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Trends in HIV Diagnoses, HIV Care, and Uptake of Antiretroviral Therapy Among Heterosexual Adults in England, Wales, and Northern Ireland

Rice, Brian MSc*†; Elford, Jonathan PhD; Yin, Zheng PhD*; Croxford, Sara MSc*; Brown, Alison PhD*; Delpech, Valerie FPHM*

Sexually Transmitted Diseases: April 2014 - Volume 41 - Issue 4 - p 257–265
doi: 10.1097/OLQ.0000000000000111
Original Study

Aim To examine epidemiological trends among heterosexual adults (≥15 years) in England, Wales, and Northern Ireland (E,W&NI) newly diagnosed as having HIV between 1992 and 2011, or seen for HIV care in 2011.

Methods Trend analyses of heterosexual adults newly diagnosed as having HIV in E,W&NI in 1992 to 2011 was performed, as well as univariate and multivariate analyses examining the late diagnosis of HIV, integration into care, AIDS, uptake of antiretroviral therapy, and mortality in 2002 to 2011. Data are as reported to the national HIV and AIDS Reporting System.

Results The number of heterosexual adults newly diagnosed as having HIV in E,W&NI increased steadily between 1992 (731) and 2004 (4676), before declining (2631 in 2011). Nonetheless, in 2011, heterosexuals accounted for 49% (2631/5423) of all newly diagnosed adults in E,W&NI. Of 38,228 heterosexual adults as having HIV between 2002 and 2011, 72% were black African, of whom 99% were born abroad. Over the decade, there was an increase in the percentage of HIV diagnosed heterosexuals integrated into care within 28 days of diagnosis (61%–78%) and in receipt of antiretroviral therapy within 1 year of diagnosis (45%–52%) and a decline in the percentage with AIDS (16%–7%; all, P < 0.01). Late HIV diagnoses (CD4 <350 mm3) among heterosexuals exceeded 60% in all years.

Conclusions Our analyses highlight the impact of migration on the epidemiology of heterosexually acquired HIV in E,W&NI. Although there was evidence of an improvement in clinical care over time, continued high rates of late diagnosis suggest that current testing policies are failing among heterosexuals.

We describe trends in HIV diagnoses among heterosexuals in the United Kingdom and examine late diagnoses, prompt integration into care, AIDS, uptake of antiretroviral therapy, short-term mortality, and social deprivation.

From the *Public Health England, Colindale, London, UK; and †City University London, UK

The authors thank all reporting sites for their continuing help and support. National HIV surveillance is funded by the Department of Health. The views expressed in the publication are those of the authors and not necessarily those of the Department of Health.

Brian Rice is currently registered for a PhD at City University London.

Conflicts of interest and source of funding: The decision whether to forward data relating to new HIV diagnoses or people accessing HIV services via a local facilitator or directly to Public Health England rests with the clinician. The HIV and AIDS Reporting System is held at Public Health England, and strict attention to confidentiality is maintained at every stage of data collection, analysis, and storage. The system is funded by the Department of Health. The authors have no conflicts of interest to declare. No manuscript resembling the enclosed article has been or will be published elsewhere.

Correspondence: Brian Rice, MSc, Department of HIV and STI, Public Health England, 61 Colindale Ave, Colindale, London, NW9 5EQ, UK. E-mail:

Received for publication October 2, 2013, and accepted February 3, 2014.

© Copyright 2014 American Sexually Transmitted Diseases Association