Annual Epidemiological Spotlight on HIV in London: 2014 data Field Epidemiology Services PHE...

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


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


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)


Figure 3: New HIV and AIDS diagnoses and deaths, London, 2005-2014


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


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


Figure 5: Number of new HIV diagnoses by age group and gender (A) and probable exposure category in males (B), London residents, 2014


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)


Figure 6: Number of new HIV diagnoses by ethnic group (adjusted for missing information), London residents, 2005-2014


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


Figure 7: Number of new HIV diagnoses by world region of birth (adjusted for missing information), London residents, 2005-2014


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


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*


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*


(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


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


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


Figure 12: Number of residents living with diagnosed HIV and accessing care by probable route of transmission (adjusted for missing information), London, 2014


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


Figure 13: Percentage of residents with diagnosed HIV and accessing care by age group, London, 2005 and 2014



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



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


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

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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)


Figure 16: Diagnosed HIV prevalence per 1,000 residents aged 15-59 years by local authority, London, 2014


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


Figure 17: The London HIV treatment cascade among adults living with HIV, 2014


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


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]


http://fingertips.phe.org.uk/profile/sexualhealth

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/395207/PHE_Guide_to_National_Local_Sexual_Reproductive_Health_Data.pdf%0D



https://www.gov.uk/government/publications/sexually-transmitted-infections-london-2014-data



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