Epidemiology of HIV/AIDS in England (United Kingdom) 2009-2017

This report provides a comprehensive overview of the epidemiology of HIV/AIDS in England (United Kingdom) between 2009 and 2017. It begins with an introduction to HIV/AIDS, discussing its global presence and the factors influencing its prevalence. The report delves into the causes and distribution of HIV, diagnosis and testing services, and control and prevention methods, including safe sex practices and voluntary medical male circumcision. It examines the global presence of the disease, including trends in HIV-related deaths and prevalence rates by gender. The report also analyzes HIV prevalence and demography within the UK, highlighting variations by gender and ethnicity, and discussing the age groups most affected. The report concludes by emphasizing the importance of early diagnosis, promoting voluntary testing, and addressing social stigmas to effectively control and prevent the spread of HIV/AIDS, with a focus on the UK context.

Public Health Intelligence

TABLE OF CONTENTS
Title: ................................................................................................................................................1
INTRODUCTION ..........................................................................................................................1
Epidemiology of HIV/AIDS............................................................................................................1
Global presence of the disease ........................................................................................................4
HIV prevalence and demography within UK .................................................................................6
Factors influencing disease prevalence ...........................................................................................9
Critical evaluation of secondary data source used ........................................................................11
CONCLUSION .............................................................................................................................12
REFERENCES .............................................................................................................................14

Title:
Epidemiology of HIV/AIDS in England (United Kingdom) between the years 2009 and
2017.
INTRODUCTION
Human immunodeficiency virus popularly known as HIV/AIDS and is one of the most
significant cause of reducing mortality rates. According to the statistics present by World Health
organization, in 2017 there were 36.9 million people suffering with the disease (World health
organisation, 2019). The prevalence of the disease is greatly affected by the demography and
regional aspects. Since the disease is one of the most devastating chronic illness and does not
have any treatment which can provide complete cure it is vital that its epidemiological and
demographical aspects must be understood. It will help to improve the mortality rate in the
region (Reinhardt et al., 2017). This paper will discuss the epidemiology of HIV in United
Kingdom. It will also evaluate the factors which influences the prevalence and control of disease
so that necessary measures can be taken to control the disease.
Epidemiology of HIV/AIDS
Causes and distribution of HIV:
HIV is defined as the progressive diseases which leads continuous damage to the immune
system of body. The symptoms of this chronic disease may take one year or less than that to
appear. Gradually the HIV virus is transformed into its ultimate stage called acquired
immunodeficiency syndrome or AIDS which destroy the immune system. As a result of this
infected person becomes more prone to infections and malignancies which leads to death. At
present there are no remedies which can eliminate the disease completely but several treatment
methods are available which helps to slow down the destruction of immune system (Jangu, Tam
and Maticka-Tyndale, 2017). In the year 2017 there were approximately 101,600 people in
United Kingdom which are infected by HIV virus (HIV In the UK Statistics, 2017). Out of these
infected people the highest number of patients are diagnosed in Lambeth borough of England. In
Lambeth it is estimated that on every 1000 people around 15% people are below the age of 15
and are diagnosed with HIV (Progress towards ending the HIV epidemic in the United Kingdom,
2018).
1

HIV is caused by the direct transmission of fluids such as semen, blood, breast milk and
genital secretions from the infected individual to others. The primary and common cause of HIV
is sexual intercourse with an infected person. The transmission of blood can also cause the
disease. For instance, the people suffering from haemophilia requires blood and thus the supply
of infected blood to such patients can make them HIV prone. Pregnancy related HIV
transmission is also one of the alarming situations for the individuals. Since the disease has
ultimate result of death it becomes essential that, the individuals who are not even born must be
protected from the infection. The HIV virus directly targets the immunity of human beings and
thus body becomes vulnerable to cancer and other life threatening infections. The continuous
destruction of immune system makes individuals immunodeficient. Gradually the reduced
functionality of immune cells functions which is measured by CD4 cell count results in AIDS
(Acquired immunodeficiency syndrome) AIDS is the common term which refers to development
of cancerous tissues and other clinical manifestations.
Diagnosis and testing services:
For the diagnosis of HIV enzyme immunoassays (EIAs) and other serological tests are
performed. A single test cannot provide the accurate diagnosis so these tests are performed in
combination. Serological tests does detect the direct presence of HIV virus instead these tests
determine the antibodies produced by healthy immune system (Davies, Ustianowski and Fox,
2016). The most challenging aspect of HIV diagnosis is to detect its presence among children
and infants. For the infants born from infected mothers in addition with serological test
virological test is also performed. Due to social stigma HIV testing services are not much
preferred by people. There is need to promote voluntary testing. Mandatory testing are violation
of human rights thus individuals must have self concern and awareness regarding this testing
procedures and needs. According to World health organisation HIV testing services must assure
that they follow principles such as confidentiality, informed consent, counselling, accuracy in
test results and connection with the care and treatment services (World health organisation,
2019).
The HIV virus can also transmit from placenta or the breast milk (Handiso, Negash and Mekiso,
2019). In order to avoid this severe risk, antiretroviral medications are provided to both females
and infants so that vulnerabilities can be reduced. The long-term exposure of antiretroviral
medications can help the infected individuals to eliminate even the sexual transmission of the
2

virus. There have been several misconceptions among people that the virus is spread by
coughing or even casual contact like handshake or hugging. However, the virus is fragile and is
unable to survive outside the body (Grover et al., 2018). When the virus is detected in the early
stage then it is called as primary infection and it is possible for the health professional to delay
the occurrence of AIDS or final stage. Usually there is gap of around more than 10 years in
reaching from primary to final stage.
Control and prevention:
The foremost and critical prevention method for avoiding HIV is to follow the safe and
protected sex practices. It has been analysed that heterosexual individuals have high risks of
getting infected with the disease. Thus, it is recommended that individuals must get screening in
every three months so that the diagnosis can be performed on time and suitable control measures
can be taken. The taboo and social stigmas related to HIV must be addressed as the priority.
These stigmas are the main reason that individuals always try to escape the diagnosis or care
services. It is the responsibility of health care authorities to create awareness among people so
that they can understand the importance of on time diagnosis of the disease and the social
perspective related to disease can be changed (Reinhardt et al., 2017).
Voluntary medical male circumcision (VMMC) can be one of the effective prevention method
and it can reduce the heterosexual HIV risk by around 60%. The sex education along with the
information regarding condom usage and HIV testing can prevent the disease occurrence. The
people must be provided the counselling of HIV and other STIs so that they can understand the
risk factors and their prevention methods. For instance the use of male and female condom
during sex can eliminate the risk of HIV infection. It is estimated by WHO that the use of
condom can reduce the risk by 85% so individuals must be encouraged and informed regarding
their benefits.
For the prevention and control of the disease it is recommended that the sexual clinics
must be increased in different parts of UK so that HIV screening can be promoted and
encouraged. For instance, the mothers have high risk thus their diagnosis in the initial stages of
pregnancy can help to protect child from the infection. The regions which have high prevalence
must be tested with HIV so that on time control actions and services can be provided to them
(Guaraldi and Silva, 2016). The healthcare professionals and community servers must provide
necessary information and resources so that HIV risks can be eliminated. The health service
3

providers must also enhance the HIV test monitoring and policies so that care services can be
improved and perspective of people towards disease can be changed.
Global presence of the disease
The prevalence of HIV is common in adults as well as among children. It has been
estimated by UNICEF that out of 36.9 million infected people nearly 3 million individuals are
below 20 years of age and it is assumed that every day around 4900 people are being infected by
the virus (Global and regional trends, 2018).
(Source: HIV/AIDS, 2019)
There has been continuous increase in the deaths caused by the HIV infection from 1990 and
were at peak in year 2015 (Guaraldi, Gomes and Silva, 2016).
4
Illustration 1: Percentage of HIV prevalence
in different regions of world

(Source: Roser., M. and Ritchie., H., 2018)
From the graph it can be observed that with the efforts of World health organisation and
health departments of the nations there has been decline in the number of new infected people.
Like in year around 3 millions new infected cases were reported while in 2016 the number
reduced and only 1.8 millions infected people were recorded. The number of deaths due to HIV
has also decreased from 1.8 million to 1 million between year 2005 and 2016 by emphasis on
minimising the rate of infection in new born babies from their mothers. The infected people
within age group 15-49 years have shown maximum number of HIV associated deaths. Thus, it
is very essential that demographics must be considered in prevention and control methods of
HIV.
5
Illustration 2: Global HIV statistics

(Source: Roser., M. and Ritchie., H., 2018)
The HIV prevalence rates also differs on the basis of gender. In many countries females
have higher rate of AIDS related deaths as compare to men. According to HIV In the UK
Statistics (2017) in UK only 31% of HIV victims are females while the infected men's account for
69%. One of the major causes for this difference is that in many societies’ women have very less
role in making sexual or protection decisions. Along with this lack of sexual education among
women is also critical aspect which makes them more vulnerable to the disease.
HIV prevalence and demography within UK
It has been reported in UK healthcare statistics that in 2017 around 93,385 people
received HIV care and the number of people seeking these cases have been increased by 54%
within 10 years (HIV In the UK Statistics, 2017). UK has small epidemic and prevalence of HIV
with near 102,000 people with HIV (HIV and Aids in the United Kingdom, 2019)). The HIV
6
Illustration 3: Age group based death statistics of HIV sufferers

prevalence in UK also observes variations in terms of gender and ethical composition. Contrary
to global trends, in UK percentage of men suffering from HIV is higher than that of women.
HIV prevalence by gender in UK % of HIV infected people
Male 69.00%
Female 31.00%
(Source: HIV In the UK Statistics, 2017)
UK Community % of HIV
White 54.70%
Black African 29.10%
Black Caribbean 3.00%
7
Illustration 4: % of males and female HIV infected
population in UK

Black other 2.90%
Asian 3.70%
Other/Mixed 5.40%
Along with British UK is home to several cultural groups such as African, Asian,
Caribbean and several other small groups. As per HIV In the UK Statistics (2017) HIV
prevalence is highest among white (54.7%) and African communities (29.1%) while Asians and
Caribbean groups in the region have less proportion in the infected communities (Crum-
Cianflone and Sullivan, 2017).
(Source: HIV In the UK Statistics, 2017)
Among majority of people in UK who are receiving HIV care are within age group of 55 and
above. It comprises around 33% of total UK population which is suffering from the disease.
8
Illustration 5: Ethnicity percentage among HIV
infected people in UK

(Source: Progress towards ending the HIV epidemic in the United Kingdom, 2018)
It has been surprising that majority of people, around 91.6% patients receives HIV care in
England. Apart from England, Wales, Scotland and North Ireland are the major regions within
UK where care services are easily accessible and used by the patients.
(Source: HIV In the UK Statistics, 2017)
According to the statistics of public health England, there has been decline in the number of
people who are diagnosed with HIV over last few years. As per the 2017 statistics of HIV in UK,
number of diagnosed incidences has reduced by 17%. Sexual contact is the most common
9
Illustration 6: Different age groups receiving HIV care in UK
Illustration 7: UK distribution of HIV

transmission route for the disease. In 2009 almost 95% of the HIV positive cases were reported
due to this mode of transmission (HIV and AIDS statistics, 2010). Though drugs and blood
products are also significant reasons for the transmission of disease but there has been decline in
such transmitted infection (Siuki et al., 2018). There has been routine screening of blood
products in healthcare organisations so that risk possibilities and vulnerabilities can be avoided.
It has been also analysed that some individuals diagnosed with HIV in UK originally got
infection from abroad.
Discussion
One of the reasons for high prevalence of the disease among native UK citizens as
compare to other communities is migration pattern. There has been less migration from the
countries which have higher prevalence of HIV. After the sexual transmission most commonly
factors which cause the HIV infection are drug injections and virus transmissions through blood
or other body tissues. This can be considered as the major challenge because for the regulatory
authorities it is vital to eliminate the infections particularly from mothers to their children (Jain et
al., 2015). There has been lack of awareness and sexual education which enhances the risk of
disease exposure. Due to negligence and lack of awareness most of the people in UK does not
consider it essential to diagnose the issue
Timely diagnosis is one of the key approaches to minimise the extent of this lifelong
chronic disease. However, the discrimination and stigma related to HIV make it uncomfortable
for majority of people to take necessary steps for diagnosis and treatment of the disease. It not
only increases risks and harm to the victim but also enhances the risk of infection transmission
among people.
Apart from the timely diagnosis the only effective way to avoid the prevalence of HIV is
to use safe approaches which can eliminate the disease occurrence. For instance, the protective
sex and blood transmission after proper evaluation and assessment can reduce the HIV
transmission to great extent.
The lack of sex education is one of the critical factor which affects the disease prevalence. For
instance the lack of sex education has caused increasing percentage of HIV vitcims in the age
groups of 15 to 49. As per the statistics presented by Roser and Ritchie (2018) in 2016 around
5,00,000 people were in the age group 15-49 who died due to HIV. The religious factors have
also impacted on HIV testing and related conceptions. For instance Muslim and African women
10