Data definitions

New HIV diagnoses first made in England are used as proxy for HIV transmission in the HIV Action Plan. This is because it excludes HIV probably acquired abroad. New diagnoses must be interpreted together with trends in HIV testing. The HIV Action Plan aims to reduce new HIV diagnoses first made in England by 80% between 2019 and 2025. If new HIV diagnoses decrease at the same time as HIV testing rises or stays the same, this indicates a fall in transmission.

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.

These data measure all new HIV diagnoses including people who were previously diagnosed abroad prior to UK arrival. 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. New diagnoses must be interpreted together with trends in HIV testing.

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
• Low <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: geographic region.

Pre-exposure prophylaxis (PrEP) is a drug taken by HIV-negative people prior to sex to stop HIV acquisition. 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.

Two indicators are presented.

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. This shows which populations are in highest need of PrEP.

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.

Breakdown: geographic region.

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

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. A negative test can provide access to PrEP, a drug to prevent HIV transmission among people who are HIV negative. The higher the proportion, the better.

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

Eligible attendees at specialist sexual health services by proportion who were offered a test, not offered a test and declined a test.

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. The higher the proportion, the better.

HIV testing: offer and acceptance.

This indicator shows the proportion of eligible attendees at sexual health clinics who have an HIV test, decline a test or are not offered an HIV test. This measure is used to assess missed opportunities for HIV testing. The higher the proportion of people accepting an HIV test, and the lower the proportion not offered or declining a test, the better.

These data are from the UKHSA 12 month evaluation report of the NHSE programme to implement opt out BBV testing in emergency departments in high HIV prevalence settings. Only HIV information is presented here.

Three indicators are presented, which use a subset of 16 of the 33 clinics involved in the opt out programme. Most of the clinics are based in London with clinics in Sussex, Manchester and Blackpool also included in the programme.

The first indicator measures the proportion of people attending 16 of 33 emergency department who have blood taken as part of their care, who have an HIV test.

The second indicator measures the proportion of people who had an HIV test in 16 of 33 clinics who tested positive (including known HIV infections as well as newly diagnosed infections).

The third indicator measures the proportion of people who had an HIV test who were newly diagnosed with HIV. This is taken from a deep dive exercise of five clinics included in the programme.

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.  The lower the proportion, the better.

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. HIV treatment saves lives and prevents onward HIV transmission.

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.

Breakdown: geographic.

The number of people taking antiretroviral treatment at their last clinic attendance divided by everybody in HIV care. HIV treatment saves lives and prevents onward HIV transmission. The higher the proportion, the better.

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

A viral load under 200 copies/ml. The number of people who are virally suppressed (<200 copies/ml) divided by the number of people receiving HIV treatment. A person who has suppressed virus at this level is unable to pass on HIV infection to sexual partners. This is known as undetectable = untransmissible (U=U).  The higher the proportion, the better.

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

This indicator measures the extent people seen for HIV care are seen on an annual basis, in accordance with BHIVA standards of care. People in care have their HIV monitored to ensure good health, the right medication and to assess whether people with HIV are virally undetectable. The retention in care measure assesses the proportion of people seen within 15 months of their last attendance date up to and including October 2021. The higher the proportion, the better.

Breakdown: large geographic area, gender.

Data relating to needs is from the Positive Voices survey. This is a representative survey conducted in 2017 and 2022 of people living with HIV who provided information about their lived experience in relation to satisfaction with HIV care, treatment, co-morbidities, lifestyle, needs and unmet needs and stigma.

The questions asked for stigma related to life satisfaction, enacted stigma in healthcare settings (experienced being treated badly), anticipated stigma (avoiding health care because of HIV stigma) and sharing one’s HIV status.

Breakdown: geographic region.

Data relating to need is from the Positive Voices survey. This is a representative survey conducted in 2017 and 2022 of people living with HIV who provided information about their lived experience in relation to satisfaction with HIV care, treatment, co-morbidities, lifestyle, needs and unmet needs and stigma.

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.

Breakdown: geographic region (where available).