The COVID-19 pandemic continued to impact the HIV epidemic in the UK in 2021. While numbers of people tested, of diagnoses and of people seen for care showed signs of a partial recovery, and overall pre-pandemic trends were sustained, this was not homogenous between different populations.

HIV testing among GBMSM in 2021 exceeded the testing levels seen in 2019, whilst testing in other groups such as heterosexual men remained at the reduced levels in 2021 that they were in 2020. In 2021, internet testing was the main route of access to HIV testing in England but is disproportionately accessed by GBMSM, especially outside London. This apparent inequity in access to internet testing needs to be addressed (7), and should be accompanied by increased access to testing in other settings as outlined in the government’s HIV Action plan, for example opt-out testing in emergency departments in areas of high and very high prevalence and full implementation of HIV testing among people presenting with indicator conditions.

Among people accessing specialist SHSs who were defined as having PrEP need, 79.1% had their need identified at a clinical consultation, and 69.6% initiated or continued PrEP. These proportions were greatest among GBMSM and people of older age groups. As a key route into PrEP access, it is vital that access to testing is expanded to facilitate this.

Many people who may have tested in 2020 in the absence of the COVID-19 pandemic service disruptions, appear to, in effect, have had their diagnosis deferred to 2021. This is supported by a fall in median CD4 count, a rise in the proportion testing positive for some groups despite decreased testing, and a rise in the number of people diagnosed late. The one-year mortality rate increased in those diagnosed late in 2020, and may be due to both the direct and indirect impacts of COVID-19 infection.

While numbers of new diagnoses have plateaued, it is reassuring that excluding 2020, pre-pandemic trends in the decline in new HIV diagnoses were sustained into 2021. The small increase in HIV diagnoses between 2020 and 2021 in GBMSM may be a temporary departure from the trend, and the result of deferred tests from 2020. However, the plateauing of diagnoses in heterosexual men and women, in the context of sub-optimal test coverage is of concern and reinforces the need for awareness of the need to test, and access to testing.

The number of people seen for care in 2021 in England increased beyond pre-pandemic levels. However, people exposed by vertical transmission and injecting drug use continue to display significantly lower levels of viral suppression. These points highlight the need for interventions to maintain and re-engage people in care, thereby increasing the number of people on treatment with undetectable levels of virus to reduce the potential for onwards transmission.

In conclusion, the data for 2021 shows signs of a partial, but uneven recovery. The recovery of testing in GBMSM indicates that it is likely that HIV incidence in this group continues to fall. Meanwhile, in heterosexual men, and heterosexual and bisexual women, there are weaker indications of recovery, and opportunities to identify need for PrEP and other prevention interventions that are missed; this requires urgent action. The data reinforces the need for increased levels of and expanded access to HIV testing across a wider range of settings.

The HIV Action Plan monitoring and evaluation framework will explore in detail the inequalities and gaps in HIV prevention, testing and care and indicators of progress required to achieve the ambition to end HIV transmission by 2030 in England.


HIV testing, PrEP, new HIV diagnoses, and care outcomes for people accessing HIV services: 2022 report