A new report by Public Health England shows that for the first time the number of new HIV diagnoses in gay and bisexual men outnumber new diagnoses in heterosexual adults by only 100 cases.

The number of gay and bisexual men (GBM) with newly diagnosed HIV fell to the lowest point in 20 years, according to a new report from Public Health England (PHE) published today.

The report shows there were 1,700 new HIV diagnoses in GBM in 2019 compared to 1,500 in 2000.

Overall, the number of people with a new HIV diagnoses fell by 10% (from 4,580 in 2018 to 4,139 in 2019). There was also a 34% decline from a peak of 6,312 new diagnoses in 2014.

There were 1,700 new HIV diagnoses in gay and bisexual men (GBM) in 2019 compared to around 1,600 cases in heterosexual adults. This is the lowest number of new HIV diagnoses in GBM since the year 2000 (1,500) and since 1998 in heterosexual adults (1,600).

HIV transmission in GBM has fallen by 80%; newly acquired HIV infections fell from an estimated peak of 2,700 cases in 2011 to an estimated 540 in 2019 (see background information).

While the proportion of people diagnosed late remained high at 42%, the overall number decreased from around 1,900 in 2015 to 1,300 in 2019. People diagnosed late in 2019 had an eight-fold risk of death compared to those diagnosed promptly.

The decline in HIV transmission in GBM can be directly linked to the increase in combination prevention, including:

• the use of condoms

• pre-exposure prophylaxis (PrEP)

• frequent HIV testing in a wide range of settings

• starting antiretroviral therapy (ART) as soon as possible after diagnosis

Treatment is now so effective that 97% of people receiving ART have undetectable levels of virus, which means it is impossible to pass the virus on, even if having sex without condoms. Undetectable = untransmittable (U=U).

HIV testing is vital for preventing HIV-related illness and death and to achieve the goal of ending HIV transmission in the UK by 2030. The UK continues to meet the United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 targets for the third consecutive year – however, there are opportunities to improve uptake of testing and support those testing positive to continue their treatment.

Almost 300,000 people declined to have an HIV test when they attended a specialist sexual health service. Black African heterosexual women attendees were more likely to decline a test than Black African heterosexual men (20% versus 9% declined testing) but less likely than heterosexual women and men overall (25% versus 13%). More focused conversations on HIV, testing, prevention and treatment in schools and clinical settings can help to combat high rates of declined tests.

By comparison, only 4% of GBM attending specialist sexual health services declined an HIV test – this is the group in which greatest declines in HIV transmission have been achieved.

Dr Valerie Delpech, Head of HIV Surveillance at PHE, said:

In the UK, we have made great progress towards eliminating HIV transmission by 2030. Frequent HIV testing, the offer of PrEP among those most at risk of HIV, together with prompt treatment among those diagnosed, remain key to ending HIV transmission by 2030.

Further progress can only be achieved if we also address the inequalities in reducing HIV transmission that exist around sexuality, ethnicity and geography.

The most common way of getting HIV in the UK is through sex with a person who is unaware of their HIV infection.

You can protect yourself from HIV by consistent and correct condom use with new and casual partners, by using PrEP, or if your partner is on treatment and is undetectable if they are living with HIV. Correct and consistent condom use will also stop you getting or transmitting other sexually transmitted diseases (STIs).

People can get tested through free tests available from sexual health clinics, GP surgeries, as well as through a self-sampling service or by using a self-testing kit.

Background information

Those at risk of HIV and STIs can still access services through sexual health clinics during the COVID-19 pandemic. Many clinics offer online testing, which means people can order tests using clinic websites, take them in the privacy of their own home, return by post and receive results via text, phone call or post.

New HIV diagnoses reflect diagnoses that occurred within a year. Since people can live with HIV for many years without being aware of their HIV infection, trends in diagnoses do not necessarily reflect trends in newly acquired infections. We use models to estimate newly acquired infections (infections acquired recently) for gay and bisexual men only.

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However, Public Health England (PHE) said challenges around the virus remain, with figures showing that almost half the people newly diagnosed last year were at a late stage of infection, increasing their risk of death.

Diagnoses fell by just over a quarter (28%) from 6,271 in 2015 to 4,484 in 2018, PHE said, adding that the continued decline in the virus was down to the success of preventive measures.

These include HIV testing, condom provision, more use of the pre-exposure prophylaxis (PrEP) drug – taken before sex by HIV-negative people at high risk of contracting the virus – and drugs that keep the level of HIV in the body low and prevent the virus being passed on, known as anti-retroviral therapy (ART).

The biggest falls in new diagnoses have been among gay and bisexual men, particularly those who are white, born in the UK, aged between 15 and 24 and living in London, the figures show.

During the same period, between 2015 and 2018, diagnoses fell by 24% among people who got HIV through heterosexual contact.

Last year, 43% of people were diagnosed at a late stage of infection. Late diagnoses increase the risk of death within a year up to tenfold, compared with people diagnosed promptly, PHE said.

The public health minister, Jo Churchill, welcomed the overall drop in diagnoses, but vowed not to be complacent as the government works towards a target of having no new HIV transmissions by 2030.

She said: “I am delighted to see new figures released today which show we are well on our way to achieving our ambition of zero HIV transmissions in England by 2030, with HIV diagnoses at their lowest level since 2000.

“This decline in diagnoses is a result of our unwavering commitment to prevention which has led to more people getting tested, and has allowed people with HIV to benefit from effective treatment, stopping the virus from spreading further.

“However, I am not complacent and remain dedicated to ensuring we reach our target of zero new HIV transmissions by 2030.”

The Terrence Higgins Trust has called for wider access to the three-year PrEP trial, which recruited more than 13,000 participants by June this year and is scheduled to end next year.

Ian Green, the chief executive at the trust, said: “In light of today’s data from Public Health England, we’re urging NHS England, the Department of Health and local councils to immediately begin planning for PrEP to be given a home as part of routine sexual health services.

“Raising awareness of PrEP outside of the gay community will also go a long way in helping us to reach zero transmissions by 2030.”

The drug is almost 100% effective at preventing HIV when taken as prescribed. It involves a pill containing a combination of two anti-HIV drugs, emtricitabine and tenofovir, taken daily or around the time of sexual activity.

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Blood pressure is the pressure of circulating blood against the walls of blood vessels. It is one of our main vital signs and one of the most commonly monitored variables in all types of medical check-ups, in triage before admission to hospital, etc., and is an especially informative parameter of the general condition of a patient. Blood pressure varies greatly from one individual to another, is subject to circadian rhythms, and is affected by stress, nutritional factors, medication intake and disease. It is a universally understood measure, and is essential from a clinical point of view. In addition, high blood pressure increases the risk of heart attack and strokes, while lower blood pressure is seen as positive.

In terms of health monitoring, a key element in the transition toward preventive health systems, accurate and continual monitoring of blood pressure is widely seen as a fundamental parameter. Knowing a patient’s heart rate, at a time when more and more people are using wearables such as the Apple Watch, which provide continuous recording through photoplethysmography or even a pretty reliable electrocardiogram, is certainly useful, but more important is being able to combine that information with other parameters. Talking to cardiologists, the parameter they all say is most useful for diagnoses, besides heart rhythm, is blood pressure.

Now, a group of researchers from the University of Toronto have come up with a way to measure blood pressure accurately using a smartphone camera and a procedure similar to taking a selfie. The measurement is carried out by transdermal optical imaging: the light emitted by the smartphone camera bounces off the proteins near the surface of the skin at different speeds, allowing a minimal measurement of changes in hemoglobin, which with a battery of 900 images taken in 30 seconds provides an accurate blood pressure reading.

It’s not clear yet whether the procedure works for all skin types, which is important given the higher incidence of high blood pressure and associated mortality in black people, but the idea, without a doubt, has potential, because dedicating thirty seconds a day to taking one’s blood pressure is not difficult and could help detect numerous health problems early. In addition, regardless of whether something is detected or not, the information collected could, if shared, feed numerous studies and contribute to the advancement of medical science as a whole.

Wearables of various types that record our vital parameters, beds that monitor our sleep, simple but precise analytics that replace checks we used to carry out once a year or less, and artificial intelligence to process all these data are just some of the elements that will radically alter healthcare in the coming years, based on a pro-active approach rather than waiting until we fall sick. This type of innovation and its possibilities, both for research and medical practice, have to be introduced into university programs as soon as possible if we want to see a real change in the mentality of health practitioners.

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