National HIV Testing Week

National HIV Testing Week takes place between 5 and 11 February 2024. Public health policy is devolved; this briefing discusses HIV testing, treatment and policy arrangements in England.

National HIV testing week

National HIV Testing Week is an annual campaign run by HIV Prevention England, running between 5 and 11^th February in 2024. It aims to promote regular testing in England, particularly among groups at increased risk of contracting HIV.

The campaign is supported by the Terrence Higgins Trust, and testing kits are funded by the Department of Health and Social Care.

As part of the campaign, people can order free testing kits. Home test kits are self-administered and produce a result within 15 minutes. Alternatively, people can return the test kit to a lab via the post, which will then follow up with a result.

Background

HIV

Human immunodeficiency virus (HIV) damages cells in the immune system and weakens a person’s ability to fight infections and disease. HIV is distinct from acquired immune deficiency syndrome (AIDS) – a term used to describe a range of infections and illnesses which can result from a weakened immune system caused by HIV. If HIV is left untreated, it can lead to AIDS.

HIV can be transmitted from one person to another through bodily fluids, including semen, vaginal and anal fluid and blood. HIV can also be transmitted through sharing needles, syringes or other injecting equipment, or from mother to baby during pregnancy, birth or breastfeeding. HIV cannot be transmitted through sweat, urine or saliva. In the UK, the most common way of getting HIV is through having anal or vaginal sex without a condom.

Some groups of people are at higher risk of becoming infected with HIV. These include:

• People with a current or previous partner with HIV.
• Men who have unprotected sex with men, people who inject drugs and share equipment.
• People who have received a blood transfusion, transplant or other risk-prone procedures in countries that do not have strong screening for HIV.

The NHS website provides information about HIV and AIDS, treatment and prevention.

Statistics 

Around 102,150 people were living with diagnosed HIV infection and accessing care in the UK in 2022. Numbers have tended to increase year on year over the past decade, rising by 27% since 2013 (80,560 people)

As the chart below illustrates, in each year men make up around two thirds of those living with HIV.

Source: UK Health Security Agency HIV: annual data tables – UK tables

The number of newly diagnosed cases of HIV showed a declining trend between 2014 and 2021, before increasing by 19% in 2022 – up from around 3,400 new cases in 2021 to 4,040 in 2022.

This increase was largely explained by a rise in cases which were first diagnosed outside the UK, a 63% increase from 864 in 2021 to 1,411 in 2022. These infections were likely acquired abroad and therefore do not reflect a rise in transmission in the UK.

Source: UK Health Security Agency HIV: annual data tables – UK tables

Further information is available from the latest UK Health Security Agency publication: HIV testing, PrEP, new HIV diagnoses and care outcomes for people accessing HIV services: 2023 report

Treatment

HIV is treated using antiretroviral medicines. They stop the virus replicating in the body and allow the immune system to repair itself and prevent further damage. The aim of HIV treatment is for the affected person to have an ‘undetectable viral load’, meaning the level of HIV in the body is too low to be detected by a test.

Prevention 

Pre-exposure prophylaxis (PrEP) describes a practice where a HIV-negative person takes antiretroviral medication to reduce the likelihood of contracting HIV from an infected partner. PrEP can be taken regularly, or alternatively, immediately before and after sex. PrEP is available as tablets that contain two medicines called tenofovir disoproxil and emtricitabine. People at higher risk of contracting HIV can obtain PrEP from sexual health clinics.

The risk of transmitting HIV can also be reduced by using male or female condoms or lubricant during sex and not sharing needles and other injecting materials during drug use.

People can contact their local sexual health service to access HIV testing, prevention and treatment.

HIV testing in England

In England, local authorities are responsible for providing HIV testing services, along with other public health services. Each local authority receives an allocation from the Government’s ring-fenced public health grant. Under the grant, the DHSC has made £3.6 billion available to local authorities for 2024/25. Local authorities may directly provide or commission sexual health services, and providers commonly include general practice, sexual health clinics and community partners. People wishing to access HIV testing can contact their local sexual health service.

Some areas of England are subject to opt-out testing. This is where patients attending A&E departments automatically have their blood samples tested for HIV, hepatitis C and hepatitis B, unless they choose not to.

In the HIV Action Plan (2021), the Department for Health and Social Care (DHSC) said that NHS England and NHS Improvement would expand opt-out testing in emergency departments in the highest prevalence local authority areas, and would invest £20 million over the next three years to support this activity.

Within the first 18 months, the NHS England HIV opt-out testing programme preliminarily identified 578 people newly diagnosed with HIV, and 344 people previously diagnosed but disengaged from care. The UK Health Security Agency published a 12-month interim report evaluating the programme (November 2023). It concluded that “the programme has demonstrated that opt-out [emergency department blood borne virus] testing can be delivered at scale” but identified that improvements could be made in operational aspects and links to further care.

NHS England now provides opt-out testing in all A&E departments in London. In November 2023, DHSC announced £20 million funding from the National Institute for Health and Care Research to support a research project to evaluate and expand opt-out testing in England. 47 emergency departments covering 32 areas of high HIV prevalence will be included within the project. Funding will support 12 months of testing for each emergency department, to begin in the 2024/25 financial year.

For background on opt-out testing in England, see section 2.5 of the Library’s briefing, National HIV Testing Week 2023.

The HIV Action Plan for England

In 2019, the Government set out an ambition to achieve zero new HIV infections, AIDS and HIV-related deaths in England by 2030.

Welcoming this ambition, three national charities, Terrence Higgins Trust, National AIDS Trust and Elton John AIDS Foundation established the HIV Commission to support its delivery. The Commission, which has been endorsed by government, considered how the Government could achieve the 2030 target and published its recommendations in a December 2020 report. This included:

• England should take the necessary steps to be the first country to end new HIV transmissions, by 2030, with an 80% reduction by 2025.
• National government must drive and be accountable for reaching this goal through publishing a comprehensive national HIV Action Plan in 2021.
• HIV testing must become routine – opt-out, not opt-in, across the health service.

In December 2021, the Department for Health and Social Care (DHSC) published Towards Zero: HIV Action Plan for England 2022 to 2025.

Principally, it set out how the Government intends to achieve the interim ambition, set by the HIV Commission, of reducing new HIV transmissions in England by 80%, by 2025. It also sets out progress the Government hopes to make by 2025, towards its 2030 ambition of zero new HIV infections, AIDS and HIV-related deaths in England:

1. To reduce the number of people first diagnosed in England from 2,860 in 2019, to under 600 in 2025.
2. To reduce the number of people diagnosed with AIDS within 3 months of HIV diagnosis from 219 to under 110.
3. To reduce deaths from HIV/AIDS in England from 230 in 2019 to under 115.

On 7 June 2023, the DHSC published the first of its annual updates to Parliament on progress made towards the HIV Action Plan, which highlights key achievements under each of the Plan’s objectives.

It reports a 32% reduction in the number of new HIV diagnoses made in England, between 2019 and 2021. In the same period, the number of people diagnosed with AIDS fell by 21%.

The update acknowledges progress made so far but cautions that progress towards HIV elimination is unevenly distributed across population groups.

For further discussion on the Plan, progress made towards its objectives and other health targets, see the Library’s briefing, Debate on the HIV Action Plan Annual Update, 2022-23.