38,000,000
estimated number of people living with HIV in 2019

1,700,000
people were newly infected with HIV in 2019

690,000
people died of HIV-related causes in 2019

68%
percentage of adults living with HIV received lifelong antiretroviral therapy (ART) in 2019*

*Worldwide, courtesy of WHO

While there is no cure for HIV, there are very effective treatments that enable most people with the virus to live a long and healthy life

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Statistics on late HIV diagnosis in the UK

Overall, in the period from 2015 to 2017, an average of 41.1% of people aged 15 years and older who were newly diagnosed with HIV were diagnosed at late stage of infection (4,461 out of 10,848 people)

In the same period, the percentage of people whose HIV diagnosis was made at a late stage of infection was significantly higher than the England average among the Black African, Other Black, Black Caribbean and Asian ethnic groups (at 55.2%, 51.3%, 48.5% and 47.8% respectively), and significantly lower than the England average among the White and Other (including Mixed ethnicity) groups (at 36.9% and 36.2% respectively)

Between 2009/11 and 2015/17, the percentage of people whose HIV diagnosis was made at a late stage of infection fell significantly for Black African people (from 64.0% to 55.2%), people from the Other (including Mixed ethnicity) group (from 44.5% to 36.2%), and White people (from 42.0% to 36.9%)

Although there appears to be a large drop for the Other Black group in the same period, there were too few people in this group to draw firm conclusions

Throughout the period from 2009/11 to 2015/17, the percentage of people whose HIV diagnosis was made at a late stage of infection was significantly higher in the Black African ethnic group compared with all other ethnic groups (except for the Black Caribbean Group in 2015/17 and Other Black ethnic group in the periods 2009/11, 2010/12, and 2015/17)

Source: HM Government

The world has made significant progress since the late 1990s, but HIV remains a major global public health issue. And like many other major health issues, it faces additional challenges during the COVID-19 pandemic.
HIV prevention, testing, treatment and care services are all being disrupted particularly in countries with fragile heath systems. The breakdown in essential HIV services due to COVID-19 is threatening lives. Any slowing down in provision of these services will leave many vulnerable populations at greater risk of HIV infection and AIDS-related deaths.
Nevertheless, all over the world, health workers and community representatives are doing their utmost to keep services going, adopting innovative ways to overcome disruptions in services caused by COVID-19.

What are HIV and AIDS?

HIV- Human Immunodeficiency Virus

HIV attacks the body’s immune system gradually causing damage. Without treatment, the immune system will become too weak to fight off illness and infection.

There is currently no cure for HIV. But major advances in treatment mean that many people can lead long and healthy lives, although some may experience side effects from the treatment.

HIV is present in blood, genital fluids (semen, vaginal fluids and moisture in the rectum) and breast milk.

AIDS- Acquired Immune Deficiency Syndrome

AIDS is the term used to describe a stage of HIV infection when the body is too weak to fight off a range of diseases.

You cannot catch AIDS. HIV causes AIDS and it is HIV that can be passed on. Being diagnosed with AIDS means different things for different people.

Image credit: NIAID, CC BY 2.0

3D print of HIV. The virus surface (yellow) is covered with proteins (purple) that enable the virus to enter and infect human cells.


Just because someone has AIDS does not mean they will die – but it is essential to have medical care and treatment.

The main ways HIV can be passed on

In the UK, most cases of HIV are caused by having sex with a person who has HIV without using a condom.

A person with HIV can pass the virus on to others even if they don't have any symptoms. People with HIV can pass the virus on more easily in the weeks following infection.

HIV treatment significantly reduces the risk of someone with HIV passing it on.

Sexual contact

Most people diagnosed with HIV in the UK acquire the virus through unprotected vaginal or anal sex.

It may also be possible to catch HIV through unprotected oral sex, but the risk is much lower.


The risk is higher if:

the person giving oral sex has mouth ulcers, sores or bleeding gums

the person receiving oral sex has recently been infected with HIV and has a lot of the virus in their body, or another sexually transmitted infection

Other risk behaviours

Other ways of getting HIV include:

sharing needles, syringes and other injecting equipment 

from mother to baby before or during birth or by breastfeeding

sharing sex toys with someone infected with HIV

healthcare workers accidentally pricking themselves with an infected needle, but this risk is extremely low

blood transfusion – now very rare in the UK, but still a problem in developing countries



How HIV is transmitted

Diana, Princess of Wales on one of her many visits to Mildmay. Diana did a huge amount to effect public perceptions and understanding about HIV/AIDS.

HIV isn't easily passed on from one person to another. The virus doesn't spread through the air like cold and flu viruses.

HIV lives in the blood and in some body fluids. To get HIV, one of these fluids from someone with HIV has to get into your blood.

The body fluids that contain enough HIV to infect someone are:

semen

vaginal fluids, including menstrual blood

breast milk

blood

lining inside the anus


Other body fluids, like saliva, sweat or urine, don't contain enough of the virus to infect another person.


The main ways the virus enters the bloodstream are: 

by injecting into the bloodstream with needles or injecting equipment that's been shared with other people

through the thin lining on or inside the anus, vagina and genitals

through the thin lining of the mouth and eyes

through cuts and sores in the skin


But there are ways of preventing HIV infection in all of these situations.

There are many effective ways to prevent or reduce the risk of HIV infection. Speak to your local sexual health clinic or a GP for further advice about the best way to reduce your risk.

HIV isn't passed on through:

spitting

kissing

being bitten

contact with unbroken, healthy skin

being sneezed on

sharing baths, towels or cutlery

using the same toilets or swimming pools

mouth-to-mouth resuscitation

contact with animals or insects like mosquitoes


Symptoms of HIV

These vary from person to person, People can live with HIV for years before having any symptoms. The only way to be sure if you have HIV is to have an HIV test. You cannot tell from symptoms alone.
Diagram of early symptoms of HIV
However, most people infected with HIV experience a short, flu-like illness that occurs 2-6 weeks after infection. After this, HIV may not cause any symptoms for several years.

It's estimated up to 80% of people who are infected with HIV experience this flu-like illness.

The most common symptoms are:

raised temperature (fever)
sore throat
body rash

Other symptoms include:

tiredness
joint pain
muscle pain
swollen glands

The symptoms usually last 1-2 weeks, but can be longer. They're a sign that your immune system is putting up a fight against the virus.

But having these symptoms does not necessarily mean you have the HIV virus. Remember: they're commonly caused by conditions other than HIV.

If you have several of these symptoms and think you've been at risk of HIV infection within the past few weeks, you should get an HIV test.

After the initial symptoms disappear, HIV may not cause any further symptoms for many years.

During this time, the virus continues to be active and causes progressive damage to your immune system.

This process can vary from person to person, but may take up to 10 years, during which you'll feel and appear well.
Once the immune system becomes severely damaged, symptoms can include:

weight loss
chronic diarrhoea
night sweats
skin problems
recurrent infections
serious life-threatening illnesses

Earlier diagnosis and treatment of HIV can prevent these problems.

Why take an HIV Test?

You should still take an HIV test if you may have been at risk at any time in the past, even if you do not experience any symptoms.

The sooner you’re diagnosed with HIV, the sooner you can start treatment.

Antiretroviral drugs(ARVs) will keep the virus under control by stopping it from reproducing itself. The goal is to keep levels of HIV so low that in tests the person has an undetectable viral load.

If someone with HIV is on effective treatment and has an undetectable viral load they cannot pass on HIV.

HIV rapid test being administered

Find out more on the Terrence Higgins Trust (THT) website.

Terrence Higgins Trust is the UK's leading HIV and sexual health charity.


There are now many quick and convenient ways to test for HIV

HIV tests are available in lots of healthcare settings. This might be in a sexual health clinic, doctor’s surgery, hospital or private clinic, for example. In many countries, there are also places where you can be tested in your local community.

In the UK, you can get a free and confidential HIV test at any NHS sexual health or GUM (genito-urinary medicine) clinic.

These clinics are linked into specialist HIV services, and there will be support available to you if your result is positive.

More information about HIV and how to get tested:

Terrence Higgins Trust

The UK's leading HIV and sexual health charity

AVERT

UK-based charity providing accurate and trusted information about HIV and sexual health worldwide

NHS: Find testing services near you

An HIV test is the only way to know if you have HIV

Current treatment for HIV

Antiretroviral drugs cannot cure HIV but work by reducing the amount of HIV in the body so the immune system can work normally.

This doesn’t get rid of HIV completely, but with the right treatment and care, someone with HIV can expect to live a long and healthy life.

It is now recommended that everyone diagnosed with HIV starts treatment straight away.

Early diagnosis enables better treatment outcomes and reduces the risk of onward transmission.

People diagnosed late have a much higher risk of developing complex health conditions including HIV -associated brain impairment.

If you test positive

If you're diagnosed with HIV, you'll have regular blood tests to monitor the progress of the HIV infection before starting treatment.

2 important blood tests are:

HIV viral load test – a blood test that monitors the amount of HIV virus in your blood

CD4 lymphocyte cell count – which measures how the HIV has affected your immune system

Treatment can be started at any point following your diagnosis, depending on your circumstances and in consultation with your HIV doctor.

hiv-aids-treatment

HIV/AIDS Treatment Image by Nick Youngson CC BY-SA 3.0 Alpha Stock Images


Antiretroviral drugs

Image by Tomasz Ryś

HIV is treated with antiretroviral medications, which work by stopping the virus replicating in the body. This allows the immune system to repair itself and prevent further damage.

A combination of HIV drugs is used because HIV can quickly adapt and become resistant.

Some HIV treatments have been combined into a single pill, known as a fixed dose combination, although these often cost more to prescribe.

Usually, people who have just been diagnosed with HIV take between 1 and 4 pills a day.

Different combinations of HIV medicines work for different people, so the medicine you take will be individual to you.

The amount of HIV virus in your blood (viral load) is measured to see how well treatment is working. Once it can no longer be measured it's known as undetectable. Most people taking daily HIV treatment reach an undetectable viral load within 6 months of starting treatment.

Many of the medicines used to treat HIV can interact with other medicines prescribed by your GP or bought over-the-counter.

These include some nasal sprays and inhalers, herbal remedies like St John's wort, as well as some recreational drugs. Always check with your HIV clinic staff or your GP before taking any other medicines.

PrEP and PEP

What is PrEP?

Pre-exposure prophylaxis (PrEP) is an HIV prevention strategy that uses antiretroviral drugs to protect people who do not have HIV but who are at high risk of contracting HIV.

To be effective, Prep must be taken regularly, as directed. It does not prevent other sexually transmitted infections.

What is PEP?

Post-exposure Prophylaxis (PEP) is a short-term treatment that stops HIV spreading through the  body.

It must be taken within 72 hours of possible exposure to HIV.


HIV-Associated Brain Impairment (HAND)

Mildmay specialises in the treatment of HIV-Associated Neurocognitive Disorder, or HAND, impairment caused by HIV entering and affecting the brain.

This is a form of severe dementia which Mildmay is able to curtail or even reverse in the majority of our patients, enabling them to return to some form of independent living.

People with HAND often display symptoms that are very similar to

 dementia, such as memory loss, confusion, loss of a sense of self, difficulty in walking, speaking or carrying out every day tasks.

Mildmay’s specialised treatment, care and rehabilitation includes highly skilled medical and nursing care, treatment, rehabilitation and a combined range of therapies.

Read more about HAND

Image by StarGladeVintage


HIV-associated neurocognitive disorders (HAND) are neurological disorders associated with HIV infection and AIDS. It is a syndrome of progressive deterioration of memory, cognition, behaviour, and motor function in HIV-infected individuals during the late stages of the disease, when immunodeficiency is severe.

HAND may include neurological disorders of various severity. HIV-associated neurocognitive disorders are associated with a metabolic encephalopathy induced by HIV infection and fuelled by immune activation of macrophages and microglia. These cells are actively infected with HIV and secrete neurotoxins of both host and viral origin.

The essential features of AIDS dementia complex (ADC) are disabling cognitive impairment accompanied by motor dysfunction, speech problems and behavioural change.

Cognitive impairment is characterised by mental slowness, trouble with memory and poor concentration. Motor symptoms include a loss of fine motor control leading to clumsiness, poor balance and tremors.

Behavioural changes may include apathy, lethargy and diminished emotional responses and spontaneity.




HIV in the UK*

London has the largest numbers of people living with HIV, but numbers are growing in every part of the UK.

Globally

Sub-Saharan Africa has the most serious HIV and AIDS epidemic in the world. In 2013, an estimated 24.7 million people were living with HIV, accounting for 71 per cent of the global total.

HIV Pregnancy and Birth**

In the UK with the right treatment and care, 99 per cent of women living with HIV give birth to healthy babies without passing on HIV.



Mildmay is the first specialist unit aiming to provide pioneering step-down care for the homeless population of London and the surrounding regions.

With homelessness in London and other major cities across the UK increasing, there is urgent need for highly focused, specialist care of the sort that Mildmay Hospital provides.

*UK figures: Public Health England

**All global figures from unaids.org and Avert


Registered Charity no: 292058

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