New HIV diagnoses among heterosexual people are higher than in gay and bisexual men in England for the first time in a decade, according to figures from the UK Health Security Agency (UKHSA).

In 2020, almost half (49%) of new HIV diagnoses were in heterosexuals compared to 45% in gay and bisexual men, who are often wrongly assumed to be the only group who can contract the virus.  

HIV diagnoses fell by 33% compared with last year, but the UKHSA has attributed the fall to reduced access to testing during the pandemic rather than reduced transmission. 

These figures come after lockdowns and Covid restrictions which led to a 30% drop in HIV testing overall with a 33% drop in HIV testing among straight people, compared with just a 7% decrease among gay and bisexual men.  

According to the UKHSA, straight people are far more likely to be diagnosed late than gay and bisexual men, meaning they stand a higher chance of damage to their immune system.  

Of those diagnosed with HIV in 2020, more than half (51%) of the women, 55% of the heterosexual men and 66% of those aged 65 and over were diagnosed at a late stage. This compares to just 29% of gay and bisexual men, figures from the UKHSA showed.  

Terrence Higgins Trust (THT), a charity that campaigns for HIV education, said this is likely driven by a belief among heterosexual men and women ‘that they are not at risk of HIV, which is often reinforced by healthcare professionals’.  

The trust attributed the fall in diagnoses among gay and bisexual men to the ‘growing availability of HIV prevention pill PrEP’ and ‘targeted promotion of routine HIV testing followed by the rapid initiation of HIV treatment for those diagnosed, meaning they are more quickly virally suppressed and cannot pass on HIV’.  

PrEP in pharmacies 

In December, the Government pledged to ‘explore the acceptability’ of making PrEP available to people who need it from pharmacies.  

This comes as part of the Government’s HIV action plan, which has pledged £23m to reduce new HIV infections by 80% by 2025, and end infections and deaths by 2030.  

Last year, pharmacists and sexual health specialists told The Pharmacist that making PrEP available in pharmacies would be ‘fairly straightforward’ and it would have multiple benefits including increasing accessibility and reducing stigma.   

In April, MP Elliot Colburn wrote a letter to the Department of Health and Social Care (DHSC) calling for pilot work on improving access PrEP via community pharmacies to be taken forward ‘as quickly as possible’.   

THT said it hoped that ‘with greater awareness, increased testing and better access to PrEP for heterosexuals this can be replicated across the wider population.  

More heterosexual people must get tested ‘HIV can affect anyone and everyone needs to know how to protect themselves against HIV – regardless of sexuality, gender, ethnicity or age,’ it added.  

Data from the UKHSA suggests that new HIV diagnoses among gay and bisexual men began to fall in 2014 and that has continued every year since, with a fall of 70% between 2014 and 2020.  

Increased HIV testing is ‘crucial’ as it is estimated that around 5% of people living with HIV in the UK (4,660) are unaware, which can adversely affect their health and means they may pass HIV on, the body explained.  

Taku Mukiwa, head of health programmes at THT, said: ‘We need to see more heterosexuals getting tested to avoid anyone living with undiagnosed HIV for a long time.’ 

Meanwhile, Kate Folkard, the interim deputy director of the HIV Division at the UKHSA, said: ‘To end HIV transmission, we need to diagnose people early, start treatment promptly and support people to continue with their treatment.  

‘We encourage everyone to take up the offer of a free test, only by knowing your HIV status can you be empowered to take action.’ 

 As part of National HIV Testing Week (7 -14 February), free HIV test kits are being made available to the public by the NHS. Anyone who is sexually active is being encouraged to take a test. 

Read more about whether community pharmacists should be providing PrEP and other HIV services here.