The latest figures on HIV diagnoses among gay and bisexual men in the UK gives us cause to celebrate.
Last year was the first time that we were able to report on a significant decline in new diagnoses, with 2,810 new cases. This year the number of new cases dropped by a further 17%. It’s another huge reduction in a single year, with only 2,330 new cases.
We still have a long way to go before new HIV diagnoses can be consigned to history, but the numbers are now going in the right direction.
The factors behind the drop?
Maybe you’re thinking, ‘Thank the Gods for PrEP.’ Of course, we should all be grateful that there’s now an extremely effective method of prevention, which people who aren’t living with the virus can use against HIV (frustratingly still not available to all on the NHS). But PrEP is only one part of the story.
We’ve only seen dramatic drops in HIV diagnoses in the last couple of years but it is now believed that new HIV infections started to drop in 2013. This was a couple of years before there was any significant use of PrEP in the UK.
The drop in HIV infections wasn’t due to increased condom use. Since the late 1990s, and the introduction of effective combination HIV treatment, condom use by gay and bi men has dropped steadily. In that time, we’ve learned more about HIV treatment and its impact.
As dosing improved, and the side-effects of HIV treatment lessened, the wisdom of waiting until the immune system started to fail before beginning treatment was questioned. In 2015, the START study finally confirmed that people with HIV were likely to enjoy longer and healthier lives if they started treatment immediately.
Undetectable = Untransmittable
The other leap forward was in our understanding of the impact that HIV treatment has on preventing onward transmission of the virus.
From the early days of effective treatment it was observed that when more people were on treatment the number of new infections dropped.
Study after study investigated this impact. Researchers looked for even a single case of someone who was virally suppressed on treatment (aka undetectable) passing the virus to a sexual partner and found none. We went from concept, via caution, through confidence, finally arriving at a certainty that when someone is on effective HIV treatment it is not possible to pass the virus on via sex.
Incredible UK HIV statistics
Treatment rates vary considerably from region to region but here in the UK we have achieved greatness. The latest figures just released by Public Health England report that 98% of all those who are diagnosed with HIV are on treatment and 97% of those are virally suppressed to the point that the virus is undetectable.
That means that 95% of all people who are diagnosed HIV-positive pose no risk to their sexual partners. How great is that?
This means that if someone tells you that they have HIV, the odds are heavily in favour of them being unable to pass the virus on during sex. That’s with or without condoms.
The enormous progress that we’ve made means that now only about 8% of people who are living with HIV in the UK have not been diagnosed. Add to that the one in 20 people who have been diagnosed who have not yet achieved viral suppression and we have about 13% of people with HIV in the country who can pass the virus on.
That’s low enough to have contributed to the falls that we have seen but it’s not yet low enough to stop the virus in its tracks.
‘So close to ending this’
We are now so close to ending this. The pincer movement of offering PrEP to people at high risk of HIV exposure combined with our efforts to treat people with HIV, which has the brilliant added benefit of rendering us uninfectious, means that we’re tantalisingly close to halting HIV.
Here’s where you can play your part: if you’ve never received a positive diagnosis and you’ve had sex since your last test, go get tested. This applies even if you reckon you’ve been pretty safe, you’ve always used condoms or you’ve only had sex with people you trust.
If your risk has been low the odds are in your favour that you’ll still be negative. But it won’t hurt to be certain, right?
If you are HIV, the sooner you start treatment the better it will be for your health and life expectancy. And, as a bonus, you can be confident that you won’t be able to pass the virus on. Sharing the news that effective HIV treatment is also effective HIV prevention also helps to challenge stigma – and that’s great too.
If you are HIV-negative, think about what you’re willing to do to ensure that you stay that way. You can use PrEP, you can use condoms or you can stop having any sex with a risk of transmission. It’s up to you to find a method of prevention that you can stick to, which meets your needs and desires.
It was a combination approach to HIV treatment that finally managed to end AIDS. It will be a combination approach to prevention that will do the same for HIV.
Matthew Hodson is Executive Director of NAM aidsmap and the recent winner of Social CEO of the year. Follow him on Twitter at @Matthew_Hodson. NAM aidsmap provides HIV news and treatment information to support people living with HIV, throughout the UK and internationally, to live longer and healthier lives. If you would like to make a donation to support NAM’s vital work, please visit: www.aidsmap.com/donate.