reported rates above the regional average (6.5 per 100,000).

The rate of HIV per 100,000 remains highest in those in the most deprived deciles and lowest in the least deprived. Data for Leeds is undergoing assessment due a known reporting issue and may be subject to change in future publications.  

Among new cases who are Yorkshire and Humber residents, heterosexual contact accounted for the majority of new diagnoses (62%). 45% of all newly diagnosed cases were in people of black African ethnicity. Of all new diagnoses, 46% were late diagnoses, compared to 43% in England. Heterosexuals and people of White ethnicity were more likely to be diagnosed late.

In 2022, 41,673 people were tested in SHSs in Yorkshire and Humber which represents a 43% decrease in annual tests compared to 2018.

85% of those newly diagnosed in Yorkshire and Humber started treatment within 91 days. Of those people who were HIV negative and recognised as having a Pre-exposure prophylaxis (PrEP) need, 64% initiated or continued with PrEP.

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

New diagnoses

In 2022, an estimated 357 Yorkshire and Humber residents were newly diagnosed with HIV, accounting for 9% of new diagnoses in England. This number of new diagnoses represents a rise of 46% from 2021 and higher than in 2013 (347 diagnoses). 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 Yorkshire and Humber residents (6.5 per 100,000) was below that of England in 2022 (6.7 per 100,000) but higher than all regions outside of London. Considerable variation exists in the rate of new HIV diagnoses between local authorities in Yorkshire and Humber; the 2 local authorities with the highest rates (Leeds and Sheffield) are classified as areas of high diagnosed prevalence.

The proportion of all new diagnoses in Yorkshire and Humber that were in gay, bisexual and other men who have sex with men (GBMSM) continued to decline in 2022 (30% compared to 42% in 2021 and 42% in 2013). This corresponds to a 28% reduction in the number of GBMSM resident in Yorkshire and Humber newly diagnosed with HIV (106, adjusted for missing information) compared to 2013. Of the GBMSM newly diagnosed with HIV, 63% were white and 53% were UK-born. In Yorkshire and Humber, there has been a downturn in the proportion of new HIV diagnoses which are in GBMSM.

The proportion of new diagnoses through probable heterosexual contact has increased, reflecting national trends outside of London. This route of exposure was the largest infection route for new diagnoses in Yorkshire and Humber residents in 2022 (62%). Of these, infections in African born people accounted for 65% of all heterosexually acquired cases in 2022 (n=87), compared to 51% (n=82) in 2013.

Infections in UK born persons accounted for 20% of all heterosexually acquired cases in 2022. Similarly, a year-on-year increase in the proportion of new diagnoses in those previously diagnosed abroad has been observed since 2020. Black Africans represented 45% of all newly diagnosed Yorkshire and Humber residents in 2022 (compared to 32% in 2021 and 26% in 2013). A small proportion of new diagnoses in 2022 were in black Caribbeans (2%).

Injecting drug use accounted for just 3% of new diagnoses in Yorkshire and Humber residents in 2022.

Late diagnoses

Reducing late HIV diagnoses is one of the indicators in the Public Health Outcomes Framework. People who are diagnosed late have a tenfold higher risk of mortality within one year of diagnosis compared to those diagnosed promptly. Late diagnosis is defined as a CD4 count of less than 350 cells per cubic millimetre (cells/mm³)  at diagnosis.

A large proportion of late diagnoses is of particular concern nationally and regionally (46% of Yorkshire and Humber residents from 2020 to 2022 and 43% in England). Heterosexuals were more likely to be diagnosed late (54% of males, 40% of females) than GBMSM (39%). By ethnic group, black Africans were less likely to be diagnosed late than the white population (45% and 47% respectively).

People living with diagnosed HIV

The 5,946 people living with diagnosed HIV in Yorkshire and Humber in 2022 was 5% higher than 2021 and 40% higher than 2013. This increase is partly due to the effectiveness of HIV treatment, which has reduced the number of deaths from HIV, and partly due to the increasing number of new diagnoses.

The diagnosed prevalence rate of HIV in Yorkshire and Humber in 2022 was 1.6 per 1,000 residents aged 15 to 59 years. The 2 local authorities in Yorkshire and Humber with a diagnosed HIV prevalence in 2022 in excess of the threshold for expanded HIV testing (rate of 2 per 1,000 population aged 15 to 59 years) were Leeds (2.7) and Sheffield (2.1). The 2 local authorities which also have the highest rates of new HIV diagnoses.

The 2 most common probable routes of transmission for Yorkshire and Humber residents living with diagnosed HIV in 2022 were sex between men and women (59%) and sex between men (37%). The changing epidemiology of new HIV diagnoses in Yorkshire and Humber will increasingly impact on prevalence rates.

In 2022, 42% of those living with diagnosed HIV in Yorkshire and Humber were aged between 35 and 49 years, and 46% were aged 50 years and over (up from 23% in 2013). Males represented 62% of Yorkshire and Humber residents living with diagnosed HIV in 2022 and females represented 38%.

In 2022, 50% of Yorkshire and Humber residents living with diagnosed HIV were white and 39% 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 (28 per 1,000) than in the white population (1 per 1,000).

Continuum of HIV care

Excluding London, 98% of HIV diagnosed residents in England in 2022 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.

For Yorkshire and Humber residents diagnosed in 2022, the proportion starting treatment within 91 days of diagnosis for the period 2020 to 2022 was the same proportion as England: 85%.

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 infections.

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 is likely to vary by exposure group with the highest proportion undiagnosed estimated to be among:

• people living with HIV who inject drugs (8%, CrI 1% to 27%)
• non-black African heterosexual women (8%, CrI 6% to 12%)
• non-black African heterosexual men (7%, CrI 4% to 20%)

HIV testing

Since 2020, the proportion of HIV testing which takes place through online services has risen sharply. It is not currently possible to include these in the HIV testing coverage measure, for 2 reasons. 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 and secondly, they may not code and report the outcome of an HIV test in their Genitourinary Medicine Clinic Activity Dataset (GUMCAD) submissions. 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 SHSs following online testing (where further testing, treatment or care was required).

A total of 41,673 people were tested in SHSs in Yorkshire and Humber in 2022, a decrease of 43% since 2018. The overall HIV testing coverage at specialist SHSs in Yorkshire and Humber in 2022 was 46%, which compares to 48% across England. This coverage was higher in men (60%) than women (38%), and highest in GBMSM (80%).

PrEP

In 2022, 7% (6,753 out of 97,670) of HIV-negative Yorkshire and Humber residents accessing SHSs in England were defined as having a PrEP need, among whom 64% initiated or continued PrEP, slightly lower for England as a whole (71%). Of those with a PrEP need, 87% had this need identified at a clinical consultation. Among GBMSM, the group with greatest PrEP need, 72% were identified as having a PrEP need, of whom 89% were identified at a clinical consultation. 68% of those with a PrEP need initiated or continued PrEP.

HIV Action Plan

The 2022 to 2025 HIV Action Plan, which has been 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 immune deficiency syndrome (AIDS) by 50% between 2019 and 2025. This will be achieved by:

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

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

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

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

HIV prevention messages

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. On at least an annual basis everyone should have an STI screen, including an HIV test if they are 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 from specialist SHSs at no charge to the user and can be used to reduce an individual’s risk of acquiring HIV. Consistent use of PrEP can be an effective intervention to prevent HIV acquisition. Despite PrEP being routinely available through specialist SHSs, awareness, accessibility and uptake of primary prevention initiatives is variable for different population groups (1). HIV post-exposure prophylaxis (PEP) can be used to reduce the risk of acquiring HIV following some sexual exposures. PEP is available at no charge to the user from most specialist SHSs 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 can 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 SHSs are free to use 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

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

Figure 1 is a bar chart showing that London reported the highest rate of new HIV diagnoses per 100,000 population in 2022, with Yorkshire and Humber and East Midlands reporting the second and third highest rates (15.5, 6.5 and 6.1 respectively).

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

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

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

Figure 2 is a bar chart showing that Leeds reported the highest rate of new HIV diagnoses (16 per 100,000) in 2022 and Sheffield and Hull reported the second and third highest (11 and 7 per 100,000 respectively). The regional rate was 6.5 per 100,000.

Note: The number of new diagnoses will depend on accessibility of testing as well as infection and transmission. HIV diagnosed prevalence is defined as rate per 1,000 aged 15 to 59 years as per National Institute for Health and Care Excellence (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 does not relate to new diagnosis but to the data in the diagnosed prevalence section later.

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

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

Figure 3 is a line graph showing that between 2013 and 2022 the number of new HIV diagnoses has increased from 347 in 2013 to 357 in 2022. There was a decreasing trend from 2013 to 2020, which then became a sharp increase from 2020 to 2022. The number of deaths between 2012 and 2022 has also increased from 28 in 2013 to 37 in 2022. The number of deaths began to rise after 2018, however this coincides with improved ascertainment of death as a result of the National HIV Mortality Review.

It is however important to note that an extended reporting delay may be seen for deaths as these are not always notified directly to the HIV surveillance system. In addition, region of death may not be established immediately.

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

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

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

Figure 4 is a chart showing that between 2018 and 2022 the number of new HIV diagnoses previously diagnosed abroad has increased slightly, whilst the number of new HIV diagnoses not previously diagnosed abroad (NPDA) has remained stable.

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 5a. New HIV diagnoses by probable route of acquiring HIV (adjusted for missing route information), Yorkshire and Humber residents, 2013 to 2022

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

Figure 5a is a line graph showing that between 2013 and 2022 the number of new HIV diagnoses from the probable infection routes of sex between men and women and other infection routes increased from 185 to 223 and 15 to 28 respectively. All other probable routes of infection decreased.

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: New HIV diagnoses detailed ‘other’ route of acquiring HIV (not adjusted for missing information), Yorkshire and Humber residents, 2013 to 2022

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

Figure 5b is a line graph showing that the detailed breakdown for other routes of probable infection shows low numbers for each type of probable route, with 7 new diagnoses from intravenous drug use and other and 6 new diagnoses from mother-to-child.

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

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

Figure 6a is a bar chart showing that, of the new HIV diagnoses reported in 2022 in Yorkshire and Humber residents, the highest number of new diagnoses was reported in males. The largest number of new HIV diagnoses were reported in:

• the males aged 25 to 34 group (78 diagnoses)
• the males aged 35 to 44 group (59 diagnoses)
• the females aged 35 to 44 group (55 diagnoses)

Data for people aged under 15 was not included due to the development of a new surveillance system.

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

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

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

Figure 6b is a bar chart showing that the probable route of infection for most new HIV diagnoses in males was due to sex between men. This transmission route accounted for 75 cases compared to 68 which were transmitted via other routes. The age group reporting the largest number of new HIV diagnoses transmitted via sex between men was those aged 25 to 34 (36 new infections).

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

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

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

Figure 7a is a line graph that shows that between 2013 and 2022 the number of new HIV diagnoses probably acquired through sex between men has decreased in every age group except the 45 to 54 age group which has remained the same.

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. 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, Yorkshire and Humber residents aged 15 to 64 years, 2013 to 2022

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

Figure 7b is a line graph that shows that between 2013 and 2022 the number of new HIV diagnoses probably acquired through sex between men and women has decreased in every age group except the 35 to 44 age group which has increased and the 55 to 64 which has remained the same.

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. Number of new HIV diagnoses by ethnic group (adjusted for missing ethnic group information), Yorkshire and Humber residents, 2013 to 2022

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

Figure 8 is a line graph that shows that the number of new HIV diagnoses has increased in the black African and other ethnic groups between 2013 and 2022. The number of new HIV diagnoses have stayed consistent or decreased in every other ethnic group.

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 9. Number of new HIV diagnoses by world region of birth (adjusted for missing world region of birth information), Yorkshire and Humber residents, 2013 to 2022

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

Figure 9 is a line graph that shows that between 2013 and 2022, the number of new HIV diagnoses by region of birth has increased in the categories of those born in Africa and those born in all other countries. The number of new HIV diagnoses in people born in any other country has decreased since 2013.

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 10. Percentage of new HIV diagnoses, by local authorities of residence, that were diagnosed late, Yorkshire and Humber, aged 15 years and over, 2020 to 2022

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

Figure 10 is a bar chart showing that York was the local authority which reported the highest percentage of late HIV diagnoses, followed by Barnsley and East Riding of Yorkshire (100%, 89% and 86% respectively).

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

Figure 11a. Percentage and number of new HIV diagnoses by probable route of infection that were diagnosed late, Yorkshire and Humber residents, aged 15 years and over, 2020 to 2022

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

Figure 11a is a bar chart showing that amongst those aged 15 years and over, the percentage of new HIV diagnoses that were diagnosed late was highest amongst injection drug users (64%), between 2020 and 2022.

Note: Only includes new diagnoses in those aged 15 years or older with no prior diagnosis abroad and for which a CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count of less 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 11b. Percentage and number of new HIV diagnoses by ethnic group that were diagnosed late, Yorkshire and Humber residents, aged 15 years and over, 2020 to 2022

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

Figure 11b is a bar chart that shows that amongst those aged 15 years and over, the percentage of new HIV diagnoses that were diagnosed late was highest amongst people of White ethnicity (47%), between 2020 and 2022.

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

Figure 12. Percentage of new HIV diagnoses that were diagnosed late by probable route of infection and year of first UK HIV diagnosis, Yorkshire and Humber residents, aged 15 years and over, 2013 to 2022

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

Figure 12 is a line graph which shows that, in 2022, 100% of people with a new HIV infection from ‘Other Infection Routes’ were diagnosed late. Between 2013 and 2022 the percentage of new HIV infections acquired through sex between men and women, which were diagnosed late, decreased from 53% to 39%.  The percentage of new HIV infections acquired through sex between men, which were diagnosed late has increased from 25% to 40%.

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

Figure 13. Age distribution of new HIV diagnoses that were diagnosed late by year of first UK HIV diagnosis, Yorkshire and Humber residents, aged 15 years and over, 2013 to 2022

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

Figure 13 is a line graph which shows that between 2013 and 2022 the percentage of new HIV diagnoses diagnosed late in each age group has remained similar. The age group with the highest percentage of late diagnoses in 2022 is the 35 to 44 age group (27%).

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

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

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

Figure 14 is a bar chart that shows that HIV prevalence (per 1,000 residents) is highest in London (5.3 out of 1,000), followed by North West (2.0 out of 1,000) and West Midlands (1.9 out of 1,000). Yorkshire and Humber reports the third lowest HIV prevalence at 1.6 out of 1,000.

Figure 15. Number of residents living with diagnosed HIV and accessing care, Yorkshire and Humber, 2013 to 2022

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

Figure 15 is a line graph that shows that the number of people living with diagnosed HIV and accessing care has increased steadily from 4,260 in 2013 to 5,946 in 2022.

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

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

Figure 16 is a bar chart that shows that the number of residents living with diagnosed HIV and accessing care in Yorkshire and Humber, using data from 2022, is highest amongst those who have sex between men and women (3,486), and lowest amongst those whose likely transmission route was via blood or healthcare worker (65).

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

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

Figure 17 is a bar chart that shows that between 2013 and 2022 the percentage of those diagnosed with HIV and accessing care has decreased in all age groups, apart from for those who are aged 50 years or above. Amongst this age group it has increased from 23% to 46%.

Figure 18. Diagnosed HIV prevalence per 1,000 residents by ethnic group (all ages), Yorkshire and Humber, 2022

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

Figure 18 is a bar chart that shows that in Yorkshire and Humber between 2013 and 2022, people of black African ethnicity have the highest prevalence of HIV (28.1 per 1,000). Prevalence in all other ethnicities is below 5.0 per 1,000.

Figure 19. Rate of HIV diagnoses per 100,000 population by Index of Multiple Deprivation decile, Yorkshire and Humber, 2022

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

Figure 19 is a bar chart that shows that in 2022, HIV prevalence is highest in the Index of Multiple Deprivation decile 1 (2.1 per 1,000) and decreases as deprivation decreases.

Figure 20. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by local authority, Yorkshire and Humber, 2022

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

Figure 20 is a bar chart that shows that in 2022, HIV prevalence (per 1,000 residents) amongst those aged 15 to 59 in Yorkshire and Humber is highest in Leeds, followed by Sheffield and Barnsley.

Figure 21. Diagnosed HIV prevalence per 1,000 residents aged 15 to 59 years by local authority, Yorkshire and Humber, 2022

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

Figure 21 is a map which shows that in 2022, HIV prevalence (per 1,000 residents) amongst those aged 15 to 59 in Yorkshire and Humber is highest in Leeds with all other local authorities reporting lower rates.

Figure 22. Diagnosed HIV prevalence per 1,000 residents (all ages) by middle super outer area of residence Yorkshire and Humber, 2022

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

Figure 22 is a map which shows that In 2022, HIV prevalence (per 1,000 residents) amongst those aged 15 to 59 in Yorkshire and Humber is highest across a variety of middle super output areas including many in Leeds and Sheffield.

Figure 23. The continuum of HIV care, 2022

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

Figure 23 is a bar chart that shows that England, excluding London, surpassed the The Joint United Nations Programme on HIV and AIDS (UNAIDS) 90:90:90 target for HIV care in 2022, with 95% of individuals diagnosed with HIV knowing their infection status and of these 93% were on treatment and 91% had viral suppression.

Figure 24. HIV test coverage by population group, Yorkshire and Humber residents, 2018 to 2022

Source: UKHSA, GUMCAD.

Figure 24 is a line graph shows that between 2018 and 2022, HIV test coverage decreased across all population groups, with the largest decrease observed in males which reported 74% test coverage in 2018 and 60% test coverage in 2022.

Note: The proportion of eligible attendees at specialist SHSs who accepted a HIV test. An eligible attendee is defined as a patient attending specialist SHSs 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.

Table 1. People tested for HIV by population group, Yorkshire and Humber residents attending all SHS, 2018 to 2022

Gender or sexual orientation	2018	2019	2020	2021	2022	% change 2018 to 2022	% change 2021 to 2022
Heterosexual men	29,329	29,116	16,410	16,927	18,502	-37%	9%
GBMSM	6,369	7,567	7,199	10,585	10,999	73%	4%
Subtotal (men)	37,243	38,335	24,645	28,995	32,719	-12%	13%
Hetero/bisexual women	39,895	41,108	29,204	33,249	34,022	-15%	2%
Women who only have sex with women	237	277	397	627	511	116%	-19%
Subtotal (women)	41,986	43,351	30,700	35,451	37,793	-10%	7%
Total (all genders)	79,512	82,063	55,688	65,360	73,581	-7%	13%

Source: UKHSA, GUMCAD.

Table 1 shows that from 2018 to 2022 the number of people tested for HIV decreased in all population groups except women who only have sex with women (WOSW) and GBMSM which saw an increase of 116% and 73% respectively. The large percentage increase for WOSW may be in part due to the low numbers relative to the other sexual orientations. The largest decrease was in the heterosexual males (-37%).

Figure 25. HIV pre-exposure prophylaxis (PrEP) need and initiation/continuation in residents attending specialist sexual health services (SHS), Yorkshire and Humber, 2022

Source: UKHSA, GUMCAD.

Figure 25 is a bar chart that shows that recognised PrEP was substantial higher among GBMSM (72%) than any other population group (less than 1% to 8%). However, the identification of a need for PrEP during consultation was considerable for all other population groups, although highest in GBMSM (89%).

Initiation or continuation of PrEP was highest for WOSW (70%) and GBMSM (68%). Rates were much lower for heterosexual and bisexual women (34%) and heterosexual men (34%).

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 SHS, 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, SOPHID and 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.

Office for National Statistics (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 and the counts have not been adjusted. Where charts display adjusted data, this is indicated in the chart title.

The denominators for all percentages exclude records for which information was unknown. This means when calculating the proportion of new diagnoses where probable route of infection was sex between men, new diagnoses for which 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

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

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

Annual epidemiological spotlight on STIs in Yorkshire and Humber: 2022 data

Local authorities have access to additional HIV and STI intelligence via the Data Exchange and the HIV and STI web portal. They should also have received a set of tables containing HIV data specific to their authority. They should contact geraldine.leong@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 YHFS@ukhsa.gov.uk.

If you have any comments or feedback regarding this report or the, contact Eliza.Thompson@ukhsa.gov.uk or Gareth.Hughes@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’ UKHSA  December 2023