Dear Boyz reader,
Welcome to this year’s World AIDS Day special issue of Boyz, and we have some good news for you. New HIV diagnoses in gay and bisexual men are falling. In the last 2 years the number of gay men who have been diagnosed with HIV has decreased by almost a third. In 2015, almost 3500 gay men were diagnosed in the UK with the virus; last year less than 2,500 were told they had HIV – it was a 30% decrease. This is the first decline in new HIV diagnoses in gay men since the AIDS epidemic was first detected over 30 years ago.
In London the figures are even more impressive where new diagnoses amongst gay and bisexual men fell by a staggering 44% from over 1400 in 2015 to less than 800 in 2017. Between 2015 and 2016 within London, the steepest decline in HIV diagnoses was seen among men aged 16 to 24 years, a 57% decrease; followed by 25 to 34 year olds where there was a 33% decrease. The UK is one of the first countries in the world to witness such a substantial decline in HIV diagnoses amongst gay and bisexual men.
We’re devoting much of this issue to asking the question whether the ambitious target of having zero new transmissions of HIV amongst gay and bisexual men is now possible – and what are the hurdles? The target to eliminate HIV in London by 2030 has been set as part of the Fast-Track Cities initiative backed by the Mayor of London, Sadiq Khan, the London Councils, Public Health England and NHS England.
London has already made great strides towards achieving the primary United Nations targets for the Fast-Track Cities initiative. In 2016, for the first time in London, all the UN’s 90-90-90 targets were met, with 90 per cent of people living with HIV infection diagnosed, 97 per cent of people diagnosed receiving treatment, and 97 per cent of people receiving treatment being virally suppressed. London was only the third city to achieve this target – joining Amsterdam and Melbourne.
But despite the good news there are still challenges. It’s estimated by Public Health England that over 6,000 gay and bisexual men living with HIV are undiagnosed, and so don’t know they have the virus. That’s 13% of all gay men with HIV. Just under 60% of those undiagnosed gay men were estimated to be aged 16 to 34 in 2016; about 2,500 men. This matters because these sexually active men will probably have a high viral load and are therefore very likely to pass the virus on to others during unprotected sex (although if their partner is on PrEP this will stop HIV being passed on), but also the health of these undiagnosed men will be at risk because of the way that HIV attacks their immune system.
The overall proportion of people diagnosed at a late stage of HIV infection has remained persistently high over the last five years at close to 40%. Being diagnosed late – that means with a T cell count below 350 – is associated with a ten-fold risk of short term death within a year of diagnosis. Over the last 10 years, the number of gay and bisexual men being diagnosed late has reduced by 25%, but it was still around 900 men in 2016. People diagnosed late have typically been unaware of their HIV infection for 3 to 5 years. In 2017 there were over 200 people with AIDS-defining illness reported at HIV diagnosis and there were still over 400 deaths among people with HIV.
Despite the concerns about late diagnosis, generally the news about the fall in new HIV infections amongst gay men is to be truly celebrated and the team from 56 Dean Street are giving Boyz readers a thumbs up on our cover this week to mark this important achievement. It’s time to say well done to everyone for getting regularly tested, taking up PrEP, taking your medication (if like me you are HIV positive) and above all talking about HIV together as a community, and how we can continue to reduce the number of gay and bisexual men being affected… and infected.
So this week in Boyz – for World AIDS Day this Saturday – we talk to the doctors and medical staff, the clinics and outreach teams, the charities and campaigners, and the local and national government teams – all working to get us to #ZeroHIV.