Context

Guidance

In 2014, an estimated 103,700 people (69,200 men and 34,400 women) in the UK were living with HIV. The overall HIV prevalence was 1.9 per 1,000 people aged 15 and over (Public Health England's HIV in the UK).

Although there are significant pockets of HIV in other populations and communities, the most significant burden of HIV continues to be borne by men who have sex with men and by black Africans. An estimated 45,000 men living with HIV in the UK in 2014 had acquired their infection through sex with other men, an increase from 43,000 in 2013. One in 20 men aged 15 to 44 who have sex with men is estimated to be living with HIV.

A recent increase in HIV testing coverage among men attending sexual health clinics is likely to be the reason for an increase in new diagnoses and a decline in undiagnosed infections: about 6,500 men who have sex with men were unaware of their infection in 2014, compared with 8,500 in 2010 ('HIV in the UK').

Almost 1 in 1,000 heterosexual people aged 15 to 44 in the UK is estimated to be living with HIV. Prevalence is higher in black African heterosexual women (1 in 22) and men (1 in 56), who together form the second largest group affected by HIV. Late diagnosis remains a significant problem in heterosexual people: in 2014, 55% were newly diagnosed at a late stage of infection (just over half of whom were black African) ('HIV in the UK').

Overall, 17% of people estimated to have HIV are unaware they are infected and so are at risk of passing it on. More people living outside London are unaware of their HIV infection (24%) compared with those in London (12%) ('HIV in the UK').

In 2013, in response to the international AIDS epidemic, UNAIDS launched a new target known as '90-90-90' (UNAIDS's 90-90-90: An ambitious treatment target to help end the AIDS epidemic). By 2020:

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
90% of all people receiving antiretroviral therapy will have viral suppression.

In 2011, NICE published guidelines PH33 and PH34, which aimed to increase the uptake of HIV testing in black Africans living in the UK and in men who have sex with men. In 2014, experts reviewed the evidence and agreed that the guidelines should be updated to reflect changes in the way HIV testing is delivered (following the legalisation of self-sampling and self-testing kits) and to reflect the normalisation of HIV testing across health services.