Each month in Boyz the team from NAM aidsmap report the latest news on HIV and sexual health. Keep up to date and read more on their website at aidsmap.com.
Official figures released in January show dramatic progress in preventing HIV and slowing down the HIV epidemic in the UK. The research suggests that if current trends continue, there will be almost no HIV transmission happening in the UK by the year 2030.
New HIV diagnoses have been going down for several years. One thing to bear in mind is that figures for HIV diagnosis (which are the numbers we hear most often) don’t just reflect new cases of HIV transmission. Someone who is diagnosed this year may have had HIV for several years, so the numbers also reflect older infections. Changes in how frequently people are tested for HIV can affect the figures.
The true rate of new infections (what scientists call HIV incidence) is a more meaningful figure. It’s an estimate of the number of people who became HIV positive in a specific year, whether or not they got tested. It’s harder to calculate, which is why you don’t hear these figures so often.
In their latest report, Public Health England estimates that the true rate of new HIV infections in gay and bisexual men fell by 71% between 2012 and 2018. Only around 800 gay men acquired HIV in 2018.
This shows that having a combination of HIV prevention methods is working. This includes condom use, regular HIV testing, HIV-positive people taking treatment, and PrEP.
The UK is already beating a set of targets that guide HIV policy around the world. One target is for at least 90% of people who have HIV to be diagnosed (in the UK the figure is 93%) and the next is for at least 90% of people with HIV to be taking treatment (here it is 97%). The third target is for over 90% of people taking treatment to have an undetectable viral load, which means that they can’t pass HIV on (our figure is 97%).
Experts believe these results are the key to the fall in HIV transmission in the UK. The prevention medication PrEP could make a big difference in the future, but not enough people are taking it yet.
The report shows that London is doing better than other parts of the country. Diagnoses have fallen fastest in the capital and there are fewer people who have HIV without knowing it in London than elsewhere.
Diagnoses are also falling faster in gay men born in the UK than in men born abroad. This may be because some men who have come from other countries may be less familiar with the NHS and less connected with prevention services. In particular, diagnoses aren’t going down in South American gay men.
Another impact of the scale-up of HIV treatment is even fewer HIV-related deaths. In fact, the official figures show that someone under the age of 60 who is diagnosed with HIV in good time is now less likely to die than other people in the general population of the same age, probably due to getting better medical care.
One in 714 men with HIV died in 2018, compared to one in 507 men in the general population. This is a remarkable change from the worst years of AIDS when the annual death rate was more like one in five.
Read more at aidsmap.com/node/32443
What is ‘unsafe’ or ‘risky’ sex now?
People often imagine that ‘safer sex’ refers to sex with condoms when, in fact, there are lots of ways to make sex safer. And people sometimes talk about ‘unsafe sex’ or ‘risky sex’ without being clear about what they mean by the term.
One group of American researchers found that the proportion of HIV-positive gay and bisexual men having ‘unsafe sex’ falls from 42% to 2% when a nuanced definition of the term is used. They looked at a survey of 281 men living with HIV in New York.
The traditional definition of ‘risky sex’ is anal sex without a condom with a partner who is HIV negative or of unknown HIV status – 42% reported this in the past three months.
Given that undetectable = untransmittable (U=U), a more nuanced definition takes into account viral load. The researchers’ second definition was men who were not undetectable who reported anal sex without a condom with a partner who is HIV negative or of unknown HIV status – 6% reported this.
Partners may also be protected by PrEP. The researchers’ third definition was men who reported anal sex without a condom with a partner who is HIV negative or of unknown HIV status, who was not on PrEP – 25% reported this.
The most accurate definition would take into account both viral load and PrEP. The final definition of unsafe sex was therefore men who were not undetectable who reported anal sex without a condom with a partner who is HIV negative or of unknown HIV status, who was not on PrEP – 2% reported this.
Read more at aidsmap.com/node/32146
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