Data definitions

The data measure all new HIV diagnoses. People can live with undiagnosed HIV infection for many years. This means that new HIV diagnoses are not necessarily infections that have been recently acquired.

Breakdown: age, exposure, ethnicity (where available), and geographic region of diagnosis.

The rate of people living with a diagnosed HIV infection per 1,000 people aged 15-59 years.

Rates are categorised as follows:

• Extremely high >5 per 1,000
• High 2-5 per 1,000
• Lower <2 per 1,000.

In areas with high and extremely high HIV prevalence, HIV testing services should be expanded outside of sexual health settings in accordance with NICE and BHIVA testing guidelines.

Breakdown: exposure (where available) and geographic region.

The number of people taking antiretroviral treatment at their last clinic attendance divided by everybody in HIV care.

Breakdown: age, exposure, ethnicity (where available), and geographic region.

A viral load under 200 copies/ml. A person who has suppressed virus at this level is unable to pass on HIV infection to sexual partners.

Breakdown: geographic region.

New HIV diagnosis is not synonymous with incidence; however, it provides a timely insight into the onward HIV transmission in a country and consequently allows targeting efforts to reduce transmission. Although the majority of HIV diagnoses are made in genitourinary medicine (GUM) services, HIV testing has been introduced in a variety of different medical services and non-medical settings, including the expansion of self-sampling or self-testing.

HIV diagnoses among people newly diagnosed in England with no previous diagnosis abroad reported, expressed as a rate per 100,000 population.

Data are presented by area of residence and exclude people diagnosed with HIV in England who are living in Wales, Scotland, Northern Ireland or abroad.

Adults (aged 15 years and over) only. The data measure the percentage and number of HIV diagnoses that are made with CD4 counts <350 cells within 91 days of diagnosis, which is indicative of a late stage of infection.

A person diagnosed late has been living with an undiagnosed HIV infection for around three to five years and is more susceptible to infections compared to a person with a higher CD4 count. People diagnosed late have a tenfold risk of death compared to those diagnosed promptly.

People with a CD4 count <350 who have evidence of recently acquired HIV infection have been excluded.

Breakdown: exposure (where available), and geographic region of diagnosis.

Data are presented for three years combined.

This indicator presents the number and proportion of people newly diagnosed with HIV who start antiretroviral therapy within 91 days of their diagnosis. The indicator measures prompt treatment initiation which reduces the risk of onward HIV infection to partners. Successful antiretroviral therapy decreases a person’s viral load and HIV transmission does not occur when the viral load is undetectable. This has been the basis of the 2016 Undetectable = Untransmittable (U=U) campaign endorsed by 790 organisations worldwide including key UKHSA stakeholders for HIV prevention in the UK (British HIV Association (BHIVA), National AIDS Trust, Terrence Higgins Trust, NAM aidsmap). The 2016 interim BHIVA treatment guidelines recommend that all people living with diagnosed HIV infection should be offered treatment as soon as possible after diagnosis.

This indicator monitors this standard and, along with ‘Proportion with undetectable viral load (%)’, supports the wider monitoring of the UNAIDS 90:90:90 target: 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; 90% of all people receiving antiretroviral therapy will have viral suppression. This target was met at the England level in 2018. Regional level data by Government.

Proportion of people who started antiretroviral therapy within 91 days of their HIV diagnosis. These include all reports of HIV diagnoses made in the UK, regardless of country of first HIV-positive test (that is including people who were previously diagnosed with HIV abroad).

Data is presented by area of residence and exclude people diagnosed with HIV in England who are resident in Wales, Scotland, Northern Ireland or abroad.

This indicator presents the number of people who tested for HIV (and not the number of tests reported) out of those people considered eligible for an HIV test when attending specialist sexual health services. HIV testing is integral to the treatment and management of HIV infection. Knowledge of HIV status increases survival rates, improves quality of life and reduces the risk of onward transmission.

The proportion of eligible attendees at specialist sexual health services (SHS) who accepted an HIV test.

An eligible attendee is defined as a patient attending specialist SHS at least once during a calendar year. Patients known to be HIV positive, or for whom a HIV test was not appropriate, or for whom the attendance was related to Sexual and Reproductive Health (SRH) care only, are excluded.

Specialist SHS refers to genitourinary medicine (GUM), and integrated GUM and SRH clinics.

Breakdown: gay, bisexual and men who have sex with men/men/women and geographic region.

This indicator presents the number and proportion of gay, bisexual and other men who have sex with men (gay and bisexual men) who have tested for HIV more than once at the same clinic in the previous year. This indicator measures the NICE testing guideline which recommends that gay and bisexual men should be tested for HIV at least once a year and every 3 months if they are having unprotected sex with new or casual partners. Repeat testing facilitates prompt diagnosis of HIV and this indicator complements other HIV indicators presented on the Sexual and Reproductive Health Profiles such as late diagnosis rate and new HIV diagnosis rate.

Proportion of gay, bisexual and other men who have sex with men who tested for HIV with at least one test in the previous year at specialist sexual health services. Specialist sexual health services refers to genitourinary medicine (GUM), and integrated GUM and sexual and reproductive health (SRH). Please refer to BASHH guidelines for definitions of service levels (Appendix B).

Data is presented by area of patient residence, and exclude people accessing services located in England who are residents in Wales, Scotland, Northern Ireland or abroad.

Pre-exposure prophylaxis (PrEP) is a drug taken by HIV-negative individuals before they have sex to stop them acquiring HIV. As part of a combination approach to HIV prevention, the roll out of routine PrEP commissioning began in England in the autumn of 2020. Specialist sexual health services (SHS) are responsible for the delivery of PrEP to those at higher risk of acquiring HIV.

Determining PrEP need

This indicator is used to determine PrEP need among people accessing specialist SHS. It assesses the proportion of all HIV-negative people accessing specialist SHS who are at substantial HIV risk, and therefore could benefit from receiving PrEP. The indicator includes people who are having their need for PrEP met by receiving PrEP (met need) as well as those with need who are not currently receiving PrEP (unmet need). This indicator does not relate to better or worse performance as it will vary between services depending on local populations.

Proportion of all HIV-negative individuals accessing specialist SHS with PrEP need. People who attended for Sexual and Reproductive Health (SRH) care only are excluded as no risk assessment for PrEP takes place at these consultations.

Initiation or continuation of PrEP among those with PrEP need

This indicator assesses what proportion of individuals accessing specialist SHS with PrEP need start or continue PrEP. The higher the proportion, the better PrEP need is being met through providing PrEP. A lower proportion indicates that more people with need are leaving the service without PrEP, the reason for which will be multifactorial.

Proportion of all HIV-negative people accessing specialist SHS with estimated PrEP need who started or continued PrEP. People who attended for Sexual and Reproductive Health (SRH) care only are excluded as no risk assessment for PrEP takes place at these consultations.

Breakdown: geographic region.

The needs of people living with HIV are diverse and the extent to which these needs are assessed, planned for, and met directly impact on the overall health and wellbeing of the patient.

In 2017, the Positive Voices survey asked whether people had used specific services (29 in total) in the previous 12 months, and whether or not they had received that service.

The proportion of ‘need’ was defined as the percentage of people with HIV who stated their need for a service, out of all those who responded to the question. The proportion of ‘unmet need’ was defined as the percentage of people with HIV who did not receive it, out of those who stated they needed the service.

These data have been provided by Positive Voices. This is the most recent data available.

Breakdown: geographic region (where available).