The COVID-19 pandemic has changed patterns of sexual behaviour, uptake of HIV testing, and access to sexual health and HIV services, according to a report released this week by the UK Health Security Agency (UKHSA).
The release of the annual HIV surveillance data for 2020 coincided with the release of the Government’s new HIV action plan for England, which sets out how the Government aims to achieve their commitment to end HIV infections and deaths by 2030.
The UKHSA data showed that the number of HIV diagnoses in England dropped by 33% last year, continuing the encouraging recent trend for year-on-year reductions in new HIV diagnoses.
However, this decline may be in part due to reduced testing and access to sexual health services during the COVID-19 pandemic, rather than solely a decline in new HIV infections. Data showed that the number of people receiving HIV tests fell by around 30% in 2020, and almost half the people testing ordered a self-test online.
In addition, fewer people with existing HIV infection accessed HIV care in 2020 than would have been anticipated.
The report points to other possible reasons for the decline in new diagnoses during the pandemic, including surveys that reported declines in the frequency of sexual activity and in numbers of sexual partners during the UK lockdowns.
“The continued decline in HIV diagnosis in England is encouraging”, said Dr Valerie Delpech, head of HIV surveillance at UK-HSA, “but last year’s data needs to be considered in the context of a COVID-19 pandemic which saw prolonged and unprecedented public health restrictions, coupled with intense pressure on health services, resulting in a decline in HIV testing overall.
“It is now crucial that we continue to ramp up testing and start people on treatment at the earliest possible opportunity.”
Reducing HIV transmission
The UKHSA data revealed differences in levels of new HIV diagnoses and uptake of HIV testing between different population groups in the UK.
The decline in new HIV diagnoses was most pronounced among gay and bisexual men - a reduction of 41% between 2019 and 2020. As levels of testing for HIV remained high in this group (7% lower than in 2019 but higher than 2018), this decline appears to reflect genuine falls in HIV transmission.
Among gay and bisexual men, the decline in new diagnoses was highest among White men, men living in London, and younger men.
There was a much sharper decline in testing among heterosexual men and women, with around a 33% reduction in testing compared with 2019. This suggests that the 23% drop in new HIV diagnoses in this group may reflect reduced uptake of HIV testing and sexual health services rather than declines in transmission.
The UKHSA report warns that: “We may see a rise in late HIV diagnoses in the coming years as a result.”
Action Plan on HIV
The UKHSA data suggests that the Government cannot take for granted the progress of of the £23 million HIV plan for England, launched last week.
The new action plan aims to scale up HIV testing in high-risk populations to ensure new infections are identified rapidly, and to increase access to pre-exposure prophylaxis for key groups. But continued disruption to health services as a result of the COVID-19 pandemic may make these measures more difficult to implement.
Dr Delpech said: “We must address inequalities and find creative ways to achieve a reduction in transmission across all populations.”
“We welcome the HIV action plan and expanding of HIV testing to provide greater opportunities for people to be offered an HIV test throughout the NHS.”
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Cite this: Tom Broder. UK Government Data Suggests Drop in HIV Diagnoses Due to COVID Disruption - Medscape - Dec 06, 2021.