Select Committee on Health Appendices to the Minutes of Evidence

Attachment 1



  Though about 30,000 people are living with HIV, the UK remains a relatively low-prevalence country, probably because of the early interventions against HIV in the late 1980s. Since 1996, however, numbers living with HIV have been rising steadily, by about 10 per cent per annum. This is due to two factors. Firstly, there are new transmissions and infections being added to the population. Secondly, combined anti-viral drugs are now allowing people to survive who would previously have died. A consequence of this success is that the medical costs of HIV (over £250 million in 1998-99 in England) are also rising, by more than 10 per cent per annum.

  The epidemiology of HIV in the UK is also changing. The contribution of heterosexually acquired infections is increasing and in 1999, newly diagnosed infections acquired through this route for the first time exceeded those acquired through sex between men. Though many of the heterosexual infections are acquired abroad, heterosexual transmission is also occurring in the UK, albeit at quite low levels. Data collected by the PHLS and others indicate that behaviours that place heterosexuals and homosexuals at risk of acquiring HIV have probably been increasing recently. For instance, rates of gonorrhoea have risen in both groups, with the greatest increases being among young heterosexuals.

  The main burden of HIV infection falls on homosexual males and African ethnic minority groups, but there are also inequalities of access, with heterosexuals in general and black Africans in particular finding it less easy to access diagnostic and care services. London has the largest number of people in groups at high risk of HIV, and the capital accounts for 60 per cent to 70 per cent of all diagnosed HIV. In a broad-ranging review of opinion among health professionals in 1999, conducted by the PHLS (the Overview of Communicable Diseases), HIV was considered the top priority infection.


  A paradoxical effect of the success of combined antiviral HIV therapies in sustaining healthy life, is that treatment for HIV infected adults or children has risen dramatically. On the other hand, the potential saving resulting from preventing a single HIV infection has also risen. This means, for example, that it is now justified to screen pregnant women for HIV even in very low prevalence areas. Furthermore, preventing one infection will often prevent others by interrupting the chain of transmission.


  There is an element of complacency over HIV, which is sometimes presented as having been "stabilised" in western countries by international agencies. Other industrialised countries have recently seen increases in HIV transmission among drug injectors (Canada) and gay men (USA) which could happen here. In the UK, the risk to homosexuals, injecting drug users and multi-partnered heterosexuals is unabated. Perhaps the most vulnerable heterosexual group is the Afro-Caribbean. They experience higher levels of bacterial STDs which probably facilitate HIV transmission.

  Because of its close links with developing countries, the UK is especially likely to feel the influence of unfavourable trends in HIV infection in these resource-poor settings. Over 60 per cent of HIV infection world-wide is in Commonwealth countries and there are continuing close links with them at all levels. It should not be assumed that the UK will maintain low levels of heterosexual transmission and that the present unacceptably high levels of homosexual HIV transmission will be contained. Without greater preventive efforts both may rise.


  The response to HIV requires co-ordination of agencies within and beyond the health sector. Early diagnosis of HIV infection will in future play a more important role and health agencies, including the Department of Health, the NHS Executive, the Health Development Agency, District Health Authorities, NHS Hospital and Community Trusts, and Primary Care Groups/Trusts must support testing initiatives. However, agencies outside the health sector are equally important in reducing male homosexual transmission and containing heterosexual transmission with voluntary, non-governmental and community based organisations playing a crucial role for this infection. Education, youth and social services all play a vital role in promoting sexual health.


  The role of the PHLS is to provide primary and reference HIV testing, epidemiological data, and data analyses to support policy development, performance monitoring and specialist advice. In England a new AIDS Strategy will update that of 1995 which had too little impact except in the field of antenatal HIV testing. A key issue is how this new Strategy will relate to the broader Sexual Health Strategy and drug abuse intervention. The PHLS feels strongly that the responsibilities of agencies over-lap and should be shared. Risky drug and sexual behaviours that put young people at risk of HIV also place them at considerably greater risk of acquiring other sexually transmitted infections (such as gonorrhoea and chlamydia) and blood borne viruses (such as hepatitis B and C).


  HIV remains the most important infection in the UK. There are substantial opportunities for health gain but to achieve these there needs to be a new AIDS strategy within a broader sexual health agenda. PHLS seeks both to promote this and monitor its progress.


  Unlinked Anonymous Surveys Steering Group. Prevalence of HIV in the United Kingdom 1998. Report of the Unlinked Anonymous Seroprevalence Monitoring Programme in England and Wales. Department of Health, Public Health Laboratory Service, Institute of Child Health (London), Scottish Centre for Infection and Environmental Health, December 1999.

  Prepared by Drs Angus Nicoll and Philip Mortimer.

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Prepared 28 March 2001