Decline in new HIV diagnoses in gay and bisexual men in London

In 2016, 5,164 people were newly diagnosed with HIV in the United Kingdom (UK) (3,938 men and 1,226 women), representing an 18% decline from the 6,286 diagnoses reported in 2015. The decrease was most apparent in gay and bisexual men. In this group, the number of HIV diagnoses reported steadily increased from 2,850 in 2007 to 3,570 in 2015, and then decreased by 21% to 2,810 in 2016.

The UK is one of the first countries in Europe to witness a substantive decline in HIV diagnoses in gay and bisexual men. Combination prevention is working: the decline is driven by large increases in HIV tests among gay and bisexual men attending sexual health clinics (from 37,224 in 2007 to 143,560 in 2016) including repeat testing in higher risk men, as well as improvements in the uptake of anti-retroviral therapy (ART) following HIV diagnosis. Other factors, including sustained high condom use with casual partners and internet access of preexposure prophylaxis (PrEP), will also have contributed to the downturn in HIV diagnoses in this group.

The decrease in HIV diagnoses in gay and bisexual men represents the most exciting development in the UK HIV epidemic in 20 years, when effective treatment became widely available. The HIV response in England will be further strengthened with the implementation of the PrEP Impact Trial over the next three years. It is critical that the success of increased HIV testing and prompt ART is replicated for all groups at greatest risk of the virus. For heterosexual men and women, further expansion of HIV testing in a variety of settings is critical in reducing late HIV diagnoses, and consequently undiagnosed infection.