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Annual Epidemiological Spotlight on HIV in London: 2014 data
Field Epidemiology Services
PHE Publications gateway number 2015509
Summary of 2014 data for London residents
• 2,516 new HIV diagnoses
• New diagnosis rate: 36 per 100,000 residents aged 15 years or older
• 63% of new diagnoses in MSM / 33% of new diagnoses in heterosexuals
• 22% of new diagnoses in Black Africans
• 37% of diagnoses are late (2012-14)
• 35,363 people living with diagnosed HIV
• Diagnosed prevalence rate: 5.9 per 1,000 residents aged 15-59 years
• Only one LA in London (Havering) had a diagnosed prevalence below the 2 per 1,000 threshold above which expanded HIV testing is recommended.
• 12% of Londoners living with HIV remain undiagnosed (estimated 5,100 people)
• 90% of those diagnosed are on antiretroviral therapy (ART)
• 95% of those on ART are virally suppressed
2 Annual Epidemiological Spotlight on HIV in London: 2014 data
Figure 1: New HIV diagnosis per 100,000 population aged 15 years or older by PHE centre of residence, 2014
3 Annual Epidemiological Spotlight on HIV in London: 2014 data
36.5 9.9 9.0 8.6 8.1 7.7 7.2 6.1 5.50.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
London North West WestMidlands
East Midlands East ofEngland
South East Yorkshire andHumber
North East South West
Ra
te p
er
10
0,0
00
England (dotted lines represent 95% confidence intervals)
Source: Public Health England, HIV and Aids New Diagnosis Database (HANDD). The number of new diagnoses will depend on accessibility of testing as well as infection transmission.
Figure 2: New HIV diagnoses per 100,000 population aged 15 years or older by upper tier local authority of residence, London residents, 2014
4 Annual Epidemiological Spotlight on HIV in London: 2014 data
152
85 76 55 53 52 51 48 46 44 43 42 36 36 33 33
27 25 23 19 18 18 17 16 16 14 14 13 13 7 7 7 6
0.0
50.0
100.0
150.0
200.0
250.0
300.0
Ra
te p
er
10
0,0
00
po
pu
lati
on London (dotted lines represent 95% confidence intervals)
Source: Public Health England, HIV and Aids New Diagnosis Database (HANDD). The number of new diagnoses will depend on accessibility of testing as well as infection transmission.
Figure 3: New HIV and AIDS diagnoses and deaths, London, 2005-2014
5 Annual Epidemiological Spotlight on HIV in London: 2014 data
Source: Public Health England, HIV and Aids New Diagnosis Database (HANDD). The number of new diagnoses will depend on accessibility of testing as well as infection transmission. *Numbers may rise as further reports are received. This will impact on interpretation of trends in more recent years.
0
500
1,000
1,500
2,000
2,500
3,000
3,500
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Dia
gn
ose
s/d
eath
s
New HIV diagnoses
AIDS diagnoses
Deaths
Figure 4: New HIV diagnoses by probable exposure category (adjusted for missing information), London residents, 2005-2014
6 Annual Epidemiological Spotlight on HIV in London: 2014 data
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2,000
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Nu
mb
er o
f n
ew H
IV d
iag
no
ses
MSM
Heterosexual contact
Other infection routes
Source: Public Health England, HIV and Aids New Diagnosis Database (HANDD). The number of new diagnoses will depend on accessibility of testing as well as infection transmission.
Figure 5: Number of new HIV diagnoses by age group and gender (A) and probable exposure category in males (B), London residents, 2014
7 Annual Epidemiological Spotlight on HIV in London: 2014 data
1000 500 0 500
<15
15-24
25-34
35-44
45-54
55+
New HIV diagnoses
Age
gro
up (
year
s)
Male
Female
800 600 400 200 0 200
<15
15-24
25-34
35-44
45-54
55+
New HIV diagnosesA
ge g
roup
(ye
ars)
Sex between men
All other exposures
(A) (B)
Source: Public Health England, HIV and Aids New Diagnosis Database (HANDD). The number of new diagnoses will depend on accessibility of testing as well as infection transmission.
Figure 6: Number of new HIV diagnoses by ethnic group (adjusted for missing information), London residents, 2005-2014
8 Annual Epidemiological Spotlight on HIV in London: 2014 data
0
200
400
600
800
1,000
1,200
1,400
1,600
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Nu
mb
er o
f n
ew H
IV d
iag
no
ses
White
Black African
All other ethnicgroups
Source: Public Health England, HIV and Aids New Diagnosis Database (HANDD). The number of new diagnoses will depend on accessibility of testing as well as infection transmission.
Figure 7: Number of new HIV diagnoses by world region of birth (adjusted for missing information), London residents, 2005-2014
9 Annual Epidemiological Spotlight on HIV in London: 2014 data
0
200
400
600
800
1,000
1,200
1,400
1,600
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Nu
mb
er o
f n
ew H
IV d
iag
no
ses
UK
Africa
All other countries
Source: Public Health England, HIV and Aids New Diagnosis Database (HANDD). The number of new diagnoses will depend on accessibility of testing as well as infection transmission.
Figure 8: Percentage of new HIV diagnoses that were diagnosed late by upper tier local authority of residence, London, aged 15 years and over, 2012-2014*
10 Annual Epidemiological Spotlight on HIV in London: 2014 data
59%
55%
55%
53%
50%
49%
49%
48%
46%
43%
43%
42%
41%
41%
39%
38%
38%
37%
37%
36%
35%
35%
35%
34%
34%
30%
30%
29%
29%
28%
27%
25%
22%
0%
10%
20%
30%
40%
50%
60%
70%
80%
% d
iag
no
se
d la
te
London (dotted lines represent 95% confidence intervals)
Source: Public Health England, HIV and AIDS New Diagnosis Database, CD4 Surveillance, Survey of Prevalent HIV Infections Diagnosed (SOPHID).* Only includes new diagnoses for which CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count <350 cells/mm3. The underlying population will impact on the proportion diagnosed late, e.g. MSM are less likely to be diagnosed late..
Figure 9: Percentage of new HIV diagnoses that were diagnosed late by probable exposure category (A) and ethnic group (B), London residents, aged 15 years and over, 2012-2014*
11 Annual Epidemiological Spotlight on HIV in London: 2014 data
(A) (B)
25% 59% 52% 57%0%
20%
40%
60%
80%
100%
Sex betweenmen
Heterosexualcontact - male
Heterosexualcontact - female
Injectingdrug use
% d
iag
no
se
d la
te
(a) Probable exposure category
27% 56% 40%0%
20%
40%
60%
80%
100%
White BlackAfrican
BlackCaribbean
% d
iag
no
se
d la
te
(b) Ethnic group
Source: Public Health England, HIV and AIDS New Diagnosis Database, CD4 Surveillance, Survey of Prevalent HIV Infections Diagnosed (SOPHID).* Only includes new diagnoses for which CD4 count was reported within 91 days of diagnosis; late diagnosis defined as CD4 count <350 cells/mm3.
Figure 10: Diagnosed HIV prevalence per 1,000 residents aged 15-59 years by PHE Centre, 2014
12 Annual Epidemiological Spotlight on HIV in London: 2014 data
5.9 1.7 1.7 1.6 1.5 1.4 1.3 1.1 0.90.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
Lond
on
Nor
th W
est
So
uth
Eas
t
Wes
t Mid
land
s
Ea
st o
f Eng
land
Ea
st M
idla
nds
Yo
rksh
ire a
ndH
umbe
r
So
uth
Wes
t
Nor
th E
ast
Rat
e p
er
1,0
00
po
pu
lati
on
Expanded HIV testing threshold (2 per 1,000)
Source: Public Health England, Survey of Prevalent HIV Infections Diagnosed (SOPHID).
Figure 11: Number of residents living with diagnosed HIV and accessing care, London, 2005-2014
13 Annual Epidemiological Spotlight on HIV in London: 2014 data
22,086
35,363
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Nu
mb
er
Source: Public Health England, Survey of Prevalent HIV Infections Diagnosed (SOPHID).
Figure 12: Number of residents living with diagnosed HIV and accessing care by probable route of transmission (adjusted for missing information), London, 2014
14 Annual Epidemiological Spotlight on HIV in London: 2014 data
17,572
15,568
723 518 1600
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
Sex between men Sex between menand women
Mother to childtransmision
Injecting drug use Blood/bloodproducts recipient
Nu
mb
er
Source: Public Health England, Survey of Prevalent HIV Infections Diagnosed (SOPHID).
Figure 13: Percentage of residents with diagnosed HIV and accessing care by age group, London, 2005 and 2014
15 Annual Epidemiological Spotlight on HIV in London: 2014 data
Source: Public Health England, Survey of Prevalent HIV Infections Diagnosed (SOPHID).
2% 4%
24%
57%
12%
0%3%
16%
50%
30%
0%
10%
20%
30%
40%
50%
60%
70%
<15 15-24 25-34 35-49 50+
Pe
rce
nta
ge
Age group
2005 2014
Figure 14: Diagnosed HIV prevalence per 1,000 residents by ethnic group (aged 15-59 years), London, 2014
16 Annual Epidemiological Spotlight on HIV in London: 2014 data
Source: Public Health England, Survey of Prevalent HIV Infections Diagnosed (SOPHID).
28.0
11.0
7.2
5.2 4.8
1.91.0
0
5
10
15
20
25
30
BlackAfrican
Black Other/Unspecified
BlackCaribbean
Other/Mixed White Other Asian Indian/Pakistani/Bangladeshi
Rat
e p
er
1,0
00
po
pu
lati
on
Figure 15: Diagnosed HIV prevalence per 1,000 residents aged 15-59 years by local authority, London, 2014
17 Annual Epidemiological Spotlight on HIV in London: 2014 data
15
.1
13
.0
12
.8
9.2
8.9
8.5
8.4
8.4
8.4
8.1
7.1
6.9
6.6
6.2
6.1
5.3
5.3
5.2
4.5
4.2
4.1
3.6
3.4
3.1
2.9
2.6
2.6
2.6
2.4 2.4
2.3 2.1
1.9
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
Lam
beth
So
uthw
ark
City
of
Lond
on
Ke
nsin
gto
n an
d C
hels
ea
Wes
tmin
ster
Ham
mer
smith
and
Ful
ham
Islin
gton
Cam
den
Lew
ish
am
Hac
kney
Har
inge
y
New
ham
Tow
er H
amle
ts
Gre
enw
ich
Ba
rkin
g an
d D
agen
ham
Wan
dsw
orth
Wal
tha
m F
ores
t
Cro
ydon
Bre
nt
En
field
Mer
ton
Hou
nslo
w
Ea
ling
Ba
rnet
Red
brid
ge
Bro
mle
y
Hill
ingd
on
Be
xley
Ric
hmon
d up
on T
ham
es
Su
tton
Har
row
Kin
gsto
n up
on T
ham
es
Hav
erin
g
Ra
te p
er
1,0
00
po
pu
lati
on
London (dotted lines represent 95% confidence intervals)
Expanded HIV testing threshold (2 per 1,000)
Source: Public Health England, Survey of Prevalent HIV Infections Diagnosed (SOPHID).
Figure 16: Diagnosed HIV prevalence per 1,000 residents aged 15-59 years by local authority, London, 2014
18 Annual Epidemiological Spotlight on HIV in London: 2014 data
Bromley
Barnet
Havering
Enfield
Hillingdon
Croydon
Bexley
Ealing
B&DBrent
Harrow
Sutton
Richmond
Hounslow
Redbridge
Merton
Greenwich
Newham
Kingston
Lewisham
HaringeyWalthamForest
Wandsworth
Camden
H&F
Lambeth
SouthwarkK&C
HackneyIslington
Westminster
TowerHamletsCoL
Contains Ordnance Survey data © Crown copyright and database right 2015. Contains National Statistics data © Crown copyright and database right 2015.
Diagnosed HIV prevalence
per pop. aged 15-59 years
Less than 2
2 to <4
4 to <6
6 to <8
8 to <10
10 or higher
Source: Public Health England, Survey of Prevalent HIV Infections Diagnosed (SOPHID).
Figure 17: The London HIV treatment cascade among adults living with HIV, 2014
19 Annual Epidemiological Spotlight on HIV in London: 2014 data
100%
88%
79%74%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
HIV infected (n=40,600) HIV diagnosedǂ (n=35,600) On treatment (n=31,900) Undetectable VL* (n=30,200)
88% 90% 95%
ǂ The number of diagnosed from multi-parameter evidence synthesis data. * Viral load (VL) <200 copies/ml
Acknowledgements
Produced by Josh Forde, Paul Crook and Zheng Yin from Public Health England
Local sexual health and HIV clinics for supplying the HIV data
Institute of Child Health
PHE Centre for Infectious Disease Surveillance and Control (CIDSC) HIV and STI surveillance teams for collection, analysis and distribution of data
Stefano Conti of the PHE CIDSC modelling team for providing estimates of the total number of people living with HIV and the proportion that remain undiagnosed
20 Annual Epidemiological Spotlight on HIV in London: 2014 data
More information Please access the online ‘Sexual and Reproductive Health Profiles’ for further
information on a whole range of sexual health indicators: http://fingertips.phe.org.uk/profile/sexualhealth
For more information on local sexual health data sources please access the PHE guide: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/395207/PHE_Guide_to_National_Local_Sexual_Reproductive_Health_Data.pdf
For an epidemiology summary of STIs in London https://www.gov.uk/government/publications/sexually-transmitted-infections-london-2014-data
For a detailed report on STIs and HIV in MSM in London https://www.gov.uk/government/publications/hiv-and-stis-in-men-who-have-sex-with-men-in-london
For more information please contact Field Epidemiology Services at [email protected]
21 Annual Epidemiological Spotlight on HIV in London: 2014 data