England is on track to have diagnosed 95% of people living with HIV by 2025, putting it in a position to eliminate HIV transmission by 2030, say researchers at the MRC Biostatistics Unit, University of Cambridge, and Public Health England (PHE).
In 2014, UNAIDS set an ambitious target of 90-90-90 by 2020 – that is, 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will have viral suppression.
According to the Cambridge and PHE team, in 2019 there were an estimated 105,200 people living with HIV in the UK, of whom 94% were aware of their HIV status. In addition, 98% of those living with diagnosed HIV were on treatment, and 97% of these were virally suppressed. In other words, England had already reached the HIV transmission UNAIDS goals.
In a publication today in The Lancet Public Health, the researchers extended their analysis of evidence from multiple surveillance, demographic, and survey datasets relevant to HIV in England from estimating HIV transmission prevalence in a single year to estimating the trends over time in HIV prevalence. Trends in the number of people living with HIV, the proportion of people unaware of their HIV infection, and the corresponding prevalence of undiagnosed HIV transmissions are reported.
According to their analysis, the estimated number of people in England living with HIV aged 15-74 years who were unaware of their infection were cut in half from 11,600 in 2013 to 5,900 in 2019, with a corresponding fall in prevalence from 0.29 to 0.14 per 1,000 people.
At the same time, the increase in the number of people living with diagnosed HIV resulted in the total number of people living with HIV rising from 83,500 to 92,800 over the same period. The percentage of people living with HIV whose infection was diagnosed therefore steadily increased from 86% in 2013 to 94% in 2019, reaching the UNAIDS target in 2016 – and even earlier, in 2013, for Black African heterosexuals.
“Overall, we see a positive picture for the HIV epidemic in England, with a dramatic fall in the number of people living with undiagnosed HIV,” says Daniela De Angelis, PhD, from the MRC Biostatistics Unit, the study’s senior author. “We estimate we are already several years ahead of the UNAIDS 2020 goals and are on target to reach 95% diagnosed by 2025 and to eliminate HIV infections by 2030.”
In England, gay, bisexual, and other men who have sex with men, and Black African heterosexuals remain disproportionately affected by HIV, with considerably higher undiagnosed HIV prevalence per population in 2019 than heterosexuals in other ethnic groups. However, undiagnosed HIV prevalence rates within these communities have seen dramatic falls: for gay, bisexual, and other men who have sex with men, prevalence fell from 13.9 to 5.4 per 1,000, and for Black African heterosexuals prevalence fell from 3.3 to 1.7 per 1,000 population.