HIV prevention

Although not yet curable, HIV can be effectively treated and managed through a daily pill. For the vast majority of people, daily medication means they are able to lead a long and healthy life, in the same way as everyone else. This treatment also means the level of HIV in the individual’s system, often referred to as the ‘viral load’, will be undetectable, which means they will not pass HIV on to anyone else (this is sometimes called ‘U=U’, Undetectable = Untransmissible).

In 2020 an estimated 97,740 people in England were living with HIV. This figure includes an estimated 4,660 with an undiagnosed HIV infection. A late diagnosis means many are unaware of their infection which can result in potential ill health, premature death and onward transmission. Those with a late diagnosis are at an eight fold increase risk of death.

People diagnosed with HIV have access to free, world class treatment and care and it’s important to note that caught early HIV can be effectively treated with extremely effective drugs allowing individuals to lead long and healthy lives without passing on the virus to others. This is part of a wider holistic approach to support people through diagnosis and treatment. Routine hospital blood tests are therefore essential to discreetly identify undiagnosed people living with HIV, especially in population groups less likely to access HIV testing in traditional sexual health services, such as people of Black African heritage.

The government has adopted the United Nations AIDS (UNAIDS) target to reduce HIV transmission in England to zero by 2030, with an interim target of an 80% reduction from 2019 levels by 2025, and NHS action on prevention, early identification and treatment as described above means we are on track to being the first country in the world to achieve this.

To deliver this ambition the government launched its HIV Action Plan in December 2021. A key component of this is to implement emergency department opt out HIV testing in the areas with the highest prevalence rates. These are:

  • London
  • Brighton
  • Greater Manchester
  • Blackpool

The NHS is investing £20 million to fund this routine HIV opt out testing over 3 years.

HIV opt out testing means anyone attending an emergency department (ED) in these high prevalence areas and who requires a blood test, will be tested for HIV at the same time, as standard. Posters and patient information around the department will inform people this will be happening. Individuals are able to decline and opt out if they don’t wish to be tested. By making this a routine part of ED procedures, the aim is to remove some of the stigma which still surrounds HIV. It also avoids anyone feeling they’ve been singled out. Pregnant women already have opt out HIV testing as part of prenatal care which has been shown to be highly effective in identifying people living with HIV and preventing onward transmission to their babies.

Emergency department testing is an important way to address some key health inequalities. Routine ED HIV testing has shown to be a successful way to reach members of Black Afro Caribbean communities, who are disproportionately affected by HIV, particularly when it comes to late diagnosis rates.

Working with the NHS England Eliminating Hepatitis C team, we will also take the opportunity to implement simultaneous testing for hepatitis B and C at many sites. Hepatitis B and C are also blood borne viruses and if left untreated they can cause liver cancer and liver failure. Caught early, hepatitis C is preventable, treatable and for most people, curable. Effective antiviral drugs can cure more than 95% of people with hepatitis B and hepatitis C with minimal side effects; meaning it can be eliminated. We are working with the Government to meet the WHO 2035 elimination target for new transmissions.

Announcement of new HIV funding

In November 2024 NHS England was given a further £27 million to continue HIV testing in emergency departments (ED), in areas with high HIV prevalence rates. This means a further 9 sites will now provide the testing in EDs.

The 9 new sites are:

  1. East Surrey Hospital, Redhill
  2. Lister Hospital, Stevenage
  3. Worthing Hospital
  4. Princess Alexandra Hospital, Harlow
  5. Watford General Hospital
  6. Basingstoke and North Hampshire Hospital
  7. Norfolk and Norwich University Hospital
  8. Darent Valley Hospital, Dartford
  9. St Peter’s Hospital, Chertsey

Over the past 3 years the NHS in England has delivered a highly successful ED blood borne virus (BBV) opt-out testing programme, which involves testing people having blood tests in emergency departments, regardless of their symptoms, to identify, care and treat HIV, hepatitis B, and hepatitis C.

Since April 2022 6,500 cases have been identified, with the programme making a substantial contribution to all BBV testing in England.  The number of tests done in the programme is equivalent to more than half of all BBV tests done in general practice, sexual health, drug and prison services combined. Among those tested, 73% had no record of a previous HIV test, 80% had not been tested for hepatitis C, and 76% had no record of a hepatitis B test in surveillance data. These figures show the programme is successful in reaching people who have not previously tested for these 3 bloodborne viruses.

In addition, funding will be made available to the integrated care board, to commission HIV peer support from the voluntary sector, ensuring those identified are supported to engage or reengage in care and treatment.

Blood-borne viruses opt-out testing in emergency departments in areas of high and extremely high HIV prevalence: good practice guidance

NHS England has made significant progress towards reducing both preventable blood borne virus (BBV) deaths and the stigma associated with them. However, many people are still unaware they are living with one or more BBV which can result in a late stage diagnosis, with many remaining undiagnosed.  It is clear more needs to be done to expand testing so we can identify people living with BBVs earlier; with emergency departments (EDs) playing a key role in this.

The following guidance is intended to support implementation of routine BBV opt out testing in EDs in a consistent manner which maximises uptake of treatment and care. These guidelines are informed by national guidance and models of good practice.

In November 2023 £20 million of NIHR funding was announced to expand ED HIV testing to a further 46 sites in the form of research, to evaluate the impact of expansion. This is additional to the £20 million NHS England received in November 2021 to implement testing for three years in areas with the highest HIV prevalence rates  as part of the national HIV action plan.

Opt out testing for blood borne viruses in emergency departments – a flagship initiative

The emergency department opt out testing programme aims to deliver a significant increase in testing for HIV, hepatitis B and hepatitis C in parts of England with the highest prevalence rates of HIV. It will play a significant part in the government’s ambition to end HIV transmission by 2030. The first 100 days report describes the progress, challenges, results and learnings from the first 100 days of the programme. This video provides a short explanation of the initiative, including what it means for people living with HIV and their communities.

First year blood borne virus opt out testing results

Results for the first year of blood borne virus testing, which includes HIV, hepatitis B and C were better than expected.  HIV and hepatitis clinical staff and community partners are very pleased with how effective this testing is in identifying people with previously undiagnosed blood borne viruses and providing them with access to treatment, care and community support.

Case studies and blogs