Annual HIV incidence among gay, bisexual and other men who have sex with men in England, 2014 to 2023: a prospective cohort analysis using national surveillance data.

Abstract

Objectives: Following the fall in new HIV diagnoses in gay, bisexual and other men who have sex with men (GBMSM) since 2015, the English government published an HIV Action Plan in 2021 committing to end HIV transmission by 2030. Underlying HIV transmission and access to testing influence diagnosis trends and may not reflect incidence as people could be living with undiagnosed HIV for many years. We derived HIV incidence by clinical risk markers and pre-exposure prophylaxis (PrEP) use.

Methods: Using GUMCAD STI surveillance data between 2014/2015 and 2022/2023, we calculated yearly HIV incidence among HIV-negative GBMSM attending sexual health services (SHS) in England with at least two HIV tests within 365 days ('repeat testers'). Annual incidence was stratified by clinical risk markers: bacterial sexually transmitted infection (STI) history and recent HIV test (from the previous year). Incidence was further stratified by PrEP use in 2022/2023.

Results: The number of HIV-negative GBMSM attending SHS in England increased by 34% from 111 977 in 2014/2015 to 1 49 904 in 2022/2023, of whom repeat testers were 34% (37 576) in 2014/2015 and 38% (56 896) in 2022/2023. HIV incidence reduced by 93% overall (1.77/100 person-years (py) (95 CI 1.61 to 1.94) in 2014/2015 to 0.12/100 py (0.09 to 0.16) in 2022/2023). Incidence was reduced by at least 89% in all groups irrespective of clinical risk markers: with bacterial sexually transmitted infection (STI) history (3.68/100 py (3.17 to 4.27) to 0.26/100 py (0.18 to 0.38)); the subset with a rectal bacterial infection (5.18/100 py (4.13 to 6.49) to 0.58/100 py (0.36 to 0.93)) and with a recent HIV test (1.93/100 py (1.66 to 2.24) to 0.08/100 py (0.05 to 0.13)). In 2022/2023, using PrEP reduced HIV incidence by 86% (using PrEP: 0.05/100 py (0.03 to 0.08)) vs not using PrEP: 0.36/100 py (0.26 to 0.50)).

Conclusion: There was a sustained and large decline in HIV incidence among GBMSM, while incidence remains highest among those with a recent bacterial STI history. This analysis further highlights the real-world impact of PrEP and highlights the importance of equitable provision of HIV combination prevention interventions.