New HIV cases higher in heterosexual people than gay men for first time in a decade

For the first time in a decade, the number of new HIV diagnoses among heterosexuals is higher than for gay and bisexual men, according to new figures for England from the UK Health Security Agency.

Half of all new HIV diagnoses were in heterosexuals (49%) in England in 2020, compared to 45% in gay and bisexual men.

The news highlights the changing shape of the domestic HIV epidemic despite a drop in testing caused by the COVID-19 pandemic.

HIV testing by sexual health services among heterosexuals during 2020 fell by a third (33%), compared to a 7% decrease among gay and bisexual men. This makes the number of diagnoses among heterosexuals passing gay and bisexual men even more significant.

Heterosexuals were also far more likely to be diagnosed late, meaning damage to the immune system has already begun. More than half (51%) of women, 55% of heterosexual men and 66% of those aged 65 and over diagnosed with HIV in 2020 were diagnosed at a late stage.

This compares to just 29% of gay and bisexual men. This is likely driven by a belief that they are not at risk of HIV, which is often reinforced by healthcare professionals.

Jackie, a heterosexual woman living with HIV, said: 'Not only did I never consider I could be living with HIV, neither did my doctor. I had no idea that women could get HIV until I tested positive. If you have ever been sexually active you should test regularly, it only takes once unprotected. Knowing your status is best for you and everyone else in your life.

'Recent developments mean HIV testing is free, quick and easy and HIV treatment is effective at controlling the virus and means I can't pass on the virus to anyone else. HIV can affect anyone, so everyone should test.'

Gay and bisexual men are still more impacted by HIV relative to population size, but targeted interventions for this group have led to one of the big success stories of the epidemic. New HIV diagnoses among gay and bisexual men began to fall in 2014 and that has continued every year since, with a fall of 70% between 2014 and 2020. The drop is most pronounced among white men and among those living in London.

The fall in diagnoses among gay and bisexual men is a result of the growing availability of HIV prevention pill PrEP and targeted promotion of routine HIV testing followed by the rapid initiation of HIV treatment for those diagnosed, meaning they are more quickly virally suppressed and cannot pass on HIV.

We hope that, with greater awareness, increased testing and better access to PrEP for heterosexuals, this can be replicated across the wider population. Our message is that HIV can affect anyone and everyone needs to know how to protect themselves against HIV – regardless of sexuality, gender, ethnicity or age.

Increased HIV testing is crucial, because an estimated 5% of people living with HIV in the UK (4,660) are unaware, which can adversely affect their health and means they may pass HIV on. The UK is aiming to end new HIV cases by 2030, which is why maximising every opportunity for HIV testing is necessary for achieving that aim.

This comes as free HIV test kits are made available for National HIV Testing Week, which launches today. Anyone who’s sexually active is encouraged to test and know their HIV status.

You can order a free HIV test kit to do at home during National HIV Testing Week, or you can visit your local sexual health clinic.

Taku Mukiwa, Head of Health Programmes, said: 'For the first time in a decade there are more heterosexuals than gay and bisexual men being diagnosed with HIV. Heterosexuals also saw a far steeper drop in testing for HIV during COVID-19 lockdown and are far more likely to be diagnosed late.

'That’s why we need to see more heterosexuals getting tested to avoid anyone living with undiagnosed HIV for a long time. This is important for their own health as well as for efforts to stop HIV being passed on as the vast majority of people get HIV from someone who is unaware they have it.'