Human immunodeficiency virus (HIV)

Human immunodeficiency virus (HIV) is a viral infection, primarily transmitted through sexual contact, which attacks the immune system. After initial non-specific symptoms, the infected person can remain without symptoms until advanced stages of HIV infection – acquired immunodeficiency syndrome (AIDS). Early diagnosis and treatment of infection are critical to reduce the likelihood of infecting others and of developing serious and life-threatening medical conditions. Treatment has transformed HIV from a fatal infection into a chronic, manageable condition and people living with HIV in the UK can now expect to live into old age if diagnosed promptly.[i] Late HIV diagnosis is associated with poorer health outcomes, including premature death.

It is estimated that at the end of 2015 around 101,200 people were living with HIV in the UK. Of these, around one in eight don't know they have HIV because they have never had an HIV test or they were infected after their last test.

Anti-retroviral therapy (ART) has resulted in substantial reductions in AIDS and deaths in the UK. Advances in ART and other improvements in HIV services mean that a young person diagnosed with HIV today and treated promptly would expect to have a near-normal life expectancy.[ii]

Public Health England's Sexual and Reproductive Health Profiles contain indicators on uptake of HIV testing, late diagnoses and diagnosed prevalence. The indicator on late diagnosis is key and is also included in the Public Health Outcomes Framework.

Key findings for Lancashire-14

This section summarises data for the three upper-tier authorities in the Lancashire-14 area, around uptake of HIV tests, prevalence of HIV and late diagnosis. 

Uptake of HIV tests (based on 2016 data)

HIV testing is integral to the treatment and management of HIV. Knowledge of HIV status increases survival rates, improves quality of life and reduces the risk of HIV transmission.

HIV test uptake measures the number of 'eligible new episodes' where a HIV test was accepted as a percentage of those where a HIV test was offered. Eligible new episode’ is defined as a visit to a specialist sexual health service (SHS), including all subsequent specialist SHS attendances in the following six weeks (i.e. eligibility for testing occurs only once every six weeks).

  • In Blackburn with Darwen (81.5%), Blackpool (80.8%) and Lancashire-12 (77.1%), the uptake of HIV testing is better than the England rate (76.5%) with an increasing trend in uptake observed in all three local authorities.
  • Uptake among men who have sex with men (MSM) is generally higher than overall uptake. In Blackburn with Darwen (96.8%), Lancashire-12 (94.6%) and Blackpool (94.5%) uptake among MSM is similar to the England rate (94.2%). The trend based on the most recent five years shows the HIV testing uptake among MSM to be getting better in the Lancashire-12 area and Blackpool, with no significant change observed in Blackburn with Darwen. England's HIV testing uptake in MSM is getting worse.
  • The uptake of HIV testing among men in Blackburn with Darwen (84.8%) is similar to the England rate (85.7%). In Blackpool (83.9%) and Lancashire-12 (81.6%) it is worse than the England rate. The trend based on the most recent five years (up to 2016) shows the HIV testing uptake among men to be getting better in all three upper-tier local authorities in Lancashire-14.
  • The uptake of HIV testing among women is generally lower compared to men. Compared to England (69.2%) it is statistically better (and showing an increasing trend) in all three upper-tier authorities; Blackpool (78.3%), Blackburn with Darwen (78.0%) and Lancashire-12 (73.2%).

Prevalence of diagnosed HIV infection (based on 2016 data)

In 2016, guidelines were updated by NICE HIV testing guidelines which is co-badged with Public Health England. This guidance continues to define high HIV prevalence local authorities are those with a diagnosed HIV prevalence of between two and five cases per 1,000 and extremely high prevalence local authorities are those with a diagnosed HIV prevalence of five or more per 1,000 people aged 15 to 59 years

Prevalence of diagnosed HIV provides a local authority measure of burden of infection rather than a measure of performance, as prevalence will be affected by a combination of rates of new infections, uptake of HIV testing and increased survival due to improved treatments. 

  • There are an estimated 987 people aged 15-59 years diagnosed with HIV infection (based on people accessing HIV care at an NHS service), across the Lancashire-14 area, with 317 of these from Blackpool, 579 from Lancashire-12 and 91 from Blackburn with Darwen. 
  • In Blackburn with Darwen (1.06 per 1,000 of the population) and Lancashire-12 (0.85 per 1,000) the prevalence of diagnosed HIV infection is below the national goal of less than two cases per 1,000. In both local authorities the diagnosed HIV prevalence is below the England rate (2.31).
  • In Blackpool (4.02) the prevalence of diagnosed HIV infection is in excess of two per 1,000 and above the England rate; Blackpool meets the NICE HIV testing guidelines' criteria of a high HIV prevalence local authority.
  • The trend based on six years (up to 2016) shows that in Lancashire-12 the prevalence of diagnosed HIV infection is increasing/getting worse; though Lancashire-12's HIV prevalence remains below two per 1,000. This increase could be partly due to the effectiveness of HIV treatment. The recent trend shows no significant change in the prevalence of diagnosed HIV infection in Blackburn with Darwen and Blackpool.

Late diagnosis (based on 2014-16 data)

  • Across Lancashire-14, the proportion of adults presenting at a late stage with HIV is similar to the England rate.
  • In Blackburn with Darwen 66.7% of adults with HIV were diagnosed at a late stage of infection, this figure was 47.0% in Lancashire-12 and 37.5% in Blackpool (England rate = 40.1%). The actual numbers of people diagnosed late in Blackburn with Darwen are very small therefore please use caution when interpreting the figures.

[i] Public Health England, HIV in the UK - 2016 report

[ii] The Antiretroviral Therapy Cohort Collaboration. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. The Lancet 2017. doi: 10.1016/S2352-3018(17)30066-8

Page updated May 2018

Infectious diseases