Update on Epidemiology of HIV in Ireland, to the end of 2022
HPSC has released the latest data on the epidemiology of HIV to the end of 20221,see slide set and accompanying data tables at http://www.hpsc.ie/a-z/hivandaids/hivdataandreports.
Background
The advances in antiretroviral therapy (ART) have dramatically improved the lives of many people living with HIV. Timely, successful treatment can lead to the same health and life expectancy for people living with HIV as the general population. In addition, successful treatment prevents onward transmission of HIV to sexual partners. This (also known as U=U, undetectable equals untransmittable) is an extremely important public health message which along with other HIV prevention measures has the power to end HIV.
Timely, quality HIV surveillance is critical to understanding how Ireland is responding to HIV. To have meaningful analysis of the HIV epidemiology in Ireland, we have presented data on (a) first-time diagnoses – people diagnosed in Ireland who were not previously aware they had HIV and (b) total diagnoses – all diagnoses in Ireland including those who were already aware of their diagnosis and those whose status was unknown.
First-time HIV diagnoses
The rate of first-time HIV diagnoses (3.4 per 100,000 population) decreased by 16% in 2022 compared to pre-pandemic year 2019 and is lower than the rates between 2012 and 2018. The key population group affected by HIV in Ireland remain gay, bisexual and other men who have sex with men (gbMSM), accounting for 58% of first-time diagnoses in 2022. The rate of first-time diagnoses among gbMSM2 in 2022 (88 per 100,000 estimated gbMSM population in those 18 and over) is 36% lower than the highest rate in 2015 (137 per 100,000 population). Eighty percent of first-time diagnoses in gbMSM in 2022 occurred in those born in either Ireland (41%) or Latin America and Caribbean (39%). Just over a quarter (26%) of gbMSM with a first-time diagnosis of HIV were co-infected with a bacterial STI at the time of their HIV diagnosis.
Heterosexuals accounted for 34% of first-time diagnoses in 2022 and the number of first-time diagnoses among heterosexuals is 33% lower than the peak in 2018. Over two thirds of diagnoses among heterosexual females (69%) are in those born in sub-Saharan Africa while the largest proportion of diagnoses among heterosexual males were born in Ireland (50%).
The number of first-time diagnoses among people who inject drugs (PWID) remains low and accounts for <5% of new diagnoses.
Among people with a first-time HIV diagnosis, 45% were diagnosed late (CD4 count <350 cells/µl) which is similar to the proportion diagnosed late in recent years. This is of concern as it has been shown that late HIV diagnosis is associated with poorer outcomes and an increased likelihood of ongoing HIV transmission. Groups with a higher proportion presenting late in 2022 were: females; those aged 50+years; those born in sub-Saharan Africa; living outside HSE East; PWID; and heterosexual males.
Total HIV diagnoses
In 2022, there was a large increase (68%) in the overall number of diagnoses, compared to pre-pandemic year 2019. This is largely attributable to an increase in diagnoses among people with a previous diagnosis outside Ireland. Among this group, 84% reported their region of birth to be Latin America and Caribbean (32%), sub-Saharan Africa (27%) or Eastern Europe (25%). While these people are unlikely to have benefited from HIV prevention programmes in Ireland, it is of vital importance that they are promptly linked to HIV care on arrival in Ireland for their own individual benefit and to prevent onward transmission. In 2022, of the 548 people who were previously diagnosed with HIV abroad, 92% were reported to have transferred their care from another country to Ireland and 88% had a supressed viral load (where viral load was known).
The increase in total HIV diagnoses is largely influenced by increased migration to Ireland in 2022, compared with previous years. Travel restrictions, which were in place during the COVID-19 pandemic were lifted in 2022. In addition, in February 2022, the Russian invasion of Ukraine resulted in 67,448 Ukrainian refugees to Ireland (from February 2022 to 11 December 2022). Conflict in Ukraine has also increased movement of people from surrounding countries and 2022 saw the highest annual number of applications for International Protection in Ireland.
HIV response in Ireland
In 2021, the Joint United Nations Programme on HIV/AIDS (UNAIDS) published the Global AIDS Strategy 2021−2026 to get every country and every community on-track to end AIDS by 2030. In 2023, the European Centre for Disease Prevention and Control published a report describing progress towards those goals and stated that “increased and revitalised efforts need to be made to improve prevention, testing and treatment services in the region to achieve the 2030 target”.
In order to achieve the ambitious UNAIDS targets for zero new infections by 2030, it is vital that there is a continued focus on combination HIV prevention3 approaches as endorsed by UNAIDS
- HIV treatment in Ireland is free and available to everyone. In 2017, the HSE published a position statement which recommends that all individuals living with HIV attending HIV services in Ireland are offered antiretroviral therapy (ART) as soon as possible and informed of the benefits of ART in improving their personal health and reducing HIV infectiousness (Treatment as Prevention; TasP).
- A national PrEP (pre-exposure prophylaxis) programme was introduced in Ireland in 2019 with PrEP available free of charge to those considered to be at risk of HIV through sex. The HSE Sexual Health and Crisis Pregnancy Programme (SHCPP) report that in 2022, 3,388 individuals had free PrEP prescriptions filled (proxy for those on PrEP), and 1,240 were new PrEP users (first ever PrEP prescription). (SHCPP personal communication).
- Free HIV testing is available in Ireland through a variety of services (e.g opt-out antenatal; sexual health services; emergency departments, student health services, NGO’s, drug and homeless services and primary care). HIV community-based testing is also provided in many venues nationwide. The National HSE home STI testing provides a home testing service for STIs and HIV and the MPOWER programme within HIV Ireland has a HIV self-testing programme for gbMSM since 2020.
- The National Condom Distribution Service (NCDS), established by SHCPP in 2015, distributes free condom and lubricant sachets to sexual health services, third level institutions, public sector organisations and NGOs. Condoms and lubricant are available for free and can be accessed by anyone from the age of 17 years through a range of clinical services, postal services or community venues. In 2022, the NCDS distributed over 1 million condoms seeing an increase in the demand compared to 2019, prior to the onset of COVID-19. More information about how to access free condoms and lube is available on www.sexualwellbeing.ie/freecondoms
- Sexual health services in Ireland are free – for a list of STI clinics, see https://www.sexualwellbeing.ie/sexual-health/hse-sti-services-in-ireland.html
- Continued harm reduction services for people who inject drugs are available – see Harm Reduction Campaigns - Drug and Alcohol Information and Support in Ireland - Drugs.ie
- Communication campaigns and information resources are in place and raise awareness of the benefits of testing and early diagnosis and HIV prevention measures and are targeted to the general population and specific groups in greater need.
High quality data are needed to inform progress
The latest data shows some welcome progress in the aim to eliminate HIV as a public health problem by 2030, but over forty years since the first reports of HIV and AIDS in Ireland in 1982, HIV remains a significant public health issue in Ireland and elsewhere. It shows that some people have been left behind, particularly those in whom the diagnosis was made late. Late diagnosis has the potential for both individual and population negative health consequences.
Surveillance that is of high quality, timely, detailed and comprehensive is vital for understanding and responding to the latest trends and features of the HIV epidemic in Ireland, to monitor the progress towards UNAIDS targets of zero new HIV infections by 2030.
Further Information
Further information on HIV can be found at:
https://www.hpsc.ie/a-z/hivandaids/
www.sexualwellbeing.ie/hiv
https://man2man.ie/hiv/
Notes
[1] Please note, due to the impact of the COVID-19 pandemic in 2020 and 2021, data from 2022 are compared with data from 2019.
[2] Rate of HIV among gbMSM calculated using an estimated gbMSM population (see slide set for further details)
[3] UNAIDS Prevention Reference Group agreed that combination prevention programmes are rights-based, evidence informed, and community-owned programmes that use a mix of biomedical, behavioural and structural interventions, prioritised to meet the current HIV prevention needs of particular individuals and communities, so as to have the greatest sustained impact on reducing new infections.