World AIDS day and the UK situation - cautious optimism but no room for complacency

I suspect most of us who are old enough remember the advertising campaign - the menacing HIV iceberg reminding us that the Human Immunodeficiency Virus (HIV) can strike almost anywhere. Long gone, thank goodness, are the days of assuming that the 'gay plague' could only affect men having sex with men. These days, I see far fewer headlines about the condition than I did when I was a medical student - and far fewer people with AIDS. But that certainly doesn't mean HIV has gone away.

This week sees the launch of HIV Testing Week in the run-up to World AIDS Day on 1st December. According to UK records, there were no people diagnosed with HIV in the UK until 1981. In 1984-5 the numbers rose sharply, then levelled out at about 3,000 new diagnoses a year. 1999 saw levels begin to rise again, peaking in 2005 with about 8,000 people newly diagnosed. Since then, new diagnoses of HIV have dropped slowly but steadily, with about 6,300 people diagnosed in 2012. (1)

It can be difficult, of course, to pinpoint how people were exposed to the virus. However, about 32,500 men were diagnosed last year after sex with men (up from 2,000 in 2002) and the number of heterosexuals infected after sex in the UK has been stable for most of the last decade at about 1,500 a year. (1) The number of people diagnosed with HIV after heterosexual sex abroad, which peaked in 2003-4 with about 2,500 people diagnosed a year, has fallen year on year since then to about 1,300 people a year today. Some safe sex messages, it seems, are getting through. But there is no room for complacency. Compared to 2002, when almost three quarters of new cases of infection among heterosexuals came from abroad, almost half of heterosexuals diagnosed with HIV today are thought to have been infected in the UK.

We have undoubtedly made progress in some aspects of our fight against HIV. Routine antenatal testing and treatment mean that today, over 99% of babies born to infected mothers will not be infected around birth. The development of a raft of antiretroviral medicines since the mid-1990s has totally changed the outlook for healthy lifespan - with early diagnosis and treatment, a man infected with HIV at the age of 30 can expect to live to 75 and may die of a completely unrelated condition.

Access to effective treatment in the UK is something we can be proud of too - 88% of people suitable for treatment are receiving antiretroviral therapy. This improved survival has shifted the age of the 'typical' patient receiving HIV care upwards. In 2002, one person in nine accessing HIV care was over 50; now, that figure is one in five.

But the outlook for people diagnosed and treated late remains much less rosy - and it's thought that up to 30% of the 96,000-ish people with HIV in the UK aren't aware that they are infected. It's estimated that up to one in 20 men having sex with men has HIV, but only 35% of them were diagnosed late. By contrast, black African women are as likely as men having sex with men to have HIV, but much less likely to get tested at an early stage - 61% of them are diagnosed at a late stage, when the likelihood of developing AIDS is much higher. What's more, antiretroviral therapy can reduce the viral 'load' to undetectable levels, which may reduce the risk of passing it on to someone else.

HIV need no longer be the killer that it once was - but we bury our heads in the sand at our peril.


1. HIV and STI Department, Health protection agency, Colindale:

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