愛滋病毒傳播下降，但進展因大流行而放緩
最新數據顯示，英國的 HIV 傳播持續下降，但 COVID-19 大流行減緩了消除愛滋病毒的進程。
資料來源：英國衛生安全局/2022 年 12 月 1 日/財團法人台灣紅絲帶基金會編譯
英國衛生安全局 (UKHSA) 在世界愛滋病日公佈的最新數據顯示，2019 年至 2021 年期間，英格蘭的愛滋病毒新確診人數下降了近三分之一（從 2,986 人降至 2,023 人）。
2019 年至 2021 年期間，病毒在男同性戀、雙性戀和男男性接觸者 (GBMSM) 中的傳播持續下降，並且不知道自己感染了 HIV 的 GBMSM 感染人數估計有所減少。
然而，在冠狀病毒 (COVID-19) 大流行期間，終止愛滋病毒傳播的進展有所放緩，儘管愛滋病毒檢測水平較低，但異性戀者的診斷在 2021 年略有上升。 這意味著該人群的HIV傳播率和未確診HIV感染率並未下降。
2021 年，估計有 4,400 人不知道自己感染了 HIV，相當於英國估計感染 HIV 的總人數 (95,900) 的 5%。 這個數字比 2019 年（5,600）有所下降。 與 1,100 名異性戀男性和 1,500 名異性戀女性相比，估計有 1,500 名 GBMSM 感染了未確診的 HIV。
增加檢測對於減少不知道自己感染了 HIV 的人數至關重要。 COVID-19 大流行對 HIV 檢測行為產生了影響，在整個大流行期間對其他傳染病的檢測有所減少。
在所有性健康服務 (SHS) 中，有 1,053,169 人接受了 HIV 檢測，比 2019 年報告的檢測（1,319,915 人）減少了 20%。 雖然檢測顯示 2021 年部分恢復到大流行前水平，但這主要是由於 GBMSM 的檢測比 2019 年有所增加。對異性戀男性和女性的檢測仍低於 2019 年，與 2020 年相似。
英國衛生安全局 (UKHSA) 的 HIV 行動計畫監測和評估框架報告強調，到 2030 年結束愛滋病毒傳播，繼續公平獲得和接受頻繁 HIV 檢測、HIV 暴露前預防 (PrEP) 以及暴露後預防 (PEP) 以維持個人 HIV 的重要性。
UKHSA 愛滋病毒監測臨時負責人 Alison Brown 博士說：
隨著未確診的 HIV 感染者人數的減少，我們在英格蘭可以實現 HIV 傳播的終結。 然而，COVID-19 大流行減緩了某些領域的進展——包括對異性戀者進行檢測和對已經感染愛滋病毒的人進行照護。 解決這些不平等問題，將檢測提高到大流行前的水平，以及讓人們更早地開始接受 HIV 治療，對於實現 HIV 行動計畫的雄心壯志都至關重要。
無論您的性別或性取向如何，使用安全套、使用 PrEP（如果您符合條件）、接受檢測以及（如果您的 HIV 檢測呈陽性）接受治療對於保護您和您伴侶的健康仍然至關重要。
公共衛生部長尼爾奧布萊恩說：
我們對預防和公共衛生運動的承諾透過消除恥辱感和敦促更多人接受檢測以及獲得挽救生命的治療，幫助減少了新的 HIV 感染。
我們在英格蘭 HIV 感染率最高的地方當局地區的急診科進行 2,000 萬英鎊的 HIV 檢測投資取得了巨大成功。 在 A&E 推出常規檢測後的短短 6 個月內，NHS 發現有 800 多名愛滋病毒和肝炎病毒感染者未接受治療。
這有助於我們在實現 HIV 行動計劃中的承諾方面取得巨大進展，在交付後的前 100 天內進行了超過 259,000 次 HIV 檢測。
Terrence Higgins Trust 首席執行官 Ian Green 表示：
如果我們要在 2030 年之前取得必要的進展以結束新的 HIV 病例，那麼檢測、檢測和更多檢測至關重要。這意味著 HIV 檢測水平不僅要恢復到 COVID-19 之前的水平，而且要加速超過它。 今天的數據顯示，需要優先考慮加強對異性戀者——尤其是異性戀男性的檢測。 但我們不應該對在任何群體中進行檢測而沾沾自喜，包括男同性戀者和雙性戀者。
在 HIV 感染率非常高的英格蘭地區，急診部門選擇性退出的 HIV 檢測 (Opt-out HIV testing) 已經對發現未確診的 HIV 感染者以及讓其他人接受 HIV 照護產生了重大影響。 這對人們的健康來說是個好消息，因為它可以阻止 HIV 的繼續傳播並為 NHS 節省資金。 我們需要看到更多此類創新，才能找到該國估計有 4,400 名未確診的 HIV 感染者。
抗反轉錄病毒療法可將 HIV 感染者體內的病毒數量降低到檢測不到的水平。 即使在沒有保險套的情況下發生性行為，接受治療並保持檢測不到病毒水平的 HIV 感染者也不會傳播 HIV。 這也稱為「檢測不到 = 不會傳播」或“U=U”。
2021 年，估計有 11,985 名愛滋病病毒感染者的病毒具有可傳播水平。 11,985人中，只有37%未確診； 其餘人沒有得到照顧，沒有接受治療，或者尚未達到檢測不到的病毒水平。
愛滋病毒預防取決於透過檢測減少未確診個體的數量，以及讓愛滋病毒感染者參與和維持照護途徑，從而減少可傳播愛滋病毒感染者的數量。 這種方法將改善愛滋病毒感染者的健康狀況，並防止愛滋病毒進一步傳播，進而更接近 2030 年零愛滋病毒新發感染的目標。
檢測是免費的，可通過全科醫生診所、當地醫院和性健康診所以及使用自檢套件進行。
英國衛生安全局新聞辦公室，諾貝爾之家/史密斯廣場 17 號/倫敦
ukhsa-pressoffice@ukhsa.gov.uk
HIV transmission declining but progress slowed by pandemic
Latest data shows transmission of HIV is continuing to decline in the UK, but the COVID-19 pandemic has slowed progress towards elimination.
UK Health Security Agency/1 December 2022
The latest data published by the UK Health Security Agency (UKHSA) on World AIDS Day reveals that new HIV diagnoses in England fell by nearly a third between 2019 and 2021 (from 2,986 to 2,023).
Transmission of the virus among gay, bisexual and men who have sex with men (GBMSM) continued to fall and the estimated number of GBMSM living with HIV who are unaware of their infection decreased between 2019 and 2021.
However, progress towards ending HIV transmission has slowed during the coronavirus (COVID-19) pandemic, and diagnoses among heterosexual people rose slightly in 2021, despite lower levels of HIV testing. This means HIV transmission and undiagnosed HIV infection in this group has not fallen.
In 2021, there were an estimated 4,400 people unaware of their HIV infection, equivalent to 5% of all people estimated to be living with HIV in England (95,900). This figure has fallen from 2019 (5,600). An estimated 1,500 GBMSM were living with an undiagnosed HIV infection compared with 1,100 heterosexual men and 1,500 heterosexual women.
Increased testing is vital for reducing the number of people unaware of their HIV infection. The COVID-19 pandemic has had an impact on HIV testing behaviours, with reductions in testing seen for other infectious diseases throughout the pandemic.
Across all sexual health services (SHSs), 1,053,169 people received an HIV test, a 20% reduction from testing reported in 2019 (1,319,915). While testing showed a partial recovery toward pre-pandemic levels in 2021, this has mainly been driven by an increase in testing by GBMSM compared to 2019. Testing in heterosexual men and women remains lower than 2019 and similar to 2020.
UKHSA’s HIV Action Plan monitoring and evaluation framework report continues to highlight the importance of equitable access to and uptake of frequent HIV testing, to HIV pre-exposure prophylaxis (PrEP), and also to post-exposure prophylaxis (PEP) to maintain individuals’ HIV negative status and end HIV transmission by 2030.
Dr Alison Brown, Interim Head of HIV Surveillance at UKHSA, said:
The end of HIV transmission is within our reach in England, with reductions in the number of people living with undiagnosed HIV infection. However, the COVID-19 pandemic has slowed progress in some areas – including testing among heterosexuals and engagement in care for those already living with HIV. Addressing these inequalities, ramping up testing to pre-pandemic levels and getting people started on HIV treatment earlier will all be crucial in delivering the HIV Action Plan ambitions.
No matter your gender or sexual orientation, using condoms, using PrEP (if you’re eligible), getting tested and – if you test HIV positive – getting treated remains vital in protecting your health and that of your partners.
Minister for Public Health Neil O’Brien said:
Our commitment to prevention and public health campaigns have helped to reduce new HIV infections by tackling stigma and urging more people to get tested, as well as accessing life-saving treatment.
Our £20 million investment in HIV testing in emergency departments in the highest HIV prevalence local authority areas in England has been highly successful. The NHS has found more than 800 people living with HIV and hepatitis but not receiving treatment in just 6 months following the rollout of the routine testing in A&E.
This is helping us make excellent progress towards the commitments in our HIV Action Plan, with over 259,000 HIV tests being delivered within the first 100 days of delivery.
Ian Green, Chief Executive at Terrence Higgins Trust, said:
Testing, testing and more testing is crucial if we’re to make the inroads necessary to end new HIV cases by 2030. That means levels of HIV testing not just returning to pre-COVID-19 levels but accelerating past it. Today’s data shows that upping testing among heterosexuals – and particularly heterosexual men – needs to be made a priority. But we shouldn’t be complacent about testing among any group, including gay and bisexual men.
Opt-out HIV testing in emergency departments in areas of England with very high HIV prevalence is already having a big impact in finding people living with undiagnosed HIV, as well as returning others into HIV care. This is great news for people’s health as it stops onward transmission of HIV and saves money for the NHS. We need to see more of this kind of innovation to find the estimated 4,400 people living with undiagnosed HIV in the country.
Antiretroviral therapy reduces the amount of virus someone with HIV has in their body to an undetectable level. People living with HIV who are treated and maintain an undetectable level of virus cannot pass HIV even if having sex without condoms. This is also known as ‘undetectable = untransmissible’, or ‘U=U’.
In 2021, an estimated 11,985 people living with HIV had transmissible levels of virus. Among the 11,985, only 37% were undiagnosed; the remainder were not in care, not on treatment or had not yet achieved undetectable levels of virus.
HIV prevention hinges on reducing the number of people with a transmissible HIV infection through testing to reduce the number of undiagnosed individuals, and by engaging and maintaining people with HIV in care pathways. This approach will improve the health of those living with HIV, and prevent further transmission of HIV, in turn getting closer to the 2030 target of zero new HIV infections.
Tests are free and available through GP surgeries, local hospitals and sexual health clinics, as well as by using a self-testing kit.
UK Health Security Agency press office
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