By William J. Furney
The number of HIV diagnoses among heterosexual men and women in England has dramatically increased, with a rise of over 30% in new cases in 2023 compared to the previous year, according to the latest figures released by the UK Health Security Agency (UKHSA).
The increase, which is particularly steep among ethnic minorities, threatens the country’s ambitious target of ending HIV transmission by 2030 and highlights growing health inequalities.
Concerning Figures
The data from the UKHSA’s 2023 HIV surveillance report reveals a 36% increase in diagnoses among heterosexual men, rising from 445 cases in 2022 to 605 in 2023. Women saw a 30% increase, with cases jumping from 602 to 780. Ethnic minority heterosexuals have been disproportionately affected, experiencing a staggering 45% rise in new diagnoses.
“These figures are deeply concerning,” said Dr Tamara Djuretic, Co-Head of HIV at UKHSA. “It is clear that more action is needed to curb new HIV transmissions, particularly among heterosexuals and ethnic minority groups. Addressing these widening inequalities, ramping up testing, improving access to PrEP, and getting people started on HIV treatment earlier will all be crucial to achieving this.”
The Impact of COVID-19
While HIV testing has increased overall since 2022, it remains lower than pre-pandemic levels, particularly among heterosexual men and women. HIV testing in sexual health clinics fell by 10% among heterosexual men and by 22% among heterosexual and bisexual women since 2019, despite regular testing being vital to preventing further spread of the virus. In contrast, testing rates have increased by 34% among gay, bisexual, and other men who have sex with men (GBMSM).
The overall number of HIV diagnoses made in England in 2023 increased by 15%, from 2,451 cases in 2022 to 2,810 in 2023. This includes a 7% rise among GBMSM, with cases going up from 761 to 811. In total, when factoring in those diagnosed abroad, the number of HIV diagnoses in England rose by a remarkable 51%, highlighting the complexity of the challenge.
Inequality in HIV Care
Health officials warn that the rise in cases has disproportionately affected ethnic minority groups, with 33% of diagnoses among GBMSM occurring in ethnic minority men in 2023, compared to 26% in 2019. The disparities reflect broader social and economic inequalities that influence access to healthcare, including HIV testing and treatment.
“HIV can affect anyone, no matter your gender or sexual orientation,” said Dr Djuretic. “Getting regularly tested and using condoms are key to protecting yourself and your partners’ health. An HIV test is free and provides access to prevention measures like PrEP.”
PrEP, or pre-exposure prophylaxis, is a preventative medication taken by individuals at high risk of contracting HIV. Since its introduction by the NHS in 2020, the number of people taking PrEP has increased annually, but health experts stress the need for broader availability, particularly among heterosexual and ethnic minority communities.
Government Action
The UK government has set an ambitious goal to end new HIV transmissions by 2030, outlined in its HIV Action Plan. However, the rising figures have put this target at risk. “This data shows we have much more work to do and brings to light concerning inequalities in access to tests and treatments,” said Public Health Minister Andrew Gwynne. “I will be working across government to ensure that we work to stop HIV transmissions for good.”
As part of its strategy, the government has rolled out an opt-out blood-borne virus testing programme in emergency departments, which is one factor contributing to the increase in HIV diagnoses. Clinics have also reported cases previously diagnosed abroad, adding to the rise in figures.
Advances in HIV Treatment and Potential Cures
Despite the rise in cases, there is hope on the horizon with significant advances in HIV treatment. Antiretroviral therapy (ART), which suppresses the virus and prevents transmission, has transformed HIV from a once-deadly disease into a manageable chronic condition. According to the UKHSA, 98% of those on treatment in England are virally suppressed, meaning they cannot pass the virus on to others.
Moreover, in recent years, several groundbreaking cases of HIV “cures” have been reported, albeit in specific and rare circumstances. The most well-known example is the “Berlin patient,” Timothy Ray Brown, who was cured of HIV following a stem cell transplant. Since then, a handful of other patients, such as the “London patient” and “Düsseldorf patient,” have been declared cured after undergoing similar procedures. But these treatments are currently not scalable or widely applicable, as they involve highly risky and expensive interventions typically reserved for treating life-threatening cancers.
Researchers are also exploring other potential cures, including gene editing techniques like CRISPR, which has shown promise in early trials by removing HIV from infected cells. While they’re not yet available to the public, they offer hope for the future of HIV treatment.
Making Progress
While progress in treatment has been remarkable, the rise in new diagnoses, particularly among heterosexual men and women, underscores the need for continued vigilance. Regular testing, prevention strategies like PrEP and addressing healthcare inequalities are vital to stemming the tide of new infections.
The UK government’s commitment to ending HIV transmission by 2030 remains in place, but as the UKHSA’s latest data shows, much more needs to be done to reach this goal. As Dr Djuretic notes, “Treatment is so effective that you can expect to live a long healthy life, and you won’t pass HIV on to partners. But we must act now to ensure everyone has access to this life-saving care.”
* Image shows HIV-infected cells using a scanning electron microscope. (Credit: National Informal STEM Education Network)