The Hard Truth About AIDS United Kingdom

     Homosexual men remain the group at the greatest risk of becoming infected with HIV in the UK.  throughout the 1990's , there were modest falls in the number of new diagnoses among homosexual men, except in 1996 when multi-antiretroviral therapy first became widely available and the advantages of early diagnosis became clearer. Estimation of current HIV incidence men who have sex with men is difficult. The often long period of time between the infection and diagnosis can make predicting the incidence rates hard.  Also, some of the new infections will have occurred abroad either in the course of travel or before moving to abroad. The great majority of new infections in this risk group will however be acquired in the UK, and there are indications of rises in behaviors associated with increased risk among men who have sex between men in the UK. As of the end of December 2002,  28,835 men who have have had sex with men have been diagnosed with HIV. 

     The number of heterosexually acquired HIV infection diagnosed in the UK has risen hugely over the last 15 years. in 1999, for the first time the rate of heterosexually acquired infections overtook the rate of infections acquired by men who have sex with men.  During 2002, there were 2,199 reports of heterosexually acquired HIV and the total of 16,783 at the end of December 2002. The HIV infection rates are high in African communities, where often one or both partners have acquired the infection in Africa rather than in the UK. Of the individuals who have progressed to AIDS, a much higher proportion of those heterosexually than homosexually infected had their infection recognized at around the time of developing an AIDS defining condition.

   To estimate the transmission of HIV in the UK through heterosexual activity is difficult. Some transmission occurs from those at risk of HIV (injecting drug users, bisexual men, hemophiliacs), but these routes have not made a large contribution to reported infections to date and are unlikely to do so in the future. Among heterosexuals as among homosexual men, there are markers of increases in behaviors associated with raised HIV risk. Reports of gonorrhea, an indicator of unprotected sexual intercourse, in heterosexual STI clinic attendees doubled between 195 and 2000.

   Injecting drug use has played a smaller part in the epidemic in the UK than it has in many other developed countries. 89 people acquired HIV through injecting drug use during 2001. At the end of December 2002, a total of 3,917 people had acquired HIV through injecting drug use.  The overall picture shows differences within the UK. Scotland experienced rapid HIV spread through injecting drug users in the early 1980's, which was not the case in the rest of the UK. Probably as a result of introduction of harm reduction measures such as needle exchange programs in the mid 1980's localized epidemics on the scale of Scotland have not occurred elsewhere in the UK.

    Production of the clotting factor concentrates, used mainly for treating patients with hemophilia, involves the pooling of plasma from several thousand blood donations. Before the introduction of inactivation processes in 1985, a single donation infectious of HIV could contaminate a batch of concentrate used to treat many patients.  There have been no recorded transmissions of HIV in the UK through concentrate use since the introduction of inactivation. As soon as it was realized that HIV could be transmitted through blood, members of the groups recognized to be at higher risk were asked not to donate. Since October 1985, when suitable tests became available, all blood donations have been screened for HIV antibodies. In total, 1,704 people have been reported as becoming infected through treatment blood/tissue transfer or blood factor until the end of December 2002.

   Surveillance of children recognized as born to HIV infected women relies on confidential voluntary reports from pediatricians and obstetricians.  A total of 2,553 children born to HIV infected mothers have been reported by the end of march 2002. Women who are unaware of their infection status are unable to benefit from interventions, which can reduce the risk of mother to child transmission to around 2%.