The total number of people newly diagnosed with HIV has fallen for the fifth year in a row, new figures show.
Data from Public Health England (PHE), published on Tuesday, showed that there were 4,139 new diagnoses of HIV in the UK in 2019, a 10% drop from 4,580 in 2018.
It was also a decrease of 34% from a peak of 6,312 new diagnoses reported in 2014 and the fifth consecutive annual fall since then.
The decline in new HIV diagnoses in recent years has been driven by a “steep fall” in new diagnoses among gay and bisexual men, PHE said.
Diagnoses among gay and bisexual men fell to 1,700 in 2019, an 18% drop from 2,079 in 2018 and a 47% reduction from a peak of 3,214 in 2014, new PHE data shows.
PHE said that the number of gay and bisexual men newly diagnosed with HIV was at its lowest point in 20 years.
But Ian Green, chief executive of the Terrence Higgins Trust, said progress could be even greater if the rollout of the pre-exposure prophylaxis (PrEP) was being delivered.
PrEP uses anti-retroviral drugs (ARVs) – also used for treating people with diagnosed HIV – to stop those at highest risk from contracting the virus.
HIV-negative people can take PrEP before sex to reduce their risk of getting the virus.
Mr Green said that while cash had been given to local authorities in October to provide the treatment, only a small number were delivering the promised provision.
He added: “But the progress for gay and bisexual men could be even greater and the 18% drop in this group in 2019 makes the delayed roll out of PrEP across the country even more frustrating.
“Terrence Higgins Trust is still hearing story, after story, of people being turned away from clinics with no PrEP and no way of accessing this effective HIV prevention drug.”
The new PHE data also showed that new HIV diagnoses among people who probably acquired it through heterosexual contact also fell to 1,559 in 2019 – a 6% drop from 1,664 in 2018 and 33% fall from 2,336 in 2014.
Among people who probably acquired HIV through injecting drugs, new HIV diagnoses remain stable and low at around 100 per year, PHE added.
But Mr Green said there was a “worrying disparity” in progress outside gay and bisexual men which needed to be tackled “urgently” to end HIV transmission within a decade.
He added: “Gay and bisexual men have been hugely impacted by HIV since the very start of the epidemic.
“The sharp fall in diagnoses among this group since 2015 – including an 18% drop in 2019 – is a testament to what we can achieve when we utilise everything we have in the fight against HIV, including prevention pill PrEP and the fast initiation of HIV treatment for those diagnosed to stop the virus being passed on.
“The new data shows a worrying disparity in progress for groups outside of gay and bisexual men, which needs to be urgently tackled if we’re to end HIV transmissions within a decade.
“The 6% drop in new HIV diagnoses among heterosexuals is three times lower than the one for gay and bisexual men, which clearly underlines the shocking lack of awareness of PrEP in the community at large and highlights how wrong it is that PrEP is only available in sexual health clinics.”
Mr Green said said that if health leaders want to see drops in new diagnoses across all groups similar to those in gay and bisexual men PrEP needed to be “far better known” and more widely available.
This included providing it in GP surgeries, gender clinics, pharmacies, and as part of maternity care, he added.
Deborah Gold, chief executive of the National Aids Trust, said more testing needed to be available outside sexual health clinics.
She added: “The fall in new HIV diagnoses in England shown in today’s figures is great news, showing that prevention tools are working, such as frequent testing and access to the drug PrEP.
“However, our concern is that the decline shown in recent years is slowing, and less steep in some areas, outside London, and among some communities.
“To have any hope of reaching the national target of ending new HIV transmission by 2030, we must see a significant increase in opportunities to test for HIV outside of sexual health clinics, and swift roll-out of PrEP nationwide, including health promotion activities targeted at underserved populations such as women, and those from black African communities.”
The Terrence Higgins Trust also said that there were still “worrying high” rates of late diagnosis, with more than four in 10 people who receive a diagnosis being diagnosed late.
Mr Green said: “Late diagnosis is bad for individuals, leads to unnecessary new transmissions and is expensive for the NHS.
“It is vital the Government ramps up HIV testing, has a plan to fight HIV-related stigma and learns from its mistakes – every late diagnosis is a story of missed opportunity.”
The PHE data also showed that in 2019 a total of 98,552 people were seen for HIV care in the UK, while the number of deaths among people with HIV has remained stable at 622 – down from 624 the previous year.
PHE said that the decline in HIV transmission in gay and bisexual men can be directly linked to the increase in combination prevention including the use of condoms, PrEP, frequent testing, and starting antiretroviral therapy (ART) as soon as possible after diagnosis.
Treatment is now so effective that 97% of people receiving ART have undetectable levels of virus which means it is impossible to pass on the virus, PHE said.
Dr Valerie Delpech, head of HIV surveillance at PHE, said: “In the UK, we have made great progress towards eliminating HIV transmission by 2030.
“Frequent HIV testing, the offer of PrEP among those most at risk of HIV, together with prompt treatment among those diagnosed, remain key to ending HIV transmission by 2030.
“Further progress can only be achieved if we also address the inequalities in reducing HIV transmission that exist around sexuality, ethnicity and geography.”