HIV and AIDS - Public Health Observatory

Transcription

HIV and AIDS
in the North West of England 2001
by Penny A. Cook, Andy Towle, Pauline Rimmer, Suzy Mitchell, Qutub Syed and Mark A. Bellis
© July 2002
ISBN 1-902051-39-4
British Library Cataloguing in Publication Data
A Catalogue record for this book is available from the British Library
Published by
North West HIV/AIDS Monitoring Unit
Centre for Public Health
Faculty of Health and Applied Social Sciences
70 Great Crosshall Street
Liverpool John Moores University
Liverpool L3 2AB
Tel: +44 (0)151 231 4315/4316
Fax: +44 (0)151 231 4320
e-mail: [email protected]
Designed and printed by Georgia Design Associates:
Telephone: 0151 236 1773 E-mail: [email protected]
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HIV and AIDS in the North West of England 2001
HIV and AIDS
in the North West of England 2001
by
Penny A. Cook
Andy Towle
Pauline Rimmer
Suzy Mitchell
Qutub Syed
and Mark A. Bellis
North West HIV/AIDS Monitoring Unit
Faculty of Health and Applied Social Sciences
70 Great Crosshall Street
Liverpool L3 2AB
Tel: +44 (0)151 231 4315/4316
Fax: +44 (0)151 231 4320
e-mail: [email protected]
© July 2002
ISBN 1-902051-39-4
EXECUTIVE SUMMARY
This report, the sixth annual report of the North West HIV/AIDS Monitoring Unit, presents data on
HIV positive individuals accessing treatment and care in the North West Region. During 2001 a total
of 1,964 individuals living with HIV or AIDS presented to statutory treatment centres in the North
West Region. When those individuals reported by centres in the new part of the North West Region
are excluded, this represents a 18% increase on the number reported in 2000 (1,632). This is the third
year running that there has been an increase of this magnitude in the size of the HIV positive
population seeking treatment. As was the case last year, the increase is much larger than national
predictions of 9%. Over the seven years since this level of monitoring began, the HIV positive
population in treatment in the North West has doubled (figure 1.12).
This year, because the North West Region expanded in size to incorporate North Cumbria (formerly
part of Northern and Yorkshire Region), we have collected data from a number of additional statutory
sector providers of care. A total of 45 statutory centres within the North West provided treatment and
care for HIV positive individuals resident throughout the region. The year 2002 has seen the
establishment of primary care trusts (PCTs) as the principle organising unit within the NHS, the
disappearance of health authorities and the creation of larger strategic health authorities. To reflect
these changes, we now present analyses by PCT and strategic health authority. It is not possible to
present all possible breakdowns at PCT level, however, additional tables are available on the North
West Public Health Observatory website (www.nwpho.org.uk/hiv2001).
The predominant mode of exposure to HIV for North West residents continues to be homosexual sex,
accounting for 65% of all cases presenting to North West treatment centres in 2001 (table 3.1). There
is, however, considerable variation across the three strategic health authorities, with 70% of the HIV
positive residents of Greater Manchester having been infected by sex between men, compared to 55%
of Cheshire and Merseyside residents (table 3.3a). The relatively high proportion of individuals
infected by homosexual sex is reflected in the gender distribution of HIV and AIDS cases, with males
representing 84% of all cases (table 3.4). Heterosexual sex continues to be the second largest
exposure group, accounting for one quarter of all cases in 2001 (table 3.3a). This represents an
increase on the proportion in 2000, reflecting trends for the United Kingdom as a whole. Greater
Manchester Strategic Health Authority reports the highest number of HIV positive individuals in the
North West, accounting for over half of all cases (table 3.2a) and new cases presenting to statutory
treatment centres (table 2.1a).
The proportion of HIV positive people in the older age groups (50 years and over) continues to
increase, from 7% in 1996 to 12% in 2001 (figure 3.1). This ageing cohort effect is likely to be due
to the effectiveness of antiretroviral therapies and subsequent improved prognosis of many HIV
positive individuals. However, those aged 55 years or over are more likely to have died during 2001
from an AIDS-related condition (4%) than are those younger than 55 years, of whom only 1% died.
The proportion of the HIV positive population dying from AIDS related conditions has decreased
over the years, from 10% in 1995 to 1.5% in 2001 (figure 1.12).
Executive Summary
3
A total of 449 new HIV and AIDS cases (HIV positive individuals who had not previously been seen in
North West statutory treatment centres prior to the year 2001) were reported during the year. If new
cases from the new part of the region are excluded (eight individuals), this remains the largest number
of new cases since regional monitoring of HIV and AIDS began, and represents a 32% increase on last
year’s figure of 335. New cases represented 23% of all cases, a similar proportion to previous years.
The majority of new cases were infected via homosexual sex (51%), while heterosexual sex was
reported to be the route of transmission for 38% of individuals (table 2.2a). The proportion of new
cases who were exposed through heterosexual sex continues to rise, reflecting national trends
(section 1, figure 1.6). However, unlike the situation nationally, heterosexual sex has not overtaken
homosexual sex as the predominant exposure route for new cases in the North West. The number of
new cases who were exposed by other transmission routes (injecting drug use, blood or tissue and
mother to child) remain relatively low. There was an increase in the number of babies born with HIV,
from six in 2000 to eleven in 2001. Such a rise is to be expected as the proportion of HIV positive
individuals who are women increases. While the largest proportion of new cases presenting for
treatment and care were categorised as asymptomatic (50%), the eight new cases who died during
2001 all had an AIDS defining illness. This illustrates the continuing need to attract HIV positive
people into services at an early stage of their HIV disease to maximise the efficacy of treatment
and improve prognosis.
The global AIDS pandemic continues to influence the situation in the North West of England, as
reflected in the number and pattern of HIV infections acquired abroad. A quarter of all HIV positive
individuals accessing treatment and care in the North West were reported to have been infected
outside the United Kingdom (figure 3.2). Heterosexual sex continues to be the major method of
exposure to HIV in those infected abroad (60%), a significantly higher proportion than in those known
to have been infected in the United Kingdom (12%). Of all the infections contracted outside the United
Kingdom, 51% were in Africa, predominantly sub-Saharan Africa (figure 3.3). Europe accounted for a
further 17% of the infections that were contracted abroad, with Spain being the most frequently
reported country of exposure. The role of exposure abroad was even more pronounced for cases who
were new in 2001, where over a third were reported to have been infected abroad (figure 2.2).
Ethnicity was recorded for 99% of individuals accessing treatment and care in 2001, most of whom
(85%) were self-classified as white (table 3.7). However, an increasing proportion of individuals with
HIV were from black and ethnic minority communities (15%), a substantial over-representation when
considering the proportion of North West residents who are from ethnic minority groups (3.8%). An
even higher proportion (29%) of new cases were from ethnic minority groups (table 2.6),
demonstrating the increasing burden of HIV on these communities and the need for continuing and
strengthening HIV prevention activities. The characteristics of HIV positive individuals from black and
ethnic minority groups, particularly black Africans, are different to those of the white HIV positive
population. Whereas white individuals were more likely to have been infected by homosexual sex,
heterosexual sex is the predominant method of exposure of black Africans (tables 2.7 and 3.9),
resulting in proportionally more females infected (table 2.8 and 3.8) and babies born with HIV infection
(tables 2.7 and 3.9). Black Africans were considerably more likely to present to services for the first
time already with an AIDS diagnosis than were white individuals (table 2.9). This later presentation
is a cause for concern, since it may have a significant detrimental impact on their prognosis.
4
During 2001, nearly two thirds of individuals received triple or more combination therapy, including
12% who were taking quadruple or more therapy when they last attended treatment centres in the
year (table 3.13). The level of triple or more therapy rose to 88% when considering those living with
AIDS, while only 37% of asymptomatic individuals were taking this level of therapy (table 3.14). The
improved prognosis of HIV positive individuals across all clinical categories of HIV disease, together
with relatively low numbers of individuals at early stages of HIV disease receiving combination therapy,
has implications for a potential increase in demand for combination therapies. This has both planning
and financial implications for the care of HIV positive individuals across the region.
For the third year, we can provide information on the level of inpatient and outpatient care for the
whole of the region. During 2001, North Manchester General Hospital Infectious Disease Unit,
the treatment centre with the highest number of HIV positive attendees (table 3.17), provided the
highest number of outpatient visits, day cases, inpatient episodes and inpatient days (table 3.23).
Demand for outpatient care peaked for those with an AIDS diagnosis (table 3.24), while those who
died during 2001 required the most inpatient care. Ongoing monitoring of HIV treatment and care
requirements will allow detection of any alterations in the level of demand for services, for example
due to further developments in therapies. This year, for the first time, we also measured the number
of home visits undertaken by each provider, and can show that home visits form a significant part of
the care of HIV positive individuals (table 3.23).
During 2001, eight voluntary agencies in the North West reported care of 1,037 HIV positive
individuals. Of these, 17% were not seen in North West statutory treatment centres during 2001,
illustrating the continuing contribution of the voluntary sector to the care of those HIV positive
individuals for whom the voluntary agencies may be the sole provider of care. This also has particular
significance for regional funding of HIV services, since individuals accessing voluntary agencies but not
the statutory sector are not included in the regional statistics provided to the Department of Health,
the basis of the new funding formula.
Three hospices reported providing palliative care for HIV positive individuals during 2001. Three HIV
positive individuals residing in two strategic health authorities received hospice care, accounting for
30 inpatient days (table 5.1). All three individuals also received care from the statutory sector during
2001. In addition, specialist drugs services contributed data on clients whom were known to be HIV
positive (table 5.2). Thirteen individuals were reported by seven drugs services, all but one of whom
also received HIV treatment from the statutory sector in 2001.
We hope that the tables and figures provided in this report, together with additional analyses at PCT
level available on the North West Public Health Observatory website (www.nwpho.org.uk/hiv2001),
answer most of your HIV-related information requirements. However, additional analyses and further
breakdown of the data can be provided on request. As ever, we value your suggestions as to any
developments that would improve the usefulness of the report in future years.
Executive Summary
5
ACKNOWLEDGEMENTS
A large number of people have been involved in the collection of data for this report.
We would like to thank them all, especially Mike Abbot, Pam Beswick, Lorraine Birtwhistle, Paula
Bolton-Maggs, Alistair Campbell, Sue Capstick, Lesley Capstick, Dave Chapman, Diane Comber,
Amanda Dawson, Andrea Dodd, Bill Dynes, Steve Earle, Carol Evans, Chris Flewitt, Janet Ford,
Jane Fraser, Cath Garstang, Beryl Gilbert, Karen Haigh, Renata Hewart, Maureen Holloway,
Sean Hood, Pam Jackson, Howard Jones, Leye Johns, Jayne Keaney, Karen Kelly, Dot Kewley,
Janet Lace, Anne Mather, Sam Maybe-Puttock, Gabriel McDermott, Denise McDowell, Pauline
Molyneax, Cynthia Murphy, Ged Murphy, Mark Newman, Linda van Nooijen, Kirit Patel, Kate Perry,
Tim Pickstone, Suzan Potts, Margaret Prior, Tony Proom, Anthony Quinnell, Ranjana Rani,
Sue Russell, Cath Shelley, Lindsey Shone, Chris Simpson, Ian Smith, Lesley Smith-Payne,
Cheryl Stott, Pat Sutcliffe, Julie Taylor, Helen Tinker, Sue Toomer, Julian Vyas, Sally Webb-Jones
and Alyson Wiggins.
Thanks are due to everyone in the Centre for Public Health at Liverpool John Moores University
for their support, particularly Diana Leighton, Sacha Wyke, Karen Tocque, and Juliet Hounsome.
We would also like to acknowledge the continued support of John Ashton (Regional Director
of Public Health), John Astbury (Consultant in Public Health, Morecambe Bay Primary Care Trust),
Ken Mutton (Consultant Virologist, PHLS North West), Beryl Oppenheim (Director, Manchester
PHLS), and Rod Thomson (Public Health Projects Manager, South Sefton Primary Care Trust).
6
CONTENTS
EXECUTIVE SUMMARY
3
ACKNOWLEDGEMENTS
6
CONTENTS
7
TABLES AND FIGURES
8
1. INTRODUCTION
13
Monitoring HIV and AIDS in the North West Region
14
Global surveillance of the epidemic
15
Vaccine development
15
Global perspectives on HIV and AIDS in 2001
16
Access to antiretroviral drugs in the developing world
17
The epidemic in the developed world
18
Sub-Saharan Africa
19
East Asia and the Pacific
20
South and South East Asia
20
Latin America and the Caribbean
21
North America
21
Eastern Europe and Central Asia
22
Western Europe
22
HIV and AIDS in the United Kingdom – 2001
23
Men who have sex with men
24
Heterosexual sex
28
Injecting drug users
30
Blood or tissue
31
Mother to child
32
HIV and AIDS in the North West of England - 2001
32
The sexual health of the North West
35
Refugees and HIV
36
Social deprivation and HIV in the North West
36
2. NEW CASES 2001
37
3. ALL CASES 2001
59
4. VOLUNTARY AGENCIES 2001
95
5. ADDITIONAL PROVIDERS OF HIV TREATMENT AND CARE 2001
109
GLOSSARY
112
Statutory treatment centres
112
Voluntary agencies
114
Drug services
114
REFERENCES
115
Contents
7
TABLES AND FIGURES
1. Introduction
Figure 1.1: Number of adults and children estimated to be living with
HIV/AIDS as of end 2001
16
Figure 1.2: Number of adults and children estimated to be newly infected with
HIV/AIDS during 2001
17
Figure 1.3: Number of new AIDS cases in the North West and the UK
by year of report to December 2001
18
Figure 1.4: Number of new HIV cases in the North West and the UK
by year of report to December 2001
19
Figure 1.5: Number of AIDS cases in the UK by year of report and infection route
of HIV to December 2001
25
Figure 1.6: Number of HIV cases in England, Wales and Northern Ireland by year
of report and infection route of HIV to December 2001
26
Figure 1.7: Number of HIV cases in Scotland by year of report and infection route
of HIV to December 2001
27
Figure 1.8: Number of heterosexually acquired HIV cases in the UK by year
of report to December 2001
29
Figure 1.9: HIV prevalence among pregnant women in England, 2000
(newborn infant dried blood spots collected for metabolic screening)
29
Figure 1.10: Prevalence of HIV, hepatitis B and hepatitis C antibodies
and direct sharing of injecting equipment among injecting drug users
attending drugs agencies, 2000 (voluntary saliva samples)
31
Table 1.1:
Table 1.2:
Cumulative number of AIDS cases in the North West and the UK
by infection route of HIV to December 2001
33
Cumulative number of HIV cases in the North West and the UK
by infection route of HIV to December 200s1
33
Figure 1.11: HIV prevalence among pregnant women in the North West, 1992-2000
33
Figure 1.12: Number of AIDS cases and HIV positive individuals presenting to
treatment centres in the North West Region by year and stage of HIV disease
34
2. New Cases 2001
8
Figure 2.1: Age distribution of new HIV and AIDS cases by infection route of HIV,
January-December 2001
39
Table 2.1a: Residential distribution of new HIV and AIDS cases by stage of HIV disease,
January-December 2001: strategic health authority
40
Table 2.1b: Residential distribution of new HIV and AIDS cases by stage of HIV disease,
January-December 2001: Cumbria & Lancashire primary care trusts
41
Table 2.1c: Residential distribution of new HIV and AIDS cases by stage of HIV disease,
January-December 2001: Cheshire & Merseyside primary care trusts
41
Table 2.1d: Residential distribution of new HIV and AIDS cases by stage of HIV disease,
January-December 2001: Greater Manchester primary care trusts
42
Table 2.2a: Residential distribution of new HIV and AIDS cases by infection route of HIV,
43
Table 2.2b: Residential distribution of new HIV and AIDS cases by infection route of HIV,
43
Table 2.2c: Residential distribution of new HIV and AIDS cases by infection route of HIV,
44
Table 2.2d: Residential distribution of new HIV and AIDS cases by infection route of HIV,
45
Table 2.3:
Table 2.4:
Table 2.5:
Table 2.6:
Table 2.7:
Table 2.8:
Table 2.9:
Residential distribution of total HIV and AIDS cases by age category,
46
Residential distribution of new HIV and AIDS cases by sex,
47
Infection route of new HIV and AIDS cases by sex,
47
Residential distribution of new HIV and AIDS cases by ethnic group,
48
Ethnic distribution of new HIV and AIDS cases by infection route of HIV,
49
Ethnic distribution of new HIV and AIDS cases by sex,
50
Ethnic distribution of new HIV and AIDS cases by clinical stage
of HIV disease, January-December 2001
50
Figure 2.2: The role of contact abroad in exposure to HIV of new HIV and AIDS
cases by infection route, January-December 2001
51
Figure 2.3: Global region and country of new HIV and AIDS cases who probably acquired
their infection outside the UK, January-December 2001
53
Figure 2.4: Global region and infection route of HIV of new cases who probably acquired
54
Table 2.10: The role of contact abroad in exposure to HIV of new HIV and AIDS cases
by ethnicity, January-December 2001
55
Table 2.11: Stage of HIV disease of new HIV and AIDS cases by level of
antiretrovival therapy, January-December 2001
56
Tables and Figures
9
Figure 2.5: Distribution of new HIV and AIDS cases by treatment centre,
57
Figure 2.6: Population prevalence of new HIV and AIDS cases by primary care trust,
58
3. All Cases 2001
Figure 3.1: Age distribution of total HIV and AIDS cases by stage of HIV disease,
Table 3.1:
Age distribution of total HIV and AIDS cases by infection route of HIV,
61
Table 3.2a: Residential distribution of total HIV and AIDS cases by stage of HIV disease,
62
Table 3.2b: Residential distribution of total HIV and AIDS cases by stage of HIV disease,
63
Table 3.2c: Residential distribution of total HIV and AIDS cases by stage of HIV disease,
64
Table 3.2d: Residential distribution of total HIV and AIDS cases by stage of HIV disease,
65
Table 3.3a: Residential distribution of total HIV and AIDS cases by infection route of HIV,
66
Table 3.3b: Residential distribution of total HIV and AIDS cases by infection route of HIV,
66
Table 3.3c: Residential distribution of total HIV and AIDS cases by infection route of HIV,
67
Table 3.3d: Residential distribution of total HIV and AIDS cases by infection route of HIV,
68
Table 3.4:
Table 3.5:
Table 3.6:
Table 3.7:
Table 3.8:
Table 3.9:
Residential distribution of total HIV and AIDS cases by sex,
69
Infection route of HIV of total HIV and AIDS cases by sex,
69
Residential distribution of total HIV and AIDS cases by age category,
70
Residential distribution of total HIV and AIDS cases by ethnic group,
71
Ethnic distribution of total HIV and AIDS cases by sex,
72
Ethnic distribution of total HIV and AIDS cases by infection route of HIV,
72
Table 3.10: Ethnic distribution of total HIV and AIDS cases by age group,
10
60
73
Figure 3.2: The role of contact abroad in exposure to HIV of total HIV and AIDS cases,
74
Figure 3.3: Global region and country of total HIV and AIDS cases who probably acquired
75
Table 3.11: Global region and infection route of HIV cases who probably acquired
76
Table 3.12: The role of contact abroad in exposure to HIV of total HIV and AIDS cases
by ethnicity, January-December 2001
77
Table 3.13: Residential distribution of total HIV and AIDS cases by level of
antiretroviral therapy, January-December 2001
77
Table 3.14: Stage of HIV disease of total HIV and AIDS cases by level of
78
Table 3.15: Distribution of treatment for total HIV and AIDS cases by level of
79
Table 3.16: Residential distribution of total HIV and AIDS cases by treatment centre,
January to December 2001
80
Table 3.17: Distribution of treatment for total HIV and AIDS cases by stage of HIV disease,
83
Table 3.18: Distribution of treatment for total HIV and AIDS cases by infection route of HIV,
84
Table 3.19: Distribution of treatment for total HIV and AIDS cases by age category,
85
Table 3.20: Distribution of treatment for total HIV and AIDS cases by sex,
86
Table 3.21: Residential distribution of total HIV and AIDS cases by number of
treatment centres attended, January-December 2001
87
Table 3.22: Overlap of total HIV and AIDS cases between different centres of treatment,
88
Table 3.23: Distribution of total and mean number of outpatient visits, day cases,
inpatient episodes, inpatient days and home visits by treatment centre,
91
Table 3.24: Distribution of total and mean number of outpatient episodes, day cases,
inpatient episodes, inpatient days and home visits by stage of HIV disease,
92
Figure 3.4: Population prevalence of total HIV and AIDS cases by primary care trust,
93
Table 3.25: Residence, infection route, ethnicity and stage of HIV disease by sex of
individuals known to be refugees, January-December 2001
94
Tables and Figures
11
4. Voluntary Agencies 2001
Figure 4.1: The proportion of HIV and AIDS cases presenting to voluntary organisations
and the statutory sector in the North West, January-December 2001
Table 4.1:
Table 4.2:
Table 4.3:
97
Distribution of voluntary sector care for HIV and AIDS cases by infection route
of HIV and sex, January-December 2001
98
Distribution of voluntary sector care for HIV and AIDS cases by age group,
99
Distribution of voluntary sector care for HIV and AIDS cases by ethnic group,
100
Table 4.4a: Residential distribution of voluntary sector care for HIV and AIDS cases,
101
Table 4.4b: Residential distribution of voluntary sector care for HIV and AIDS cases,
101
Table 4.4c: Residential distribution of voluntary sector care for HIV and AIDS cases,
102
Table 4.4d: Residential distribution of voluntary sector care for HIV and AIDS cases,
103
Table 4.5:
Distribution of statutory treatment for HIV and AIDS cases presenting to
voluntary organisations, January-December 2001
104
Figure 4.2: The proportion of HIV and AIDS cases presenting to the voluntary sector
and statutory sector in the North West, January-December 2001
105
Table 4.6:
HIV and AIDS cases presenting to the voluntary sector and statutory sector
by infection route, sex and ethnicity, January-December 2001
106
5. Additional providers of HIV treatment and care 2001
Table 5.1:
Table 5.2:
12
HIV and AIDS care provided by North West hospices by strategic
health authority (SHA) of residence, sex, age group, stage of HIV disease
and level of inpatient care, January-December 2001
110
HIV and AIDS care provided by North West drug services by strategic
health authority (SHA) of residence, sex and age group,
111
1
Introduction
1. INTRODUCTION
Monitoring HIV and AIDS in the North West Region
The North West HIV/AIDS Monitoring Unit collects, collates and disseminates data on the
treatment and care of HIV positive individuals in the North West. The NHS information strategy for
1998 to 2005 supports this level of clinical and public health monitoring. The strategy highlights the
1
need for comprehensive, accurate information as an integral part of improving the public’s health .
However, in view of the sensitive nature of the information collected, data are anonymised and the
Caldicott principles and recommendations (relating to data confidentiality and security) applied 2.
Over the past seven years we have collected data from over 40 statutory treatment centres
including genito-urinary medicine clinics, infectious disease units, haematology clinics and a number
of other specialist units and clinics 3-7. This year we have expanded data collection to include
treatment centres in North Cumbria, which now forms part of the expanded North West Region.
The data collected form part of the national dataset - Survey of Prevalent Diagnosed HIV Infections
(SOPHID) and are used in the production of the AIDS Control Act treatment and care reports.
In addition, data are used at regional, strategic health authority and primary care trust level to assist
in service planning, development and evaluation as well as providing analysis of the changing patterns
of disease prevalence and characteristics.
In addition to data collected from statutory treatment centres, we also access data from a number
of additional sources of HIV care within the North West. The Unit continues to collect data from
HIV/AIDS voluntary organisations across the region, and this year we are pleased to include
Barnardo’s for the first time. For the third year, we have gathered data relating to HIV positive
individuals accessing specialist drug services in the North West. Seven drug agencies provided
information on clients known to be HIV positive. Hospices in the North West also continue to
report care of HIV positive individuals to the Monitoring Unit.
This year we have extended our data collection to include information concerning home visits received
by individuals. For several service providers, home visits constitute a significant proportion of their
work (see tables 3.23 and 3.24). Also for the first time this year, we have endeavoured to collect data
on the refugee status of HIV positive individuals receiving care.
April 2002 saw a major restructuring of the NHS, with the establishment of primary care trusts (PCTs)
as the principle organising unit, the disappearance of health authorities and the creation of larger
strategic health authorities. This has created a larger number of discrete geographic units within the
region (PCTs): previous analyses involving health authority of residence have been broken down by
strategic health authorities, and on occasion by PCT. For reason of space not all analyses employing
PCTs can be included here, but can be found on the North West Public Health Observatory website
(www.nwpho.org.uk/hiv2001).
The rest of this section gives an overview of the global and national epidemiology of HIV and AIDS,
before discussing specific aspects in the North West Region. In section 2, we present analyses of new
HIV cases in the North West, and in section 3 analyses of all HIV and AIDS cases presenting for
treatment and care in the North West. Voluntary sector care and care from additional sources are dealt
with in sections 4 and 5. We hope that the tables and figures provided within the report, and the extra
analyses by PCT on the website, answer most of your HIV-related information requirements. We would
value your suggestions as to what additions would improve the usefulness of the report in future years.
14
Global surveillance of the epidemic
The need for accurate surveillance for HIV/AIDS is critical: HIV infection remains incurable,
is characterised by a high morbidity, is very expensive to treat and predominantly effects younger
adults, often the most economically active individuals. A sophisticated understanding of the
epidemiology is essential for the allocation of resources for both treatment and prevention programs 8.
Good surveillance is essential for measuring the success of prevention and treatment policies.
In England and Wales, The National Strategy for Sexual Health and HIV emphasises the need for a
sound evidence base for effective prevention campaigns 9,10. The recently published strategy for
combating infectious diseases11 places surveillance at the heart of tackling all infectious disease,
including HIV/AIDS.
For many countries, accurate figures for the number of HIV positive individuals, AIDS cases and AIDS
deaths are not available: the surveillance systems are not in place. The numbers employed here for
countries outside the UK are drawn from the publications of UNAIDS/WHO which are estimates
based on diverse sources. The figures are widely recognised as being the best available, although
a small number of dissenters contest the high prevalence in Southern Africa12,13.
Surveillance of the epidemic in the developed world has become more difficult with the advent of
antiretroviral treatment. Reliable estimations of the number of people with HIV used to be backcalculated from the number of AIDS cases. Now, because current therapies keep HIV positive people
healthier for longer, the time until onset of an AIDS defining illness is less predictable. Instead, the
epidemic is tracked by improved reporting of new HIV infections. However, this method is more prone
to bias, since it detects fewer cases in marginalised groups, such as ethnic minority communities14.
Some countries, such as the USA, are yet to fully establish monitoring of HIV diagnoses, thus
diminishing the quality of the estimations produced.
In the UK, during the early years of the HIV epidemic, there was some discussion of making HIV a
statutorily notifiable disease. This course was not taken in order to encourage individuals to come
forward for testing 8. Although reporting has been voluntary, the Public Health Laboratory Service
(PHLS) calculates that 80-90% of diagnosed cases are reported, which compares favourably with
rates for notifiable diseases 10.
Vaccine development
Despite the many obstacles to the development of an effective HIV vaccine, scientists are confident
that this objective could be achieved within the next 7-10 years15. The ideal conditions for vaccine
development require the erection of appropriate international institutional and political structures as
well as the allocation of resources to resolve the scientific difficulties. Optimism arises out of the
success of vaccines for non-human primates based on HIV or SIV (simian immunodeficiency virus)
offering partial and complete protection against the wild type virus 15-17. Successful vaccines have been
developed for other retroviruses 15,18, and most people develop some form of immune response to the
virus: groups of sex workers in both Kenya and South Africa have been identified as disease-free
despite long-term high-risk exposure 15,19,20. However, the correlates of protection against HIV infection
are as yet not understood, and the efficacy of vaccine trials with animals have been questioned15,21,22.
Trials of a vaccine for HIV-1 have been undertaken in Europe, North America, Brazil, China and
Thailand23,24. Major barriers to vaccine development remain the variability of the virus and the
complexity of its interactions with the immune system. It is likely that any vaccine that
is developed will have to be tailored to the local strain or strains in each geographical region25 and
may not work where new recombinant strains are formed26.
Introduction
15
Global perspective on HIV and AIDS in 2001
In 2001, an estimated 40 million people were living with HIV (figure 1.1), 5 million of whom were
newly infected (figure 1.2) and three million of whom died. The total number of lives claimed by the
pandemic so far is estimated to be 24.8 million. Africa continues to bear the brunt of the AIDS
epidemic: HIV/AIDS is now the leading cause of death in sub-Saharan Africa. It is estimated that
2.3 million Africans died of AIDS in 200112. Worldwide it is the fourth biggest killer12,27. The impact
of HIV/AIDS has been compared with that of the Black Death (Bubonic plague) in 14 th Century Asia
and Europe28. The situation is further complicated by the high rates of co-infection with Tuberculosis:
about a third of all those living with HIV/AIDS worldwide are also infected with tuberculosis29.
While Africa currently has the biggest AIDS problem, the future global course of the epidemic
depends on what happens in India, China and Indonesia. The apparently low national prevalence
rates mask localised epidemics and there is a threat of major generalised outbreaks.
In June 2001, the United Nations General Assembly held a Special Session on HIV/AIDS, which
ended with an approved Declaration of Commitment to address HIV/AIDS 30. A global fund to fight
AIDS, tuberculosis and malaria, was announced in July 2001. To date the fund has received pledges
of less than US$ 2 billion 31, significantly short of the annual target of US$ 7 – 10 billion 32, and doubts
remain over the fund’s aims and objectives 33. The potential for the global fund to effect change on
a global scale with these limited resources remains to be demonstrated.
Figure 1.1: Number of adults and children estimated to be living with HIV/AIDS as
of end 2001 Source: UNAIDS/WHO Report on the Global HIV/AIDS Epidemic – December 2001
Global Total : 40 Million*
Eastern Europe
& Central Asia
1 million (2.5%)
North America
940,000 (2.4%)
Caribbean
420,000 (1.1%)
Latin America
1.4 million (3.5%)
Western Europe
560,000 (1.4%)
North Africa
& Middle East
440,000 (1.1%)
East Asia &
Pacific
1 million (2.5%)
South &
South-East Asia
6.1 million (15.3%)
Sub-Saharan Africa
28.1 million (70.3%)
Australia &
New Zealand
15,000 (0.04%)
*Total may not add up due to rounding.
16
Figure 1.2: Number of adults and children estimated to be newly infected with HIV/AIDS
during 2001 Source: UNAIDS/WHO Report on the Global HIV/AIDS Epidemic – December 2001
Global Total : 5 Million*
Eastern Europe
& Central Asia
250,000 (5%)
North America
45,000 (0.9%)
Caribbean
60,000 (1.2%)
Latin America
130,000 (2.6%)
East Asia &
Pacific
270,000 (5.4%)
Western Europe
30,000 (0.6%)
North Africa
& Middle East
80,000 (1.6%)
Sub-Saharan Africa
3.4 million (68%)
South &
South-East Asia
800,000 (16%)
Australia &
New Zealand
500 (0.01%)
*Total may not add up due to rounding.
Access to antiretroviral drugs in the developing world
Access to drugs and treatment within and across the richer nations is uneven, partly due to structural
inequalities in the respective health care systems8,34-37. However, access to life-saving drugs is even
more variable in the developing world: during 2000 only six developing country governments provided
antiretroviral treatment for the majority of people needing them (Brazil, Argentina, Uruguay, Mexico,
Chile and Costa Rica)32. The World Health Organisation has recently placed antiretroviral drugs on its
list of essential drugs38, but this alone does not make access easier in resource-poor circumstances.
The lack of access to appropriate treatment for poor people was a major point of discussion during
the Thirteenth International AIDS Conference in Durban, South Africa in 2000. Due to the concerted
advocacy of activists, non-governmental organisations and other pressure groups, this issue has
subsequently become a worldwide concern32. The manufacture and marketing of generic versions of
antiretroviral drugs have widened access and reduced the prices of the patented drugs32, but this
process has been resisted by pharmaceuticals companies supported by Western, particularly the
US governments 32,39,40. The British Parliament’s own All-Party Parliamentary Group for AIDS has
recommended that the British Government distance itself from the pharmaceutical industry in
this matter41.
Introduction
17
South Africa continues to bear the brunt of the AIDS epidemic, with the prevalence as high as 36%
amongst pregnant women attending antenatal clinics in KwaZulu-Natal Province12. People with
HIV/AIDS face additional barriers to effective treatment. The South African President, Thabo Mbeki,
continues to question the link between HIV and AIDS. As a consequence the state’s response to HIV
in South Africa has been paralysed and efforts to introduce widespread treatment with antiretroviral
drugs have been hampered.
The epidemic in the developed world
In richer countries, the epidemic continues to have a very different shape to that of the developing
world, with the population living with HIV/AIDS growing as people have fewer opportunistic infections
and live longer due to life-prolonging therapies42. Correspondingly, the number of people developing
AIDS has decreased. This is demonstrated for the North West and UK in figure 1.3, where the number
of AIDS cases begins to drop after 1994, while the number of people newly infected continues at
approximately the same rate (figure 1.4). Data from the US show that even those who go on to
develop AIDS can expect to live nearly three years longer than those diagnosed in the mid 1980s43.
However, within the developed world, there are big differences in the prevalence of HIV between
countries. For example, the USA has a rate eight times higher than that of the UK44. In the developed
world HIV remains focussed in marginalised communities, for example drug users, homosexual men
and ethnic minority communities. How long this remains the case is dependent in part on the renewal
of prevention campaigns tailored to both specific groups and broader populations.
Figure 1.3: Number of new AIDS cases in the North West and the UK by year of
diagnosis to December 2001 (Source: AIDS/HIV Quarterly Surveillance Tables No.53, CDSC)
2000
Total UK
North West
100
1500
80
60
1000
40
500
20
0
Number of Individuals, UK
Number of Individuals, North West
120
0
<=85 86
87
88
89
90
91
92
93
94
95
96
97
98
99
00
01
Year of Diagnosis
<=85 86
18
87
88
89
90
91
92
93
94
95
96
97
98
99
00
01
Total
67
64
84
78
96
114
114
93
82
53
43
23
17
8
1014
722
754
430
18327
North West Region
16
33
29
Total UK
408
474
680
905 1081 1244 1387 1578 1785 1851 1767 1427 1064 770
Figure 1.4: Number of new HIV cases in the North West and the UK by year of diagnosis
to December 2001 (Source: AIDS/HIV Quarterly Surveillance Tables No.53, CDSC)
5000
Total UK
North West
250
4000
200
150
3000
100
2000
50
0
Number of Individuals, UK
300
1000
<=85 86
87
88
89
90
91
92
93
94
95
96
97
98
99
00
01
Year of Diagnosis
<=85
North West Region 274
Total UK
86
87
88
89
147
143
109 112
90
91
92
93
94
95
141
156
172
143
140 172
96
97
178
145
98
99
00
01
Total
175 197 220
100
2724
4843 2765 2504 1938 2137 2540 2712 2738 2611 2559 2635 2677 2713 2785 3013 3653 3335 48158
In the developed world, one of the challenges posed by HIV is maintaining an armoury of drugs that
are effective against HIV. The fact that treatment can be difficult to tolerate and complex to manage
can lead to non-compliance with treatment regimes, ultimately hastening the evolution of treatmentresistant forms of the virus. Another challenge is maintaining levels of safer sex behaviour in the
population. Worryingly, several richer countries report increases in risk behaviour, at least in part
due to complacency generated by the effectiveness of treatment 45,46.
Sub-Saharan Africa
Sub-Saharan Africa remains the region most severely affected by HIV/AIDS. In the year 2001 an
estimated 3.4 million adults and children were newly infected (figure 1.2), bringing the total number of
people living with HIV/AIDS to 28.1 million (figure 1.1). An estimated 2.3 million people (from a global
figure of 3 million) died from HIV/AIDS in sub-Saharan Africa.
In some southern African countries the prevalence of HIV among the adult population is estimated to
be over 30%12. The fact that the epidemic is centred on the heterosexual population in Africa, rather
than a minority group, vastly increases the number of people at risk. It is important to recognise that
the region does not have a uniform experience of HIV/AIDS, and the epidemic varies in scale and
maturity. In West Africa five countries (Burkina Faso, Cameroon, Côte d’Ivoire, Nigeria and Togo) have
a national prevalence rate of 5%, whereas the prevalence rate amongst pregnant women attending
urban antenatal clinics in Botswana is 44%12. The responses of individual governments have differed.
For example, prevention campaigns in Uganda have reduced the prevalence amongst women in urban
areas attending antenatal clinics from 30% in 1992 to 11% in 200012. There are indications of a more
co-ordinated approach to prevention: 31 countries in the region have completed a national HIV/AIDS
strategic plan, and a further 12 are under development. The Organisation of African Unity summit
Introduction
19
on HIV/AIDS, Tuberculosis and Other Related diseases in April 2001 reached a Heads of State
agreement to dedicate 15% of their respective countries’ annual budgets to health. However, the
seriousness of the situation in sub-Saharan Africa should not be underestimated, as the epidemic
continues to erode the very human infrastructure which is needed to respond to the disease12.
The situation in Africa is highly relevant for the North West of England, since three quarters of all new
infections in the North West in 2001 known to have been contracted abroad were contracted in Africa
(see chapter 2, figure 2.3).
East Asia and the Pacific
In China the HIV surveillance data are weak: the country’s health ministry estimated that
approximately 600,000 Chinese were living with HIV/AIDS in 2000. The UNAIDS organisation
estimated the figure to be over 1 million by the end of 200112. Amongst the most significant outbreaks
has been that in Henan province, where many tens of thousands of peasants have become infected
through privatised blood donation programmes since the early 1990s. Elsewhere in China, specific
groups are known to be experiencing high levels of HIV, with prevalences as high as 70% amongst
injecting drug users and up to 5% in sex workers47.
South and South East Asia
HIV/AIDS arrived relatively late in this region, with only Cambodia, Myanmar (Burma) and Thailand
reporting significant epidemics by 1999. This situation has changed dramatically in recent years.
During the course of 2001, an estimated 800,000 people became infected with HIV in South and
South East Asia (figure 1.2), bringing the total number of people living with HIV and AIDS in this
area to 6.1 million (figure 1.1). Behaviours in the region, which are associated with the highest risk,
are unprotected sex between sex workers and clients, injecting drug use and sex between men.
Several countries have seen major epidemics grow out of relatively contained infection rates
within these communities48.
The national prevalence in India was under 1% at the end of 2000, but given its huge population there
were still an estimated 3.86 million Indians living with HIV/AIDS, more than anywhere else outside of
South Africa49. Localised epidemics revealed by antenatal testing show a prevalence of over 3% in
sentinel sites, and over 10% in patients attending sexually transmitted disease clinics48. Increasing HIV
rates are also fuelling India’s tuberculosis epidemic 49,50. Without the implementation of a widespread
prevention programme, the World Bank estimates that India could have 37 million infected individuals
by 2005 49,51. Whilst there have been a number of successful prevention interventions, these have been
highly localised: the many obstacles to effective action include widespread poverty, illiteracy, social
inequality based on caste and gender, taboo on the discussion of sex and a lack of political will to
tackle the issues49.
A recent symposium on the status and trends in HIV across Asia and the Pacific region highlighted
the dramatic, if uneven emergence of HIV, especially in Indonesia. The world’s fourth-most populous
country, Indonesia has seen a ten fold increase in infection amongst blood donors between 1998 and
2000. HIV infection is rapidly increasing amongst both injecting drug users and sex workers 48.
The success of several large-scale prevention campaigns can be noted. Cambodia’s prevention
campaigns since 1994 have seen a decline in high-risk behaviours among men and a drop in the HIV
prevalence amongst pregnant women from 3.2% in 1997 to 2.3% in 2000. In Thailand the national
prevention programmes since the early 1990s have reduced the number of new infections from
140,000 in 1990 to 30,000 in 200012. Thailand has successfully implemented a programme of HIV
screening and treatment for positive pregnant women to prevent vertical transmission52.
20
Latin America and the Caribbean
These regions account for 1.82 million people living with HIV (figure 1.1). The experience of the
epidemic within the region is highly variable. Initially, the epidemic in Latin America was similar to
that in North America and Europe, with most cases in injecting drug users and men who have sex
with men53. However, now the epidemic has a complex pattern, with male to male transmission
predominant in Mexico, Chile and Cuba and injecting drug use being important in Brazil and Argentina.
More recently there have been rapid increases in the proportion of HIV positive individuals who are
infected by heterosexual sex. The Caribbean has the highest levels of HIV outside Africa, because the
predominant mode of transmission is sex between men and women and thus the epidemic is focussed
on the general population. The overall prevalence in the Caribbean of HIV is 2%, with the worst
affected country being Haiti where 5.2% of the population is infected with HIV 54. Several Central
American countries had adult prevalence rates of at least 1%, including Belize, Guyana, Honduras,
Panama and Suriname.
A number of countries have launched government schemes to distribute antiretroviral drugs to
HIV/AIDS patients, with Argentina, Brazil and Uruguay having the programmes with greatest access.
A notable success has been recorded in the Bahamas since a large scale prevention and treatment
programme was introduced in 1994. The epidemic in the Bahamas was fuelled by immigration from
high-prevalence Haiti, but since the programme began, mother to child transmission has fallen by 57%,
there has been a 55% fall in new diagnoses, condom sales have increased by 33%, child mortality has
halved and death from AIDS has been reduced by 64%11.
North America
An estimated 45,000 new infections occurred in North America during 2001 (figure 1.2), and these
contribute to an estimated total of 940,000 people living with HIV (figure 1.1). There has been a
marked increase in new infections amongst men who have sex with men in Canada: in Vancouver
HIV rates amongst gay men rose from 0.6% in 1995-9 to 3.7% in 200012.
HIV/AIDS surveillance in the US is primarily based on notifications of AIDS diagnoses. Since fewer
individuals now go on to develop AIDS, it is more difficult to interpret epidemiological trends in HIV.
The Centers for Disease Control are now trying to establish the reporting of new HIV diagnoses,
but at present relatively few states are participating55.
The group most affected remains men who have sex with men, accounting for 50% of all AIDS cases
(where route of infection is known) and 40% of new AIDS diagnoses. A high proportion (46%) of
homosexually acquired AIDS cases are from ethnic minority groups56. Homosexual men from ethnic
minority groups are also infected at a younger age than their white counterparts57. Moreover, the
incidence of AIDS and AIDS-related deaths has decreased more rapidly among whites than Hispanics
or African Americans. The epidemic appears to be shifting away from the established high-risk
groups (men who have sex with men, injecting drug users) to other vulnerable populations. In the US,
African Americans constitute 12% of the population, but 38% of AIDS cases reported in 2000. With a
prevalence of 58.1 AIDS cases per 100,000, African Americans have a rate eight times greater than
their white compatriots58. It has been noted that adolescent women are at higher risk of HIV infection
than men because of their tendency to have older male partners. This manifests itself in higher rates
of newly diagnosed HIV infection, acquired through heterosexual sex amongst women (62% of all new
cases reported between July 1999 and June 2000 for this transmission route amongst adolescents)59.
Introduction
21
Eastern Europe and Central Asia
Eastern Europe and Central Asia is the region with the fastest growing epidemic. There are now an
estimated one million people living with HIV (figure 1.1), a 250,000 increase on last year’s figure.
The majority of people with HIV are injecting drug users who live in the Russian Federation and
Ukraine – areas characterised by political and economic instability and consequent high levels of
drug use. The overlaps between the drug using and sex worker populations60 and the huge increases
in syphilis rates in Russia during the 1990s 44 are fuelling fears that the HIV epidemic will spread into
the general heterosexual population. In the Ukraine the national prevalence rate is currently 1%,
the highest in the region. The deepening economic crisis across the entire region has led to the
collapse of public health systems, and prevention campaigns have been limited in number and impact.
Although homosexuality has largely been decriminalised, the strong stigma still attached to sex
between men has meant that prevention programs have not been targeted at this vulnerable group.
There has been a more recent explosion of HIV cases in Lithuania, where injecting drug use and needle
sharing is common61. Drug use is increasingly common amongst secondary school children in the
former Soviet Union, with an estimated 1% of the entire population injecting drugs12. Given the high
probability of transmission during needle sharing62, the increasing rates of other sexually transmitted
diseases, the conditions are suitable for a massive outbreak of HIV into the wider population.
Western Europe
At the end of 2001, the number of people living with HIV in Western Europe was estimated to be
560,000 (figure 1.1), of whom 30,000 were newly infected in 2001 (figure 1.2). The overall prevalence
has increased slightly, mainly because effective therapies prolong the life expectancy of HIV positive
people. The prevalence of HIV varies widely in Western Europe, and the nature of the epidemic differs
between countries: in Portugal, Spain and Italy the epidemic is driven by injecting drug users, whilst in
Germany and Greece sex between men remains the principle transmission route. It should be noted
that there is also significant diversity within individual countries. The national prevalence rates also
vary, from under 0.1% of the adult population in the Scandinavian countries to an estimated 0.58%
and 0.74% in Spain and Portugal respectively – a greater than seven-fold difference63. Data are limited
or not available in some of the countries that are most affected by HIV, particularly those with large
injecting drug user populations (for example, France, Portugal, Italy and Spain)64. The heterosexually
transmitted infections amongst Western European countries have distinct patterns. Over 50% of
heterosexually exposed cases in Iceland, Norway, Germany and the UK are acquired in a country
with a generalised epidemic (i.e. over 1% of the population infected, typically sub-Saharan Africa).
In Finland, Sweden, Denmark and Greece the heterosexually transmitted infections were primarily
acquired domestically65.
Many Western European countries are popular holiday destinations for British tourists. Moreover,
risk behaviour, particularly among young people, increases when on holiday66. In 2001, 7% of new
HIV infections that were known to have been contracted abroad were infected in Europe
(see Chapter 2, figure 2.3).
22
HIV and AIDS in the United Kingdom – 2001
2001 saw the publication of the government’s long awaited National Strategy for Sexual Health and
HIV 9. Originally planned as a strategy for addressing HIV alone, the HIV plan has been subsumed
into a broader policy document considering sexual health, and has an initial budget of £47.5 million.
The response to the strategy has been mixed: while many welcome attempts to co-ordinate HIV
services, some have felt that HIV has been downgraded as a Department of Health priority 67.
Substantive criticisms include the end of ring-fencing for HIV prevention funding: in the future,
HIV will have to compete with other health issues for funding67,68. This is further complicated by
restructuring of the NHS, with the creation of primary care trusts (PCTs) from April 1st 2002.
Services will now be commissioned by PCTs, and some HIV specialists fear that commissioners at
this level within the NHS may not allocate significant resources to address a stigmatised health issue
that impacts mainly on marginalised groups (such as ethnic minorities, gay men, sex workers and
injecting drug users). A briefing paper produced by the National HIV Prevention Information Service
(on behalf of the Health Development Agency) for voluntary organisations admits that it is not clear
how prevention services will be commissioned under the new system69. The strategy does highlight
a number of marginalised groups for whom specific sexual health campaigns should be targeted
(alongside the wider population), although it does not mention refugees. The strategy also sets the
ambitious target of a 25% reduction in newly diagnosed HIV infections by 2007. A key component of
the strategy is the development of sexual health services within primary care. This has met with
opposition from both GPs and AIDS activists: according to a survey of GPs in the North West Region,
55% of respondents did not wish to see an increased role for themselves in the provision of HIV
services70. Patient’s records held at general practices are less secure than those within specialist HIV
services or genito-urinary clinics, and it is more difficult for patients to control knowledge of their
status in regard to employers and financial service organisations.
The sexual health of people living in the UK has continued to deteriorate, with increases in the levels
of sexually transmitted infections (STIs) such as chlamydia, gonorrhoea and syphilis 71,72. The second
National Survey of Sexual Attitudes and Lifestyles included an examination of sexual risk behaviours
amongst Britons aged 16-44 years. Compared with the previous study in 1990, all groups reported
increased numbers of sexual partners which offset the benefits of increased condom use and helps
explain the increase in the incidence of a wide range of STIs 73. The surveillance data indicate higher
STI incidence rates in 2000 than 1990, particularly in the under 25-age group. In response to the
increase in STIs amongst young people, the BMA has called for an increase in the number of clinics
for younger people 72. Interestingly, the decreasing age of first intercourse, a trend since the 1960s,
may have stabilised during the mid-1990s, with a median age of 16 for women aged 16-24 years
and men aged 16-19 73.
New diagnoses of HIV, development of AIDS and deaths of HIV positive people are reported to the
Public Health Laboratory Service (HIV, STD Division, Communicable Disease Surveillance Centre
and the Scottish Centre for Infection and Environmental Health), who compile the data into quarterly
surveillance tables. Figures 1.3 to 1.7 and tables 1.1 and 1.2 in this Chapter give an overview of trends
in the UK using these data. Most people with HIV live in London. This means that national policy is
shaped with a strong bias to the needs of London and the South East34-37. Additionally, the data underrepresent some regions of the UK (notably the North West and Trent34-37). Chapters 2 to 5 of this
report are based on monitoring of treatment and care of individuals with HIV or AIDS, and provide
the most accurate and detailed information on HIV epidemiology available for the North West.
The number of people reported as being newly diagnosed with AIDS in the UK in 2001 alone was 430,
bringing the cumulative total number of people with AIDS since notification began in 1982 to 18,327
(figure 1.3). The number of new AIDS cases represents a 77% decrease from 1994 when the number
of AIDS diagnoses was at its highest. This decline in AIDS incidence in the UK is also observed across
Europe and the USA and has been attributed to the success of antiretroviral therapies.
Introduction
23
The cumulative total of reported HIV infections in the UK rose to 48,158 at the end of 2001 (figure 1.4).
Of these, 3,335 cases were newly identified in 2001. The epidemiology of HIV in England, Wales and
Northern Ireland is shifting as a result of changing patterns in the route of transmission of new
infections (figures 1.5 and 1.6). The epidemiology of HIV differs in Scotland, as shown in figure 1.7.
An additional tool for monitoring the HIV epidemic in the UK is provided by the unlinked anonymous
HIV seroprevalence programme conducted by PHLS and the Institute of Child Health. Part of the
programme involves testing of blood samples that have been taken for other purposes, for example
antenatal screening, after having irreversibly removed patient identifying details. This allows
estimations of the extent of undiagnosed HIV infection in high risk groups as well as in the general
population. The monitoring programme has been operating throughout England and Wales since 1990
and provides low cost minimally biased estimates of current HIV prevalence74.
Men who have sex with men
The category of homosexual exposure accounts for 65% of all AIDS cases so far reported in the UK
(figure 1.5) and 58% of all HIV cases (figure 1.6), and therefore remains the largest group of people
living with HIV in England, Wales and Northern Ireland. However, the shape of the epidemic is changing,
and the proportion of new HIV diagnoses attributed to sex between men has decreased from a high
of 78% in 1986 to 33% in 2001. The pattern is different in Scotland, where men who have sex with
men account for only 33% of the total number of people who have been diagnosed with HIV (figure 1.7).
From anonymous testing of blood samples, the prevalence of HIV among gay men in London is
estimated to be 11%, significantly higher than that outside London (2%)75. It is estimated that
around one third of HIV positive homosexual men are diagnosed late in the course of their infection,
as evidenced by their low CD4 counts at diagnosis76.
The 1980s saw substantial reductions in risk behaviour among gay men in response to the AIDS crisis.
Following several years of stable levels of risk behaviour77, more recent annual surveys78 show that
gay men in London appear to be following a trend for a reduction in safer sex behaviour. This change
in self-reported risk behaviour is mirrored by increasing levels of homosexually acquired gonorrhoea
(by 36% between 1995 and 1999) in the UK79. As well as indicating increases in risk behaviour,
sexually transmitted infections may also act as a co-factor in the transmission of HIV, as demonstrated
for heterosexual transmission80. However, there have been fewer studies of the influence of sexually
transmitted infections on HIV transmission during sex between men 81.
There are suggestions that awareness of the effectiveness of antiretroviral drugs has lead to an
increase in sexual risk taking amongst both HIV infected and uninfected gay men46. This phenomenon
needs to be accounted for in the preparation of health campaigns, and highlights the problem of
‘safer sex fatigue’ amongst target audiences. A longitudinal study of HIV positive gay men in
Amsterdam on therapy showed that those with undetectable levels of virus in their blood had
increased levels of risk behaviour82.
24
Figure 1.5: Number of AIDS cases in the UK by year of diagnosis and infection route
of HIV to December 2001 (Source: AIDS/HIV Quarterly Surveillance Tables No.53, CDSC).
Percentage of Total AIDS Cases
100
Homo/Bisexual
Blood/Tissue
Injecting Drug Use
Mother to Child
Heterosexual
Undetermined
80
60
40
20
0
<=85 86 87 88
89 90 91 92
93 94 95 96
97 98
99 00
01
Year of Diagnosis
INFECTION ROUTE
YEAR OF
DIAGNOSIS
Homo/
Bisexual*
Injecting
Drug Use
Heterosexual
Blood/
Tissue
Mother
to Child
Undetermined
Total
<=1985
349
3
14
37
3
2
408
1986
406
7
16
39
4
2
474
1987
567
16
26
58
6
8
681
1988
738
28
52
75
7
8
908
1989
809
64
98
91
8
12
1082
1990
926
82
140
69
17
10
1244
1991
988
88
193
82
17
19
1387
1992
1108
84
268
71
30
17
1578
1993
1192
154
308
79
42
11
1786
1994
1228
139
335
90
43
16
1851
1995
1108
153
395
51
41
19
1767
1996
847
118
388
31
32
12
1428
1997
570
77
336
24
53
4
1064
1998
357
44
300
15
43
11
770
1999
310
29
318
15
30
20
722
2000
295
35
361
10
41
12
754
2001
132
13
251
4
12
18
430
Total
11930
1134
3799
841
429
201
18334
* includes 311 men who had also injected drugs
Introduction
25
Figure 1.6: Number of HIV cases in England, Wales and Northern Ireland by year
of diagnosis and infection route of HIV to December 2001 (Source: AIDS/HIV Quarterly
Surveillance Tables No.53, CDSC).
Percentage of Total HIV Cases
80
Homo/Bisexual
Blood/Tissue
Injecting Drug Use
Mother to Child
Heterosexual
Undetermined
70
60
50
40
30
20
10
0
<=85 86 87 88
89 90 91 92
93 94 95 96
97 98
99 00
01
Year of Diagnosis
INFECTION ROUTE
YEAR OF
DIAGNOSIS
Heterosexual
Blood/
Tissue
Mother
to Child
Undetermined
Total**
150
69
1186
3
111
4234
250
136
81
9
70
2470
1685
256
212
44
5
73
2283
1988
1337
174
210
25
12
57
1817
1989
1411
177
334
22
11
68
2027
1990
1648
172
498
22
28
51
2424
1991
1648
190
602
21
28
55
2544
1992
1588
160
729
21
56
53
2608
1993
1429
150
725
15
65
61
2446
1994
1411
139
754
13
62
44
2423
1995
1405
160
793
19
57
57
2492
1996
1469
140
786
19
58
52
2524
1997
1321
137
950
25
75
46
2556
1998
1274
110
1096
9
92
57
2639
1999
1270
93
1336
18
71
82
2873
2000
1365
86
1813
19
89
138
3510
2001
1044
59
1694
14
18
376
3206
Total***
25929
2603
12737
1573
739
1451
45076
Homo/
Bisexual*
Injecting
Drug Use
<=1985
2702
1986
1922
1987
** includes 44 with sex not stated on report
*** includes 68 patients who were first reported from the Channel Islands
26
Figure 1.7: Number of HIV cases in Scotland by year of diagnosis and infection route
of HIV to December 2001 (Source: AIDS/HIV Quarterly Surveillance Tables No.53, CDSC).
Percentage of Total HIV Cases
80
Homo/Bisexual
Blood/Tissue
Injecting Drug Use
Mother to Child
Heterosexual
Undetermined
70
60
50
40
30
20
10
0
<=85 86 87 88
89 90 91 92
93 94 95 96
97 98
99 00
01
Year of Diagnosis
INFECTION ROUTE
YEAR OF
DIAGNOSIS
Heterosexual
Blood/
Tissue
Mother
to Child
Undetermined
Total
437
8
69
0
3
611
198
20
7
1
4
297
62
126
25
5
5
3
226
1988
42
56
31
0
1
3
133
1989
40
35
25
6
5
1
112
1990
52
28
35
2
1
1
119
1991
64
51
44
3
7
1
170
1992
51
27
50
2
1
0
131
1993
69
52
41
2
2
1
167
1994
68
29
39
4
1
3
144
1995
61
22
55
1
2
3
144
1996
69
32
51
2
2
3
159
1997
68
31
53
3
6
4
165
1998
67
19
53
1
0
11
151
1999
51
16
59
1
4
10
141
2000
64
15
54
3
2
6
144
2001
51
12
63
2
0
8
136
Total
1040
1186
706
113
40
65
3150
Homo/
Bisexual*
Injecting
Drug Use
<=1985
94
1986
67
1987
Introduction
27
Heterosexual sex
Sex between men and women now accounts for 28% of the total number of HIV diagnoses in England,
Wales and Northern Ireland. However, for the second year running, heterosexual sex has accounted for
the largest number of new cases, at 53% in 2001 (figure 1.6). Heterosexual cases are categorised as
to whether they were exposed through sex with high risk partners, were exposed abroad or exposed
in the UK (figure 1.8). In 2001, 72% cases of heterosexually acquired HIV were contracted abroad.
The prevalence of HIV in the general heterosexual population is also monitored by anonymous testing
of pregnant women. These data reveal that the prevalence of HIV in the heterosexual population is
ten times higher in London compared to any other region in the UK (287 per 100,000 compared to
17 per 100,000 in the North West: figure 1.9). For those HIV positive individuals infected through
heterosexual sex, the majority (62%) are female 83. Approximately 80% of all infected women in the
UK are African and of these four-fifths contracted the virus through heterosexual sex84.
Sub-Saharan Africa is the predominant global region of transmission for those HIV cases acquired
abroad83. This is also reflected in the epidemiology of HIV in the North West, where, of those newly
reported in 2001 who were exposed abroad, nearly three quarters were exposed in Africa
(see Chapter 2, figure 2.3). Black and ethnic minorities form the majority of heterosexually transmitted
AIDS cases in the UK with black Africans constituting the largest group 83. These communities have
close connections with sub-Saharan societies, the region in which 70% of the global total of adults
and children estimated to be living with HIV/AIDS at the end of 2001 reside (figure 1.1).
Heterosexuals present later than other groups for testing and treatment, as evidenced by low CD4
counts when newly diagnosed76 and they are more likely to go on to develop AIDS within three months
of having had their HIV diagnosis 85. Because of the high proportion of ethnic minority individuals
amongst the heterosexual HIV positive population, the outcome is that such individuals are not
accessing treatment and care to the same extent as white people with HIV and have a poorer
prognosis as a result 86. It is not clear how much of this is failure to recruit heterosexuals into treatment,
or how much is related to HIV positive individuals from ethnic minority groups having newly arrived
in the country. Additionally, being from a minority ethnic group can be a marker of low socio-economic
status, which in itself is related to poorer health87,88 and possibly HIV status.
28
25
Figure 1.8: Number of heterosexually acquired HIV cases in the UK by year of diagnosis
to December 2001 (Source: AIDS/HIV Quarterly Surveillance Tables No.53, CDSC).
Exposure Abroad
Exposure to High Risk Partner
2000
Exposure in UK
Number of Individuals
Undertermined
1500
1000
500
0
<=85 86 87 88
89 90 91 92
93 94 95 96
97 98
99 00
01
Year of Diagnosis
Figure 1.9: HIV prevalence among pregnant women in England, 2000 (newborn infant
dried blood spots collected for metabolic screening) (Source: Unlinked Anonymous HIV
Prevalence Monitoring Programme: England and Wales, 2000)
Trent
56,892
Northern &
Yorkshire
30,537
North West
65,303
West Midlands
58,052
South East
79,501
London
103,852
Eastern
37,079
0
25
50
75
100
125
150
175
200
225
250
300
Number HIV positive per 100,000 population
Introduction
29
Injecting drug users
Injecting drug use accounts for 6% of the total diagnosed HIV infections in England, Wales and
Northern Ireland to date. The proportion newly diagnosed by this route in 2001 has dropped to just
1.8%, the lowest since reporting started (figure 1.6). In Scotland, the epidemic has historically been
centred on injecting drug use, which accounted for 78% of infections up to and including 1984.
This proportion has steadily decreased, and last year only 9% of new infections were attributed to
this route (figure 1.7). Anonymous testing of injecting drug users attending services reveals that,
outside London, the prevalence of HIV among injectors is low, at 0.12% in the North West. In London,
an estimated 3.6% have HIV (figure 1.10). The pioneering harm reduction strategies, such as needle
exchanges, during the 1980s have helped keep the prevalence low in the North West Region8.
Although these prevalence estimates are only available for drug users attending services, good
surveillance information should also incorporate the size of the drug using population89. Recent
research on the hidden population of drug users in the North West suggest that only a third of
problematic drug users are in contact with specialist drugs services90.
Other blood borne infections, such as hepatitis B and C, are more infectious than HIV and are
transmitted during episodes of indirect sharing (for example sharing of filters, spoons or water when
preparing drugs). Figure 1.10 shows the prevalence of HIV, hepatitis B and hepatitis C amongst
injecting drug users by region. While the prevalence of HIV remains fairly low, hepatitis B and C are
highly prevalent. London and the North West in particular have the highest prevalences of hepatitis
infections amongst clients of drugs services. A recent survey of injecting drug users from a range of
drugs service and community settings in the North West found the prevalence of hepatitis C to be yet
higher, at 53%91,92. Because HIV is less infectious than hepatitis C, those individuals who have had
sufficient high risk exposure to acquire HIV are also likely to have been infected with hepatitis C.
Having both infections makes the treatment of each more difficult to manage, increases the
progression of hepatitis disease and, for women, increases the probability of transmission of HIV to
an infant during pregnancy or birth (see review in the recent North West report 91). The extremely high
prevalence of hepatitis C among HIV-infected injecting drug users may contribute to their excess
mortality compared to other groups with HIV. This excess mortality has been detected by monitoring
CD4 at death: HIV positive injecting drug users die with higher CD4 counts than average 93.
An area of particular concern for the transmission of HIV (and hepatitis C) is within prisons.
Prisoners are particularly at risk due to the high levels of intravenous drug use and sharing of
injecting equipment within the prison environment. Tattooing and unprotected sex between men
are also high risk activities known to be widespread. To date the Home Office has not adopted
the principle elements of successful harm reduction strategies, which are needle exchanges and
unrestricted condom distribution8,94.
30
Figure 1.10: Prevalence of HIV, hepatitis B and hepatitis C antibodies and direct sharing
of injecting equipment among injecting drug users attending drugs agencies, 2000
(voluntary saliva samples) Source: Unlinked Anonymous HIV Prevalence Monitoring Programme:
England and Wales, 2000)
Wales
89
Trent
149
Northern &
Yorkshire
710
North West
814
West Midlands
119
South West
568
South East
143
62
HIV
Hepatitis B
Hepatitis C
Direct Sharing
136
570
418
77
392
79
559
London
298
274
Eastern
0
5
152
10
15
20
25
30
35
40
45
50
Percentage of Drug Agency Clients
Numbers at the base of each bar represent the sample sizes for blood tests. Direct sharing refers to receiving or passing on used
needles or syringes in the previous four weeks, and the numbers represent the sample size for the direct sharing question.
Blood or tissue
Since the introduction of screening of donated blood for HIV in 1985, infection by blood transfusion
has been rare. This is clearly indicated by the abrupt decline from 42% of all infections reported before
and during 1984 to just 0.4% in 2001 (figure 1.6).
The relatively rare instances of HIV infection via this route tend to be a result of donations collected
during the window period of HIV infection (i.e. before antibodies had developed in the donor’s blood)
or people infected prior to screening who have only recently developed HIV-related disease95.
Recently, 5,579 transfusion recipients were followed up, and none had been infected with HIV as
a result. This suggests that the current risk of transmission from a transfusion in the UK is very low,
at less than one in 5,00096.
Introduction
31
Mother to child
During 2001, 18 infants were reported to have contracted HIV from their mothers (figure 1.6).
Although this is an apparent decline on last year’s figure of 89, there is an inevitable delay in reporting
vertically transmitted HIV. This is because maternal antibodies are present for up to 18 months after
birth and confounds the diagnosis. The equivalent figure published for 2000 was 49; however,
by December 2001 this 2000 figure had been adjusted to 89. Thus it is likely that several more
diagnoses for the year 2001 will be reported during coming months.
Interventions of anti-HIV therapy for the mother, caesarean section and avoidance of breast feeding
have been successful at reducing the rates of vertical transmission from around 32% to 4%97. Currently,
the main obstacle that prevents successful intervention is lack of knowledge by the mother of her HIV
status. Results from the anonymous unlinked seroprevalence programme suggest that an estimated
452 births to HIV infected women took place in 2000 that would have resulted in an estimated 45
infected infants. If all HIV infected mothers had been offered interventions, fewer than ten babies
would have been born with HIV infection. Hence, it has recently become policy to offer an HIV test to
all pregnant women with the aim of increasing the uptake of the test to 90% of all pregnant women by
December 200298,99. In London, the proportion of pregnant HIV positive women who were diagnosed
before delivery increased from 50% in 1998 to 82% in 2000. However, there was less improvement
outside the London area: from 26% in 1998 to 56% in 2000 99.
HIV and AIDS in the North West of England - 2001
Figures 1.3 and 1.4 and tables 1.1 and 1.2 are taken from the PHLS Quarterly Surveillance Tables to
illustrate the status of the HIV/AIDS epidemic in the North West by comparison to the rest of the UK.
While these data underestimate the number of cases in the North West 34,35,37, the information is useful
for monitoring trends both nationally and regionally. For the most accurate and detailed information
about people living with HIV and AIDS in the North West, see the comprehensive overview in
sections 2 to 5 of this report.
By the end of 2001, a cumulative total of 2,724 HIV infections in the North West had been reported
to the Communicable Disease Surveillance Centre at PHLS, including 100 new cases during 2001
(figure 1.4). There were eight newly diagnosed AIDS cases in the North West, bringing the
cumulative total to 1,014, 6% of the total number of AIDS cases reported in the UK (figure 1.3).
The pattern of exposure to HIV among people with AIDS in the North West is broadly similar to
that of the UK, with the majority of people living with AIDS having been infected by homosexual
sex (table 1.1). However, the North West has a lower proportion of people infected with HIV via
heterosexual sex (18% compared to 28%) and a correspondingly higher proportion of men who
were infected by having sex with men (65% compared to 56%) (table 1.2). As in previous years,
the proportion of individuals exposed through the receipt of contaminated blood or blood product
is approximately twice the national average for both HIV and AIDS cases. At least part of this
is likely to be due to patients from other areas attending specialist haematology units in the
North West Region and in some cases moving residence for convenience.
The data in figure 1.11 are derived from the anonymous seroprevalence survey conducted by
the PHLS, and show the level of HIV infection in pregnant women; a sample intended to represent
the general population of the North West. The data for 2000 show a slight decrease in the prevalence
of HIV from 18 per 100,000 in 1999 to 17 per 100,000 pregnant women.
32
Table 1.1: Cumulative number of AIDS cases in the North West and the UK by infection
route of HIV to December 2001 (Source: AIDS/HIV Quarterly Surveillance Tables No.53, CDSC)
INFECTION ROUTE
North West Region
Total UK
Homo/
Bisexual*
Injecting
Drug Use
Heterosexual
Blood/
Tissue
Other
Undetermined**
Total
676 (66.7%)
58 (5.7%)
148 (14.6%)
102 (10.1%)
30 (3.0%)
1014 (100%)
3799 (20.7%)
840 (4.6%)
628 (3.4%)
18327 (100%)
11926 (65.1%) 1134 (6.2%)
** includes 429 children of HIV infected mothers
Table 1.2: Cumulative number of HIV cases in the North West and the UK by infection
route of HIV to December 2001 (Source: AIDS/HIV Quarterly Surveillance Tables No.53, CDSC)
INFECTION ROUTE
Homo/
Bisexual*
Injecting
Drug Use
Heterosexual
Blood/
Tissue
Total***
Other
Undetermined**
North West Region
1758 (64.5%)
168 (6.2%)
497 (18.2%)
193 (7.1%)
107 (3.9%)
2724 (100.0%)
Total UK
26939 (55.9%)
3780 (7.8%)
13420 (27.9%)
1683 (3.5%)
2292 (4.8%)
48158 (100.0%)
** includes 781 children of HIV infected mothers
*** includes 44 with sex not stated on report
Figure 1.11: HIV prevalence among pregnant women in the North West, 1992-2000
(Source: Unlinked Anonymous HIV Prevalence Monitoring Programme: England and Wales, 2000)
1992
34,411
1993
79,709
75,933
Year of Survey
1994
64,137
1995
69,462
1996
1997
72,998
1998
73,188
1999
72,488
65,303
2000
0
5
10
15
20
Number HIV positive per 100,000 population
Numbers by each bar represent sample sizes
Introduction
33
Figure 1.12: Number of AIDS cases and HIV positive individuals presenting to
treatment centres in the North West Region by year and stage of HIV disease
(All cases including those who died during each year)
2000
Asymptomatic
AIDS Related Death
Symptomatic
Death Unrelated to AIDS
AIDS
Unknown
1500
1000
500
0
1995
1996
1997
1998
1999
2000
2001
Year
YEAR
STAGE OF
HIV DISEASE
1995
1996
1997
1998
1999
2000
2001
Asymptomatic
260 (27.6%)
192 (18.9%)
228 (20.5%)
266 (21.8%)
337 (23.9%)
423 (25.9%)
606 (30.9%)
Symptomatic
370 (39.3%)
498 (49.1%)
552 (49.6%)
610 (50.1%)
660 (46.8%)
715 (43.8%)
774 (39.4%)
AIDS
198 (21.0%)
213 (21.0%)
278 (25.0%)
297 (24.4%)
376 (26.7%)
458 (28.1%)
534 (27.2%)
98 (10.4%)
87 (8.6%)
43 (3.9%)
38 (3.1%)
37 (2.6%)
30 (1.8%)
30 (1.5%)
Unknown
15 (1.6%)
24 (2.4%)
12 (1.1%)
7 (0.6%)
6 (0.4%)
14 (0.7%)
Total (100%)
941
1014
1113
1218
1632
1964
AIDS Related Death
Death Unrelated to AIDS
34
6 (0.3%)
1410
Figure 1.12 shows the number of people with HIV and AIDS who contacted statutory treatment
centres in the North West of England. These data represent the most accurate and comprehensive
source of information related to HIV and AIDS in the North West of England. The data collected by the
North West HIV and AIDS Monitoring Unit, from across the region over the last seven years, illustrate
the increasing number of people accessing HIV services. For the third year running, there has been a
large increase (18%) in the number of HIV positive individuals attending treatment centres, and again,
this increase is larger than that predicted nationally (9%)100. In order to make valid comparisons with
last year’s data, this increase of 18% has been calculated without including individuals reported solely
from treatment centres in North Cumbria (which was not part of the North West Region last year).
The continuing increase in the size of the HIV positive population is partly due to the decrease in the
number of people dying from AIDS related illnesses, but also due to an increasing number of new
cases (which this year has increased by 32% on last year’s total: see Chapter 2). A full description
of the epidemiology of HIV and AIDS in the North West is given in Chapters 2 and 3 of this report.
The sexual health of the North West
There is particular concern about the sexual health of the North West population, where rates of
sexually transmitted infections such as chlamydia, gonorrhoea and syphilis are the highest in England
outside London101. The presence of sexually transmitted infections in the population not only serves
as an indicator of sexual risk-taking behaviour, but also increase the probability of HIV transmission,
probably by weakening the defences of the genital tract 102. Of the recent outbreaks of syphilis in
the UK, the outbreak in Manchester continues to be the largest. Most of the people who contracted
syphilis in the Manchester outbreak have been homosexual men11,103.
A recent survey of gay men infected with syphilis in the Manchester outbreak revealed high levels of
anonymous sex, particularly unprotected oral sex, and low levels of awareness of the risk of syphilis
transmission through unprotected oral sex103-106. The study also revealed a high level of use of the drug
gamma hydroxybutyrate (GHB) during anonymous sex for its disinhibiting and aphrodisiac effects.
There was a high level of co-infection between syphilis and HIV, with 30% of gay men interviewed also
being HIV positive. Half of these HIV positive men stated that they had not changed their behaviour
since their HIV diagnosis, leading to the recommendation that people with HIV should routinely be
screened for sexually transmitted infections. In common with findings from London107, gay men did
not perceive their general practitioner to be a good source of information about sexual health
(with the exception of men attending the gay-friendly general practice in Manchester’s gay village).
Introduction
35
Refugees and HIV
Globally, migrants are often at greater risk of HIV infection than are resident populations, irrespective
of their country of origin108. During 2001 the UK received 71,700 asylum applications, 23% of the total
number of applications lodged in Europe109. Although not all asylum seekers are from high HIV
prevalent countries, 29% of all applications were from Africa109. Since April 2000 refugees have been
dispersed away from the traditional ports of entry and established screening systems for infectious
diseases. The affected health authorities were not notified and therefore not able to make appropriate
provision for the new arrivals110,111. Both statutory and voluntary sectors have responded with services
aimed at refugees, but this group nonetheless remains very vulnerable. Some asylum applicants have
experienced difficulty accessing primary healthcare, despite being entitled to full registration and free
healthcare111. Currently the cost of healthcare is not a material issue in the consideration of asylum
applications in the UK, and HIV positive refugees are not discriminated against on these grounds.
As a consequence of the stigma and discrimination associated with HIV, refugees are often reluctant
to test for HIV, reveal their status or access HIV care. A positive diagnosis may help a refugee’s
asylum application, since Article 3 of the European Convention on Human Rights states ‘no-one
shall be subject to inhuman or degrading treatment or punishment’ which makes it difficult to expel
an individual to a country where treatment is unavailable112.
Refugees in the North West are principally located in Liverpool and Manchester. No precise figures
exist for the numbers relocated into the region, or those arriving and applying for asylum in the area.
There are an estimated 3,500 to 5,000 refugees in Liverpool113, and Manchester City Council estimates
that there are currently 3,500 asylum seekers in Manchester alone, with a larger refugee community
of 10,000114. For the first time the Unit has recorded the refugee status of individuals accessing care
during 2001. Information about those known to be refugees is presented in table 3.25. Since no predispersal baseline figures exist, it is difficult to specify how the numbers have increased, but it is now
possible to identify this vulnerable group as a significant presence within the HIV positive community.
Social deprivation and HIV in the North West
Globally HIV impacts disproportionately upon poor and marginalised communities: 96% of cases are in
the developing world12,115. Within the developed world those who are most deprived experience greater
levels of ill health generally116,117 and HIV specifically118-123. Disease progression and access to treatment
have shown to be related to economic status, with poorer outcomes for the most deprived124,125.
A recent study, presented at the 14th International AIDS conference in Barcelona in July 2002, shows that
those living with HIV in more deprived areas of the North West were more likely to have required a stay
in hospital of at least one night than were their more wealthy counterparts, even after taking into account
their clinical stage, route of infection and ethnicity126. Although gay men are commonly perceived to be
affluent, HIV infected gay men in this study were more likely to live in deprived areas.
36
2
New Cases 2001
During 2001, 449 new HIV and AIDS
cases presented to statutory treatment
centres in the North West Region.
New cases are defined as individuals seen
in the North West Region in 2001 but not
during the years 1995 to 2000 and
include new HIV positive individuals
who died during the year. This year, the
North West Region has expanded in size
(to incorporate North Cumbria, formerly
part of Northern and Yorkshire Region)
and the HIV Monitoring Unit also collected
data from the Isle of Man. For individuals
reported by the new treatment centres,
the definition of new cases is individuals
whose year of diagnosis was either
unknown or known to be 2001 (eight
individuals).
There has been a large increase in the
number of new cases seen in the North
West Region in 2001. Not including the
eight cases in the new part of the region,
the number of new cases has increased
by 32% on the number of new cases
reported in 2000 (335)7. This figure is
much higher than last year’s increase
of 16%.
2. NEW CASES 2001
Data regarding newly reported cases of HIV infections assist in the identification of trends in incidence
and represent the most up to date information on the characteristics of HIV infection and transmission.
Such information is valuable not only for planning and evaluating the success of preventive activities, but
also for predicting the future incidence of HIV and AIDS and its impact on treatment and care services in
the North West of England. The aim of this section is to present information relating to new cases and,
where appropriate, references are made to corresponding data from previous North West reports 3-7.
To reflect the new geography of the North West Region, breakdowns are given by strategic health
authorities and primary care trusts (PCTs). PCTs have been allocated on the basis of postcode data,
and reflect the boundaries provided by the North West Public Health Observatory as of May 2002.
It is not possible to present all analyses by primary care trust; further primary care trust data are
available from the North West Public Health Observatory website (www.nwpho.org.uk/hiv2001).
Figure 2.1 illustrates the age distribution and infection route of new HIV and AIDS cases presenting
in the North West for treatment in 2001. Over a fifth (23%) of all reported cases in 2001 were seen
for the first time during this year. The majority of newly reported cases fall between the ages of
25 and 39 (61%), with incidence being highest in those aged 30-34 years (24%). Although homosexual
sex remains the predominant method of HIV transmission (51%), heterosexual sex accounts for over
a third of new cases seen. The proportion of new HIV and AIDS cases attributed to heterosexual
exposure continues to rise, from 17% in 1997, to 27% in 2000 and 38% in 2001. All the young people
aged 15 to 24 years were infected with HIV during sex (either homosexual or heterosexual).
After a decline in recent years (from 8% in 1997 to 3% in 2000), the proportion of new HIV positive
individuals infected through injecting drug use remains the same in 2001 at 3%. During the year eleven
new cases of vertical transmission were reported from North West treatment centres. No new cases
were reported as being attributed to having received contaminated blood or tissue. The infection route
for 25 new cases (6%) has not yet been determined. It is anticipated that the infection route for some
of these new cases will be resolved in future years. The proportion undetermined for all cases is
only 2% (section 3, table 3.1).
38
Figure 2.1: Age distribution of new HIV and AIDS cases by infection route of HIV,
January-December 2001 (New cases are defined as individuals seen in the North West Region
in 2000 but not between 1995 and 2000 and include new cases who died during the year)
Infection Route
120
Homo/Bisexual
100
Injecting Drug Use
Heterosexual
80
Mother to Child
Undetermined
60
40
20
0
0-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59
60+
Age Group
INFECTION ROUTE
AGE
GROUP
Homo/
Bisexual
Injecting
Drug Use
Heterosexual
0-14
15-19
Mother
to Child
Undetermined
11 (100.0%)
3 (60.0%)
Total
(100%)
11
2 (40.0%)
5
20-24
21 (65.6%)
25-29
51 (60.7%)
1 (1.2%)
30 (35.7%)
11 (34.4%)
2 (2.4%)
84
30-34
48 (45.3%)
6 (5.7%)
46 (43.4%)
6 (5.7%)
106
35-39
40 (47.6%)
5 (6.0%)
33 (39.3%)
6 (7.1%)
84
40-44
35 (60.3%)
20 (34.5%)
3 (5.2%)
58
45-49
17 (54.8%)
9 (29.0%)
4 (12.9%)
31
50-54
9 (40.9%)
12 (54.5%)
1 (4.5%)
22
55-59
1 (12.5%)
5 (62.5%)
2 (25.0%)
8
60+
6 (75.0%)
1 (12.5%)
1 (12.5%)
8
Total
231 (51.4%)
25 (5.6%)
449
1 (3.2%)
13 (2.9%)
169 (37.6%)
32
11 (2.4%)
Age ranges refer to the age of individuals at end of December 2001, or at death. Men who have had homosexual or bisexual
exposure and who are also injecting drug users are included in the homo/bisexual category.
New Cases 2001
39
Table 2.1a illustrates the clinical stage of HIV disease and residential distribution of new HIV and
AIDS cases presenting in the North West for treatment in 2001, broken down by strategic health
authority. The figures refer to the clinical condition of individuals when last seen in the year 2001;
individuals who died from AIDS related illnesses are presented in a separate category to other
AIDS cases.
HIV positive individuals categorised as asymptomatic continue to represent the largest proportion
of new cases (50%), with the proportion in each category being comparable to the 2000 data.
This maintains the observation that HIV positive individuals are contacting services at a relatively
early stage of their HIV disease. Of the eight new individuals who died during the year all had been
first diagnosed as having had AIDS defining illnesses. This suggests that despite continuing media
attention some individuals present too late to benefit from life-prolonging treatment.
Tables 2.1b, c and d present the breakdown of stage of disease by primary care trust within each
of the three strategic health authorities (Cumbria & Lancashire, table 2.1b; Cheshire & Merseyside,
table 2.1c; and Greater Manchester, table 2.1d). The widespread distribution of new HIV positive
individuals demonstrates the importance of HIV prevention initiatives in every primary care trust.
Residents of Greater Manchester Strategic Health Authority accounted for over half (55%) of new
HIV and AIDS cases presenting for treatment and care in the North West. The majority of this year’s
regional increase in the number of new cases can be attributed to new cases resident in Greater
Manchester (an increase of 32% on last year’s data), while incidence in Cheshire & Merseyside has
risen by 10%. The vast majority of new cases receiving care in the North West during 2001 were
resident within the region (91%). Of the 43 individuals known to live outside the region, 35% were
reported as residing in Northern and Yorkshire Region.
Table 2.1a: Residential distribution of new HIV and AIDS cases by stage of HIV disease,
January-December 2001: strategic health authority (New cases are defined as individuals
seen in the North West Region in 2001 but not between 1995 and 2000 and include new cases who
died during the year)
STAGE OF HIV DISEASE
SHA OF
RESIDENCE
Asymptomatic Symptomatic
AIDS
AIDS
Related Death
Unknown
8 (9.2%)
Cumbria & Lancashire
44 (50.6%)
17 (19.5%)
17 (19.5%)
1 (1.1%)
Cheshire & Merseyside
39 (53.4%)
18 (24.7%)
14 (19.2%)
2 (2.7%)
Greater Manchester
121 (49.2%)
67 (27.2%)
49 (19.9%)
5 (2.0%)
Eastern
4 (44.4%)
3 (33.3%)
London
2 (40.0%)
3 (60.0%)
Northern Yorkshire
9 (60.0%)
3 (20.0%)
South East
South West
87
73
4 (1.6%)
1 (100%)
Isle of Man
Total
(100%)
246
1
2 (22.2%)
9
5
3 (20.0%)
15
1 (100%)
1
1 (100%)
1
Trent
1 (33.3%)
2 (66.7%)
3
Wales
2 (66.7%)
1 (33.3%)
3
West Midlands
1 (50.0%)
1 (50.0%)
Unknown
2 (66.7%)
Total
226 (50.3%)
111 (24.7%)
91 (20.3%)
2
8 (1.8%)
1 (33.3%)
3
13 (2.9%)
449
Individuals living outside of the North West Region are grouped by region, and the Isle of Man is organised as a distinct category.
40
Table 2.1b: Residential distribution of new HIV and AIDS cases by stage of HIV disease,
January-December 2001: Cumbria & Lancashire primary care trusts (New cases are
defined as individuals seen in the North West Region in 2001 but not between 1995 and 2000
and include new cases who died during the year)
PCT OF
RESIDENCE
Carlisle & District
AIDS Related
Death
AIDS
Unknown
1 (100%)
West Cumbria
2 (100%)
Morecambe Bay
8 (72.7%)
2 (18.2%)
1 (9.1%)
Blackpool
12 (40.0)
4 (13.3%)
8 (26.7%)
Fylde
1 (25.0%)
1 (25.0%)
Wyre
5 (62.5%)
1 (12.5%)
1 (12.5%)
Preston
9 (69.2%)
2 (15.4%)
2 (15.4%)
Hyndburn & RibbleValley
3 (60.0%)
2 (40.0%)
Burnley,Pendle&Rossendale
1 (20.0%)
4 (80.0%)
Blackburn with Darwen
1 (33.3%)
1 (33.3%)
1
2
Chorley & South Ribble
11
1 (3.3%)
5 (16.7%)
30
2 (50.0%)
4
1 (12.5%)
2 (100%)
Total
44 (50.6%)
8
13
5
5
1 (33.3%)
3
3 (100%)
West Lancashire
Total
(100%)
3
2
17 (19.5%)
17 (19.5%)
1 (1.1%)
8 (9.2%)
87
Table 2.1c: Residential distribution of new HIV and AIDS cases by stage of HIV disease,
January-December 2001: Cheshire & Merseyside primary care trusts (New cases are
defined as individuals seen in the North West Region in 2001 but not between 1995 and 2000 and
include new cases who died during the year)
PCT OF
RESIDENCE
Asymptomatic
Symptomatic
AIDS
Southport & Formby
4 (50.0%)
1 (12.5%)
3 (37.5%)
South Sefton
2 (100.0%)
North Liverpool
AIDS Related
Death
Total
(100%)
8
2
1 (100.0%)
Central Liverpool
11 (52.4%)
9 (42.9%)
Knowsley
3 (75.0%)
1 (25.0%)
St Helens
1
1 (4.8%)
21
1 (100.0%)
1
4
Halton
4 (66.7%)
Warrington
3 (50.0%)
1 (16.7%)
Birkenhead & Wallasey
2 (66.7%)
1 (33.3%)
3
1 (100%)
1
Bebington & West Wirral
2 (33.3%)
6
2 (33.3%)
6
Ellesmere Port & Neston
2 (100%)
Cheshire West
2 (66.7%)
Central Cheshire
2 (50.0%)
1 (25.0%)
1 (25.0%)
Eastern Cheshire
2 (25.0%)
2 (25.0%)
3 (37.5%)
1 (12.5%)
1 (33.3%)
3
18 (24.7%)
14 (19.2%)
2 (2.7%)
73
Unknown
2 (66.7%)
Total
39 (53.4%)
2
1 (33.3%)
3
4
8
Individuals who reside in Cheshire & Merseyside, but whose primary care trust of residence is not known, are labelled as unknown.
New Cases 2001
41
Table 2.1d: Residential distribution of new HIV and AIDS cases by stage of HIV disease,
January-December 2001: Greater Manchester primary care trusts (New cases are defined
as individuals seen in the North West Region in 2001 but not between 1995 and 2000 and include new
cases who died during the year)
PCT OF
RESIDENCE
AIDS
AIDS Related
Death
1 (16.7%)
Ashton, Leigh & Wigan
3 (50.0%)
1 (16.7%)
1 (16.7%)
Bolton
9 (60.0%)
3 (20.0%)
3 (20.0%)
Unknown
Total
(100%)
6
15
Bury
1 (12.5%)
5 (62.5%)
1 (12.5%)
Rochdale
1 (25.0%)
1 (25.0%)
2 (50.0%)
1 (12.5%)
4
8
Salford
12 (52.2%)
9 (39.1%)
2 (8.7%)
23
Trafford North
2 (33.3%)
1 (16.7%)
3 (50.0%)
6
Trafford South
2 (66.7%)
North Manchester
29 (45.3%)
23 (35.9%)
10 (15.6%)
Central Manchester
37 (52.9%)
15 (21.4%)
15 (21.4%)
2 (2.9%)
South Manchester
5 (50.0%)
2 (20.0%)
2 (20.0%)
1 (10.0%)
10
Oldham
3 (50.0%)
1 (16.7%)
2 (33.3%)
Tameside & Glossop
4 (57.1%)
1 (14.3%)
7
Stockport
7 (38.9%)
Unknown
6 (100%)
Total
121 (49.2%)
1 (33.3%)
2 (28.6%)
6 (33.3%)
5 (27.8%)
67 (27.2%)
49 (19.9%)
3
2 (3.1%)
64
1 (1.4%)
70
6
18
6
5 (2.0%)
4 (1.6%)
246
Individuals who reside in Greater Manchester, but whose primary care trust of residence is not known, are labelled as unknown.
Table 2.2a shows the strategic health authority of residence and the route of transmission of new
HIV and AIDS cases presenting in the North West for treatment in 2001. Although the infection route
for nearly two-thirds (65%) of all HIV positive individuals seen in 2001 was attributed to sex between
men (section 3, table 3.1), this proportion was lower for new cases, where 51% were infected through
homosexual/bisexual sex. Tables 2.2b, c and d show route of infection of new HIV and AIDS cases
and the primary care trust of residence for each of the strategic health authorities. The two main gay
communities in the North West, Manchester (North Manchester and Central Manchester primary care
trusts) and Blackpool127, account for over two fifths (43%) of new cases exposed via homosexual sex
who reside within the region.
The proportion of new cases exposed to HIV via heterosexual transmission (38%) represents a large
increase when compared to previous years data (17% in 1997, 21% in 1998, 23% in 1999 and 27%
in 2000) and is also higher than the 24% of all cases exposed via this route of infection (section 3,
table 3.1). The proportion of heterosexually infected new cases is highest in Cheshire & Merseyside
(43%) and lowest in Cumbria & Lancashire (28%).
42
Table 2.2a: Residential distribution of new HIV and AIDS cases by infection route of HIV,
January-December 2001: strategic health authority (New cases are defined as individuals seen
in the North West Region in 2001 but not between 1995 and 2000 and include new cases who died
during the year)
INFECTION ROUTE
SHA OF
RESIDENCE
Homo/
Bisexual
Injecting
Drug Use
Heterosexual
Mother
to Child
Undetermined
Total
(100%)
50 (57.5%)
5 (5.7%)
24 (27.6%)
3 (3.4%)
5 (5.7%)
34 (46.6%)
3 (4.1%)
31 (42.5%)
1 (1.4%)
4 (5.5%)
73
Greater Manchester
128 (52.0%)
4 (1.6%)
95 (38.6%)
7 (2.8%)
12 (4.9%)
246
Eastern
1 (100%)
Isle of Man
1 (11.1%)
8 (88.9%)
1
London
2 (40.0%)
1 (20.0%)
Northern & Yorkshire
8 (53.3%)
7 (46.7%)
South East
1 (100%)
South West
1 (100%)
Trent
1 (33.3%)
9
2 (40.0%)
1
1 (33.3%)
1 (33.3%)
3
2 (66.7%)
1 (50.0%)
Not Known
3 (100%)
Total
231 (51.4%)
5
15
1
Wales
West Midlands
87
1 (33.3%)
1 (50.0%)
3
2
3
13 (2.9%)
169 (37.6%)
11 (2.4%)
25 (5.6%)
449
Individuals living outside of the North West Region are grouped by region, and the Isle of Man is organised as a distinct category. Men
who have had homosexual or bisexual exposure and who are also injecting drug users are included in the homo/bisexual category.
Table 2.2b: Residential distribution of new HIV and AIDS cases by infection route of HIV,
January-December 2001: Cumbria & Lancashire primary care trusts (New cases are defined
as individuals seen in the North West Region in 2001 but not between 1995 and 2000 and include new
cases who died during the year)
INFECTION ROUTE
PCT OF
RESIDENCE
Homo/
Bisexual
Carlisle & District
1 (100%)
Injecting
Drug Use
Heterosexual
Mother
to Child
Total
Undeter- (100%)
mined
1
West Cumbria
2 (100%)
2
Morecambe Bay
2 (18.2%)
9 (81.8%)
Blackpool
25 (83.3)
2 (6.7%)
1 (3.3%)
2 (50.0%)
1 (25.0%)
Fylde
1 (25.0%)
Wyre
5 (62.5%)
Preston
6 (46.2%)
1 (12.5%)
11
2 (6.7%)
4
2 (25.0%)
5 (38.5%)
4 (80.0%)
1 (20.0%)
2 (40.0%)
1 (20.0%)
1 (20.0%)
1 (33.3%)
1 (33.3%)
1 (33.3%)
1 (33.3%)
1 (33.3%)
West Lancashire
2 (100%)
Total
50 (57.5%)
30
8
1 (7.7%)
1 (7.7%)
13
1 (20.0%)
5
5
3
1 (33.3%)
3
5 (5.7%)
87
2
5 (5.7%)
24 (27.6%)
3 (3.4%)
Men who have had homosexual or bisexual exposure and who are also injecting drug users are included in the homo/bisexual category.
New Cases 2001
43
Table 2.2c: Residential distribution of new HIV and AIDS cases by infection route of HIV,
January-December 2001: Cheshire & Merseyside primary care trusts (New cases are
defined as individuals seen in the North West Region in 2001 but not between 1995 and 2000 and
include new cases who died during the year)
INFECTION ROUTE
PCT OF
RESIDENCE
Homo/
Bisexual
Injecting
Drug Use
Heterosexual
Mother
to Child
Total
Undeter- (100%)
mined
Southport & Formby
3 (37.5%)
3 (37.5%)
South Sefton
1 (50.0%)
1 (50.0%)
2
13 (61.9%)
21
North Liverpool
1 (100%)
Central Liverpool
7 (33.3%)
Knowsley
3 (75.0%)
2 (25.0%)
8
1
1 (4.8%)
St Helens
1 (25.0%)
4
1 (100%)
1
Halton
4 (66.7%)
2 (33.3%)
6
1 (16.7%)
6
Warrington
5 (83.3%)
3 (100%)
1 (100%)
3
1
1 (50.0%)
1 (50.0%)
2
Cheshire West
2 (66.7%)
1 (33.3%)
3
Central Cheshire
1 (25.0%)
1 (25.0%)
2 (50.0%)
4
Eastern Cheshire
2 (25.0%)
1 (12.5%)
4 (50.0%)
1 (12.5%)
8
Unknown
1 (33.3%)
1 (33.3%)
1 (33.3%)
3
Total
34 (46.6%)
4 (5.5%)
73
3 (4.1%)
31 (42.5%)
1 (1.4%)
44
Table 2.2d: Residential distribution of new HIV and AIDS cases by infection route of HIV,
January-December 2001: Greater Manchester primary care trusts (New cases are defined
as individuals seen in the North West Region in 2001 but not between 1995 and 2000 and include
new cases who died during the year)
INFECTION ROUTE
PCT OF
RESIDENCE
Homo/
Bisexual
Injecting
Drug Use
Heterosexual
Mother
to Child
Total
Undeter- (100%)
mined
2 (33.3%)
3 (50.0%)
Bolton
8 (53.3%)
7 (46.7%)
Bury
4 (50.0%)
3 (37.5%)
Rochdale
2 (50.0%)
Salford
15 (65.2%)
8 (34.8%)
23
Trafford North
4 (66.7%)
2 (33.3%)
6
Trafford South
2 (66.7%)
1 (33.3%)
3
North Manchester
35 (54.7%)
1 (1.6%)
25 (39.1%)
Central Manchester
31 (44.3%)
1 (1.4%)
30 (42.9%)
South Manchester
6 (60.0%)
Oldham
2 (33.3%)
Tameside & Glossop
4 (57.1%)
3 (42.9%)
Stockport
9 (50.0%)
6 (33.3%)
Unknown
4 (66.7%)
1 (16.7%)
Total
128 (52.0%)
1 (25.0%)
1 (16.7%)
15
1 (12.5%)
1 (25.0%)
5 (7.1%)
4 (1.6%)
3 (4.7%)
64
3 (4.3%)
70
10
2 (33.3%)
95 (38.6%)
8
4
4 (40.0%)
1 (16.7%)
6
1 (16.7%)
6
2 (11.1%)
18
1 (16.7%)
6
12 (4.9%)
246
7
1 (5.6%)
7 (2.8%)
New Cases 2001
45
Table 2.3: Residential distribution of new HIV and AIDS cases by age category,
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60+
0-14
AGE GROUP
SHA OF
RESIDENCE
3
2
5
12
19
18
12
8
6
1
1
(3.4%) (2.3%) (5.7%) (13.8%) (21.8%) (20.7%) (13.8%) (9.2%) (6.9%) (1.1%) (1.1%)
Greater Manchester
1
1
4
16
17
9
9
5
4
3
7
2
20
50
63
42
30
17
11
4
1
(100%)
5
Isle of Man
4
1
2
1
1
1
4
6
2
(6.7%) (26.7%) (40.0%) (13.3%)
1
1
(6.7%)
(6.7%)
1
South East
1
1
(100%)
Trent
2
1
(66.7%)
(33.3%)
2
Wales
3
1
3
(66.7%) (33.3%)
West Midlands
2
Unknown
1
1
(50.0%)
(50.0%)
1
5
32
84
2
3
(66.7%) (33.3%)
11
15
1
(100%)
South West
1
5
(20.0%) (40.0%) (20.0%) (20.0%)
73
9
(55.6%) (44.4%)
London
87
246
(2.8%) (0.8%) (8.1%) (20.3%) (25.6%) (17.1%) (12.2%) (6.9%) (4.5%) (1.6%)
Eastern
Total
4
(1.4%) (1.4%) (5.5%) (21.9%) (23.3%) (12.3%) (12.3%) (6.8%) (5.5%) (4.1%) (5.5%)
Total
(100%)
106
84
58
31
22
8
8
(2.4%) (1.1%) (7.1%) (18.7%) (23.6%) (18.7%) (12.9%) (6.9%) (4.9%) (1.8%) (1.8%)
449
Age ranges refer to the age of individuals at end of December 2001, or at death. For a breakdown of age category by primary care
trust, please see the North West Public Health Observatory website: www.nwpho.org.uk/hiv2001/table2-3.htm
Table 2.3 illustrates the residential distribution of new HIV and AIDS cases presenting in the North
West for treatment in 2001, categorised by age group. Individuals aged 30-34 represent the largest
group of new cases accessing treatment and care (24%). As would be expected, new cases tend to be
younger (median age of 35 years, with 90% aged between 22 and 54 years) than the age distribution
of all cases (median age 37 years, 90% aged between 24 and 56 years). Thus, individuals under the
age of 25 represent a larger proportion of new cases (11%) than all cases (6%: section 3, table 3.6),
demonstrating the continuing need to encourage young people at risk of HIV exposure to access
services. Individuals aged 50 years or older represent 8% of all new cases seen during 2001,
the same proportion as 2000.
46
Table 2.4: Residential distribution of new HIV and AIDS cases by sex, JanuaryDecember 2001 (New cases are defined as individuals seen in the North West Region in 2001
but not between 1995 and 2000 and include new cases who died during the year)
SEX
SHA OF
RESIDENCE
Total (100%)
Male
Female
71 (81.6%)
16 (18.4%)
87
59 (80.8%)
14 (19.2%)
73
Greater Manchester
185 (75.2%)
61 (24.8%)
246
Eastern
1 (100%)
Isle of Man
6 (66.7%)
3 (33.3%)
9
London
4 (80.0%)
1 (20.0%)
5
8 (53.3%)
7 (46.7%)
15
South East
1 (100%)
1
South West
1 (100%)
1
Trent
2 (66.7%)
1 (33.3%)
3
2 (66.7%)
3
1
Wales
1 (33.3%)
West Midlands
2 (100%)
2
Not Known
3 (100%)
3
Total
344 (76.6%)
105 (23.4%)
449
For a breakdown of sex by primary care trust, please see the North West Public Health Observatory website:
www.nwpho.org.uk/hiv2001/table2-4.htm
West for treatment in 2001, categorised by sex. As in previous years, the majority of new cases in
2001 were male (77%). This is largely due to the high proportion of homosexual/bisexual sex between
men as a method of exposure to HIV. Although more men were newly infected in 2001 compared to
2000, the proportion of individuals who are male has decreased from 83%. Compared to Greater
Manchester, Cumbria & Lancashire and Cheshire & Merseyside have a higher proportion of new
cases who are men (82% and 81% respectively compared to 75%).
The number of female new cases has nearly doubled from 57 in 2000 to 105 in 2001, and the
proportion of new HIV cases that are female has increased from 17% to 23%. This may have a knockon effect on the number of mother to child infections, especially in ethnic minority communities since
nearly three quarters (73%) of females are self-defined as being from an ethnic minority (table 2.8).
Table 2.5: Infection route of new HIV and AIDS cases by sex, January-December 2001
(New cases are defined as individuals seen in the North West Region in 2001 but not between 1995
and 2000 and include new cases who died during the year)
INFECTION ROUTE
Total
(100%)
SEX
Homo/
Bisexual
Injecting
Drug Use
Heterosexual
Mother
to Child
Undetermined
Male
231 (67.2%)
10 (2.9%)
75 (21.8%)
6 (1.7%)
22 (6.4%)
3 (2.9%)
94 (89.5%)
5 (4.8%)
3 (2.9%)
105
13 (2.9%)
169 (37.6%)
11 (2.4%)
25 (5.6%)
449
Female
Total
231 (51.4%)
344
Men who have had homo/bisexual exposure and who are also injecting drug users are included in the homo/bisexual category.
New Cases 2001
47
Table 2.5 illustrates the route of transmission of new HIV and AIDS cases presenting in the North
West Region for treatment in 2001, categorised by sex. Although sex between men remains the most
common route of infection for new HIV cases, the proportion of individuals infected by this route has
declined by 10% from 56% in 2000 to 51% in 2001, while the proportion of heterosexually acquired
HIV has increased by 41% (from 27% in 2000 to 38% in 2001). The predominant method of exposure
to HIV amongst women continues to be heterosexual sex (90%). Of those HIV positive individuals
whose route of infection has been identified, 40% of new cases presenting in the North West had
their infection attributed to heterosexual sex. This compares to 24% of all cases seen during 2001
(section 3, table 3.5) and 30% of new cases seen during 2000, reflecting the growing issue of
heterosexual transmission of HIV in the North West and in the United Kingdom as a whole
(figure 1.6). As in previous years, the majority of new individuals infected with HIV via injecting
drug use were male (77%).
Table 2.6: Residential distribution of new HIV and AIDS cases by ethnic group,
53 (72.6%)
2 (2.7%)
13 (17.8%)
Greater Manchester
153 (62.2%)
1 (0.4%)
72 (29.3%)
Eastern
1 (100.0%)
Isle of Man
8 (88.9%)
1 (11.1%)
London
3 (60.0%)
1 (20.0%)
11 (73.3%)
3 (20.0%)
South East
1 (100.0%)
Trent
3 (100.0%)
Wales
2 (66.7%)
West Midlands
2 (100.0%)
Total
4 (1.6%)
1 (1.1%)
2 (2.3%)
2 (2.3%)
87
3 (4.1%)
1 (1.4%)
1 (1.4%)
73
7 (2.8%)
6 (2.4%)
246
1
9
1 (20.0%)
1 (6.7%)
5
15
1
1
3
1 (33.3%)
3
2
2 (66.7%)
310(69.0%) 4 (0.9%)
Total
(100%)
1 (0.4%)
1 (100.0%)
South West
Unknown
2 (0.8%)
Unknown
10 (11.5%)
Other Asian
/Oriental
1 (1.1%)
Other/
Mixed
Black
African
71 (81.6%)
Indian/
Pakistani/
Bangladeshi
Black
Caribbean
Black
Other
SHA OF
RESIDENCE
White
ETHNICITY
1 (33.3%)
102(22.7%) 2 (0.4%)
5 (1.1%)
3
6 (1.3%)
10 (2.2%)
10 (2.2%)
449
For a breakdown of ethnicity by primary care trust, please see the North West Public Health Observatory website:
West for treatment in 2001, categorised by ethnic group. Ethnic group classifications are adapted from
the 1991 Census Questionnaire and are those used by the Public Health Laboratory Service AIDS and
STD Centre, for the Survey Of Prevalent Diagnosed HIV Infections (SOPHID).
48
The majority of new cases in 2001 whose ethnicity was known were self-defined as white (71%), a
lower figure than the corresponding data for all cases (85%) (section 3, table 3.7). Of those HIV
positive individuals whose ethnicity was classified, 29% are self-defined as being from an ethnic
minority, compared to 20% in 2000 and 15% in 1999. This indicates a substantial over representation
of new HIV cases within black and ethnic minority communities, when compared to their overall
proportion within the North West population (3.8%)87. Thus, the incidence of HIV is over ten times
higher in black and ethnic minority groups than in the white population in the North West. However,
there are significant variations in the proportion of people from black and ethnic minority populations
across the region, ranging from 16% in Cumbria & Lancashire to 36% in Greater Manchester.
The proportion of new cases who are from black and ethnic minority communities (29%) is higher than
the 15% identified within all cases, in particular those self-defined as black African (23% for new cases,
10% for all cases) (section 3, table 3.7). This illustrates the change in the ethnic distribution of HIV
and AIDS cases and the need for specialist services such as The Black Health Agency (BHA) and
specialist projects within the voluntary sector to provide care and support for communities which
have already been identified as having shorter life expectancies, together with poorer physical
and mental health87.
Table 2.7: Ethnic distribution of new HIV and AIDS cases by infection route of HIV,
INFECTION ROUTE
ETHNICITY
Homo/
Bisexual
Injecting
Drug Use
Heterosexual
Mother
to Child
Undetermined
White
216 (69.7%)
12 (3.9%)
61 (19.7%)
2 (0.6%)
19 (6.1%)
Black Caribbean
1 (25.0%)
3 (75.0%)
Black African
1 (1.0%)
92 (90.2%)
Black Other
1 (50.0%)
1 (50.0%)
Indian / Pakistani /
Bangladeshi
3 (60.0%)
1 (20.0%)
Other / Mixed
3 (50.0%)
2 (33.3%)
Total
(100%)
310
4
8 (7.8%)
1 (1.0%)
102
2
1 (20.0%)
1 (16.7%)
5
6
Other Asian / Oriental
2 (20.0%)
6 (60.0%)
2 (20.0%)
10
Unknown
4 (40.0%)
1 (10.0%)
3 (30.0%)
2 (20.0%)
10
Total
231 (51.4%)
13 (2.9%)
169 (37.6%)
25 (5.6%)
449
11 (2.4%)
Table 2.7 illustrates the ethnic group and HIV exposure category of new HIV and AIDS cases
presenting in the North West for treatment in 2001. Whilst sex between men remains the predominant
mode of HIV transmission amongst new cases, this is not the case for those self-defined as being from
an ethnic minority group. Of the 129 individuals from these communities, homosexual sex accounted
for only 9% of new cases, while heterosexual sex accounted for 81%. The proportion infected by
heterosexual sex is even higher in black African HIV positive individuals (90%), with only one new
case of homosexually acquired HIV in 2001. This year a new category, ‘Other Asian/Oriental’,
has been added, and accounts for ten new cases. A decisive factor influencing the dissimilar
distribution of infection route across ethnicity of new cases of HIV and AIDS may be the role
of exposure abroad (table 2.10).
New Cases 2001
49
Table 2.8: Ethnic distribution of new HIV and AIDS cases by sex, January-December 2001
(New cases are defined as individuals seen in the North West Region in 2001 but not between 1995
and 2000 and include new cases who died during the year)
Other Asian
/Oriental
Unknown
310
Other/
Mixed
Total (100.0%)
Indian/
Pakistani/
Bangladeshi
28 (9.0%)
Black
Other
282 (91.0%)
Black
African
Male
Female
SEX
Black
Caribbean
White
ETHNICITY
4 (100.0%)
35 (34.3%)
1 (50.0%)
4 (80.0%)
5 (83.3%)
6 (60.0%)
7 (70.0%)
344 (76.6%)
67 (65.7%)
1 (50.0%)
1 (20.0%)
1 (16.7%)
4 (40.0%)
3 (30.0%)
105 (23.4%)
102
2
5
6
10
10
449
4
Total
Table 2.8 illustrates the ethnic group and sex of new HIV and AIDS cases presenting in the North
West for treatment in 2001. As in previous years the vast majority of new HIV and AIDS cases are male
(77%) with 82% of these being self-defined as white. The majority of women seen in the region for the
first time in 2001 are self-defined as being from an ethnic minority (70%), a higher proportion than the
equivalent figure from last year (54%). Black Africans account for 64% of all female new cases.
Whilst in the white population the gender distribution is highly biased towards males (91%), 57% of
the new black and ethnic minority cases are female. This is predominately due to the lower proportion
of homosexual exposure and higher levels of heterosexual exposure to HIV within black and ethnic
minorities (table 2.7).
Table 2.9: Ethnic distribution of new HIV and AIDS cases by clinical stage of HIV
disease January-December 2001 (New cases are defined as individuals seen in the North West
Region in 2001 but not between 1995 and 2000 and include new cases who died during the year)
ETHNICITY
AIDS
AIDS
Related Death
3 (1.0%)
White
162 (52.3%)
79 (25.5%)
54 (17.4%)
Black Caribbean
2 (50.0%)
1 (25.0%)
1 (25.0%)
Black African
44 (43.1%)
25 (24.5%)
28 (27.5%)
Black Other
2 (100.0%)
Indian/Pakistani/
Bangladesh
4 (80.0%)
Other/Mixed
4 (66.7%)
Total
(100%)
Unknown
12 (3.9%)
310
4
4 (3.9%)
1 (1.0%)
102
2
1 (20.0%)
5
2 (33.3%)
6
Other Asian/Oriental
3 (30.0%)
Unknown
5 (50.0%)
4 (40.0%)
1 (10.0%)
6 (60.0%)
Total
226 (50.3%)
111 (24.7%)
91 (20.3%)
1 (10.0%)
10
10
8 (1.8%)
13 (2.9%)
449
Table 2.9 illustrates the ethnic group and clinical stage of new HIV and AIDS cases presenting in the
North West for treatment in 2001. The figures refer to the clinical condition of individuals when last
seen in the year 2001; individuals who died from AIDS related illnesses are presented in a separate
category to other AIDS cases.
50
Overall, 50% of new HIV and AIDS cases presented while still asymptomatic, 20% were categorised
as AIDS and 2% died during the year. However, there remain considerable variations between ethnic
groups. Whereas 28% of new cases from black and ethnic minority communities presented with an
AIDS defining illness, only 17% of white new cases presented at this stage. This late presentation at
treatment centres shows the need to encourage ethnic minorities to access care at an early stage of
their disease, receive therapy and therefore prolong their life expectancy. The reason for the late
diagnosis of individuals from black and ethnic minority communities may be that in the developed world
marginalized groups are less likely to take HIV tests14. It may also be the case that new individuals
have moved in to the region from elsewhere in the UK or from abroad whilst already at a later stage
of their disease86.
Figure 2.2: The role of contact abroad in exposure to HIV of new HIV and AIDS cases
by infection route, January-December 2001 (New cases are defined as individuals seen in
the North West Region in 2001 but not between 1995 and 2000 and include new cases who died
during the year)
Homo/Bisexual
Infection Route
Injecting Drug Use
Heterosexual
Exposed Abroad
Mother to Child
Yes
No
Undetermined
Undertermined
0
20
40
60
80
100
120
140
160
180
200
INFECTION ROUTE
EXPOSED
ABROAD
Homo/
Bisexual
Injecting
Drug Use
Heterosexual
Mother
to Child
Undetermined
Total
(100%)
Yes
22 (13.8%)
5 (3.1%)
117 (73.6%)
6 (3.8%)
9 (5.7%)
159
No
173 (77.2%)
5 (2.2%)
39 (17.4%)
3 (1.3%)
4 (1.8%)
224
Unknown
36 (54.5%)
3 (4.5%)
13 (19.7%)
2 (3.0%)
12 (18.2%)
66
Total UK
231 (51.4%)
13 (2.9%)
169 (37.6%)
11 (2.4%)
25 (5.6%)
449
New Cases 2001
51
Figure 2.2 illustrates exposure abroad and the route of infection of new HIV and AIDS cases
presenting in the North West for treatment in 2001. Over a third (35%) of all new cases of HIV and
AIDS were reported to have been contracted outside the UK, compared to 27% in 1999 and 33% in
2000. However, it is difficult to interpret trends in infection abroad, because the proportion of cases
where infection abroad is unknown has decreased considerably, from 41% in 1999 to 19% in 2000 and
15% in 2001. As in previous years heterosexual sex continues to be the major method of exposure to
HIV in those infected abroad with three quarters of those individuals infected via this route. Of those
infected abroad, the proportion who were infected via homosexual sex has decreased in 2001 to 14%,
in a reversal of the trend for the last few years (28% in 1998, 30% in 1999 and 36% in 2000). For those
new individuals reported to have been infected with HIV in the UK, sex between men is the
predominant mode of exposure (77%).
Figure 2.3 shows the global region and country of HIV transmission for new cases acquired outside
the UK presenting in the North West for treatment in 2001. Nearly three quarters of all HIV infections
contracted abroad were acquired in Africa, with 8% in South & South East Asia and 7% in Europe.
Of the 159 new cases who probably acquired their infection abroad, the country of probable exposure
is available for 146 individuals (92%). Unlike last year, where the USA accounted for the largest
number of HIV infections, this year the situation is dominated by the African countries Zimbabwe
(16%), South Africa (13%) and the Democratic Republic of Congo (8%). Exposure in Africa is spread
across 22 different countries, 21 within sub-Saharan Africa, illustrating the impact of the current
epidemic in Africa12 and its influence on the situation in the UK.
52
Figure 2.3: Global region and country of new HIV and AIDS cases who probably
acquired their infection outside the UK, January-December 2001 (New cases are
Total : 159
Europe
11 (6.9%)
North America
5 (3.1%)
Middle East
1 (0.6%)
Caribbean
1 (0.6%)
Africa
117 (73.6%)
South &
South-East Asia
12 (7.5%)
Latin America
2 (1.3%)
Australia &
New Zealand
4 (2.5%)
Unknown 6 (3.8%)
Africa
117 (73.6%)
Tanzania
2 (1.3%)
Latin America
2 (1.3%)
Angola
2 (1.3%)
Uganda
3 (1.9%)
Brazil
1 (0.6%)
Botswana
4 (2.5%)
Zambia
5 (3.1%)
Peru
1 (0.6%)
Burundi
2 (1.3%)
Zimbabwe
26 (16.4%)
Middle East
1 (0.6%)
Cameroon
1 (0.6%)
Unknown
6 (3.8%)
Dem. Rep. of Congo
13 (8.2%)
Australia &
Ethiopia
3 (1.9%)
New Zealand
Canada
1 (0.6%)
4 (2.5%)
Iran
1 (0.6%)
North America
5 (3.1%)
4 (2.5%)
Gabon
1 (0.6%)
Australia
4 (2.5%)
USA
Gambia
1 (0.6%)
Caribbean
1 (0.6%)
South &
Ghana
1 (0.6%)
Unknown
1 (0.6%)
South East Asia
Guinea
1 (0.6%)
Europe
11 (6.9%)
Pakistan
3 (1.9%)
12 (7.5%)
Kenya
7 (4.4%)
Cyprus
1 (0.6%)
Philippines
2 (1.3%)
Malawi
4 (2.5%)
Eire
1 (0.6%)
Singapore
1 (0.6%)
Nigeria
3 (1.9%)
France
2 (1.3%)
Thailand
6 (3.8%)
Rwanda
2 (1.3%)
Germany
1 (0.6%)
Unknown
6 (3.8%)
Sierra Leone
1 (0.6%)
Gran Canaria
1 (0.6%)
Total
159 (100.0%)
1 (0.6%)
Somalia
6 (3.8%)
Portugal
South Africa
20 (12.6%)
Slovakia
1 (0.6%)
Sudan
3 (1.9%)
Spain
3 (1.9%)
New Cases 2001
53
Figure 2.4: Global region and infection route of HIV of new cases who probably
acquired their infection outside the UK, January-December 2001 (New cases are
Africa
Australia &
New Zealand
Global Region
Caribbean
Europe
Infection Route
Latin America
Homo/Bisexual
Injecting Drug Use
Middle East
Heterosexual
North America
Blood/Tissue
Mother to Child
South &
South East Asia
Undetermined
Unknown
0
10
20
30
40
50
60
70
80
90
100 110 120
INFECTION ROUTE
GLOBAL
REGION
Homo/
Bisexual
Africa
Australia & New Zealand
Injecting
Drug Use
Heterosexual
Mother
to Child
Undetermined
Total
(100%)
1 (0.9%)
106 (90.6%)
6 (5.1%)
4 (3.4%)
117
4 (100.0%)
4
Caribbean
1 (100.0%)
Europe
6 (54.6%)
3 (27.3%)
Latin America
1 (50.0%)
1 (50.0%)
1
1 (9.1%)
1 (9.1%)
2
Middle East
1 (100.0%)
North America
5 (100.0%)
South & South East Asia
2 (16.7%)
Unknown
4 (66.7%)
Total
22 (13.8%)
11
1
5
8 (66.7%)
2 (16.7%)
1 (16.7%)
5 (3.1%)
117 (73.6%)
6 (3.8%)
12
1 (16.7%)
6
9 (5.7%)
159
54
Figure 2.4 shows the global region of HIV transmission by infection route of HIV for new HIV and
AIDS cases acquired outside the UK who presented in the North West for treatment in 2001. The vast
majority (91%) of individuals with heterosexually acquired HIV whose infections were probably
contracted abroad were acquired in Africa; a 17% increase on the proportion of new cases infected
in Africa in 2000. Heterosexually acquired HIV in Africa now accounts for 63% of all new cases
attributed to this mode of infection (table 2.2), up from 48% last year. Heterosexual exposure in
Africa is spread across 21 different countries, all within sub-Saharan Africa, reflecting the extent
of the epidemic in that continent 12.
Europe accounted for the largest number of new cases acquired via homosexual sex (27%), followed
by North America (23%). This could reflect the reported tendency of gay men to take risks while on
holiday 128. The predominant mode of HIV transmission in many European countries is drug use 12,53,64.
Although the numbers of new HIV infections contracted abroad due to injecting drug use remain
relatively low (five individuals), the majority of them have been attributed to countries within Europe
(one in each of Spain, Portugal and Eire).
Table 2.10: The role of contact abroad in exposure to HIV of new HIV and AIDS cases by
ethnicity, January-December 2001 (New cases are defined as individuals seen in the North West
No
209 (67.4%)
Unknown
54 (17.4%)
1 (25.0%)
3 (2.9%)
4 (3.9%)
Total (100%)
310
4
102
2 (100.0%)
Unknown
95 (93.1%)
Other Asian
/Oriental
3 (75.0%)
Other/
Mixed
Black
African
47 (15.2%)
Indian/
Pakistani/
Bangladeshi
Black
Caribbean
Yes
HIV
EXPOSURE
ABROAD
Black
Other
White
ETHNICITY
1 (20.0%)
3 (50.0%)
8 (80.0%)
2 (20.0%)
159 (35.4%)
4 (80.0%)
3 (50.0%)
1 (10.0%)
2 (20.0%)
224 (49.9%)
1 (10.0%)
6 (60.0%)
66 (14.7%)
10
10
449
2
5
6
Total
Table 2.10 shows exposure to HIV abroad by ethnic group of new HIV and AIDS cases who
presented in the North West for treatment in 2001. Of those self-defined as white, 15% were reported
as having probably been infected with HIV whilst abroad. This is not the case for those from black and
ethnic communities where 85% are reported as being exposed to HIV whilst abroad, with this figure
rising to 93% amongst individuals self-defined as black African. The role of contact abroad to HIV has
not been identified in 17% of white HIV positive individuals accessing treatment in 2001, compared to
5% for black and ethnic minorities. Although this may represent individuals where the significance of
potential exposure abroad is ambiguous, it may also reflect a reluctance to ascertain whether white
HIV positive individuals had been exposed to HIV abroad and to presume ethnic minorities have been
infected outside the UK129. The proportion of white individuals for whom exposure abroad is known has
improved from 57% in 1999 to 83% in 2001, allowing more confidence to be placed on this aspect
of HIV epidemiology of the North West.
New Cases 2001
55
Table 2.11: Stage of HIV disease of new HIV and AIDS cases by level of antiretrovival
therapy, January-December 2001 (New cases are defined as individuals seen in the North West
LEVEL OF ANTIRETROVIRAL THERAPY
STAGE OF
HIV DISEASE
Total
(100%)
No ART
Dual
Therapy
Triple
Therapy
Quad (or more)
Therapy
Asymptomatic
161 (71.2%)
1 (0.4%)
60 (26.5%)
4 (1.8%)
226
Symptomatic
61 (55.0%)
44 (39.6%)
6 (5.4%)
111
AIDS
26 (28.6%)
61 (67.0%)
4 (4.4%)
91
AIDS Related Death
4 (50.0)
4 (50.0)
8
Unknown
12 (92.3)
1 (7.7%)
13
Total
264 (58.8%)
1 (0.2%)
170 (37.9%)
14 (3.1%)
449
Table 2.11 refers to the clinical condition of individuals when last seen in the year 2001; individuals
who died from AIDS related illnesses are presented in a separate category to other AIDS cases.
Individuals are categorised by the highest level of combination therapy they received from any
treatment centre in the North West, on their most recent presentation during 2001.
As illustrated, 41% of new HIV and AIDS cases presenting in the North West received triple or more
combination therapy when last seen during 2001. The number of new individuals receiving quadruple
or more therapy has decreased from 21 (6%) in 2000 to 14 (3%). While antiretroviral therapy was not
prescribed for 59% of new cases, fewer than 1% of new cases were prescribed dual therapy and no
new cases of HIV and AIDS were prescribed mono therapy. This low level of mono and dual therapy
is consistent with the current British HIV Association (BHIVA) guidelines on the treatment of HIV
disease, which recommends the use of a triple or more regime130.
The majority (71%) of new cases categorised as AIDS received triple or more combination therapy,
while 45% of those classed as symptomatic received this level of therapy. The data also illustrate
that 71% of new cases categorised as asymptomatic were not receiving any antiretroviral therapy
at the end of 2001. The latest BHIVA guidelines advocate the initiation of therapy in the following
circumstances: immediately, if HIV infection is detected within first six months of seroconversion;
if the CD4 count is falling rapidly; when the CD4 count falls below 200; or in the event of HIV related
symptoms130. There are, therefore, implications for a continued increase in demand and supply of
combination antiretroviral therapy.
Figure 2.5 illustrates the distribution of new HIV and AIDS cases between treatment centres located
in the North West. The treatment centre with the largest number of new cases in 2001 was the
Infectious Disease Unit at North Manchester General Hospital (NMG), with 33% of new cases.
As in previous years, large numbers of new cases were also seen at Blackpool Victoria Hospital
Department of Genito-Urinary Medicine (BLAG), Manchester Royal Infirmary Department of GenitoUrinary Medicine (MRIG) and Royal Liverpool University Hospital Department of Genito-Urinary
Medicine (RLG). Several treatment centres have seen increases in the number of new cases seen in
2001 compared to 2000, notably the Royal Bolton Hospital (BOLG) (460% increase from five to 28).
The Royal Liverpool University Hospital (RLG) has also seen a big increase. This is due to their having
taken over HIV care from the University Hospital Aintree (FAZ).
Although the larger hospitals see the most new cases it is the smaller ones that have the higher
proportion of all cases that are new (For example, Booth Hall Children’s Hospital 100%, Noble’s Isle
of Mann Hospital 83%, Tameside General Hospital 67%; see chapter 3, table 3.15). This illustrates
the importance these smaller treatment centres have in attracting individuals who think they have
contracted HIV or other sexually transmitted diseases.
56
Figure 2.5: Distribution of new HIV and AIDS cases by treatment centre,
1
AHC
5
APH
2
ARM
36
BLAG
1
BLKG
28
BOLG
3
BOOT
5
7
7
BURG
BURY
CHR
2
CUM
8
FAZ
4
FGH
1
LEI
4
6
LEII
Treatment Centre
MAC
15
16
MGP
MRI
49
MRIG
150
NMG
31
NMGG
5
NOB
1
OLDG
19
PG
1
PP
27
QSC
49
RLG
5
5
6
RLI
ROCG
SALG
2
SHH
9
SPG
16
STP
2
2
2
1
1
TAMG
TRAG
WAR
WGH
WIGG
18
WITG
1
WORK
0
10
20
30
40
50
60
70
80
90
100
110
120
130
140
150
For a definition of the abbreviated treatment centres please refer to the glossary at the back of the report. Numbers may not be
totalled as individuals may attend more than one treatment centre.
New Cases 2001
57
Figure 2.6: Population prevalence of new HIV and AIDS cases by primary care trust,
January-December 2001 (New cases are defined as individuals seen in the North West Region in
2001 but not between 1995 and 2000 and include new cases who died during the year)
N
Per 100,000
Population
<1
1 to <2
2 to <3
3 to <5
5 to <10
=>10
Figure 2.6 illustrates the population
prevalence of new HIV and AIDS cases
in the North West who attended statutory
centres within the region during 2001.
The population sizes for each primary care
trust used in the prevalence calculations
are those published by the NHS North
West Regional Office 131. For a description
of the residential distribution of new
HIV and AIDS cases in the North
West of England see tables 2.1 and 2.2.
58
3
All Cases 2001
During 2001, a total of 1,964 individuals
living with HIV or AIDS accessed
treatment and care from statutory
treatment centres in the North West.
When those individuals reported by
centres in the new part of the North West
are excluded (34), this is an 18% increase
on last year’s total of 1,632 individuals,
and is the third year running that an
increase in the size of the HIV positive
population of this magnitude has been
recorded. Overall, since this level of
monitoring began in the North West
in 1995, the number of people with HIV
has more than doubled (figure 1.12).
The aim of this section is to provide
information on the demographics and
characteristics of these 1,964 individuals
and, where appropriate, references are
made to corresponding data from previous
North West reports3-7.
To reflect the new geography of the
North West Region, breakdowns are given
by strategic health authorities and primary
care trusts (PCTs). PCTs have been
allocated on the basis of postcode data,
and reflect the boundaries provided by
the North West Public Health Observatory
as of May 2002. It is not possible to
present all analyses by PCT; further
primary care trust data are available from
the North West Public Health Observatory
website (www.nwpho.org.uk/hiv2001).
3. ALL CASES 2001
Figure 3.1: Age distribution of total HIV and AIDS cases by stage of HIV disease,
January-December 2001 (All cases seen during 2001 including those who died during the year)
Asymptomatic
500
Symptomatic
AIDS
400
AIDS Related Death
Death Unrelated
to AIDS
300
Unknown
200
100
0
0-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59
60+
Age Group
AGE GROUP
AIDS
Related
Death
Death
unrelated Unknown
to AIDS
Symptomatic
AIDS
0-14
9 (27.3%)
11 (33.3%)
11 (33.3%)
15-19
7 (77.8%)
1 (11.1%)
1 (11.1%)
20-24
56 (75.7%)
12 (16.2%)
5 (6.8%)
1 (1.4%)
74
25-29
124 (51.9%)
79 (33.1%)
34 (14.2%)
2 (0.8%)
239
30-34
148 (36.9%)
151 (37.7%)
94 (23.4%)
5 (1.2%)
3 (0.7%)
401
35-39
115 (24.7%)
207 (44.5%)
131 (28.2%)
9 (1.9%)
2 (0.4%)
1 (0.2%)
465
40-44
72 (22.5%)
151 (47.2%)
89 (27.8%)
5 (1.6%)
1 (0.3%)
2 (0.6%)
320
45-49
29 (14.8%)
82 (41.8%)
80 (40.8%)
3 (1.5%)
1 (0.5%)
1 (0.5%)
196
50-54
26 (22.2%)
41 (35.0%)
44 (37.6%)
4 (3.4%)
1 (0.9%)
1 (0.9%)
117
55-59
11 (20.4%)
20 (37.0%)
19 (35.2%)
3 (5.6%)
1 (1.9%)
54
60+
9 (16.1%)
19 (33.9%)
26 (46.4%)
1 (1.8%)
1 (1.8%)
56
14 (0.7%)
1964
Total
606 (30.9%) 774 (39.4%) 534 (27.2%)
1 (3.0%)
1 (3.0%)
33
9
30 (1.5%)
6 (0.3%)
Age ranges refer to the age of individuals at end of December 2001, or at death.
60
Total
(100%)
Asymptomatic
Figure 3.1 shows a breakdown of the age and clinical stage of disease of HIV positive individuals
attending for treatment and care in 2001. The figures refer to the clinical condition of individuals when
last seen in 2001; individuals who died are presented in separate categories. The age distribution
remained concentrated in the 30-39 year age range, accounting for nearly half of all cases (44%) and,
as would be expected, shows little deviation from previous years. The entire population of HIV positive
individuals in treatment was older than the cases that were new to treatment in 2001. Whereas the
most common age of all cases is 35-39 years (24%), new cases were most commonly aged between
30 and 34 years (24%, see section 2, figure 2.1). New cases were more likely to be under 25 years
(11%) when compared all cases (6%).
The proportion of HIV positive people in the older age groups (50 years and over) continues to increase,
from 7% in 1996 to 12% in 2001. This ageing cohort effect is likely to be due to the effectiveness of
anti-HIV treatment and subsequent improved prognosis of many HIV positive individuals. However,
those aged 55 years or over are more likely to have died during 2001 from an AIDS-related condition
(4%) than are those younger than 55 years, of whom only 1% died. Those in the age range 15 to 24
years were the most likely to be asymptomatic for HIV infection.
The proportion of AIDS related deaths has decreased from 9% in 1996 to 4% in 1997 to under 2%
in 2001. Of the 36 individuals who died in 2001, 30 (83%) died of an AIDS related condition and
six (17%) died of other causes and had been classed as asymptomatic.
Table 3.1: Age distribution of total HIV and AIDS cases by infection route of HIV,
INFECTION ROUTE
AGE GROUP
Homo/
Bisexual
Injecting
Drug Use
Heterosexual
Blood/
Tissue
2 (22.2%)
2 (22.2%)
0-14
15-19
4 (44.4%)
Mother
to Child
Undetermined
Total
(100%)
33 (100%)
33
1 (11.1%)
9
20-24
52 (70.3%)
2 (2.7%)
18 (24.3%)
2 (2.7%)
25-29
158 (66.1%)
6 (2.5%)
67 (28.0%)
6 (2.5%)
2 (0.8%)
239
30-34
257 (64.1%)
14 (3.5%)
107 (26.7%)
15 (3.7%)
8 (2.0%)
401
35-39
313 (67.3%)
27 (5.8%)
103 (22.2%)
13 (2.8%)
9 (1.9%)
465
40-44
231 (72.2%)
18 (5.6%)
54 (16.9%)
11 (3.4%)
6 (1.9%)
320
45-49
133 (67.9%)
8 (4.1%)
41 (20.9%)
9 (4.6%)
5 (2.6%)
196
50-54
69 (59.0%)
2 (1.7%)
40 (34.2%)
2 (1.7%)
4 (3.4%)
117
55-59
26 (48.1%)
2 (3.7%)
19 (35.2%)
4 (7.4%)
3 (5.6%)
54
60+
32 (57.1%)
19 (33.9%)
1 (1.8%)
4 (7.1%)
56
41 (2.1%)
1964
Total
1275 (64.9%) 79 (4.0%) 470 (23.9%) 65 (3.3%)
74
34 (1.7%)
Age ranges refer to the age of individuals at end of December 2001, or at death. Men who have had homosexual or bisexual
exposure and who are also injecting drug users are included in the homo/bisexual category.
All Cases 2001
61
Table 3.1 shows the age distribution of all HIV and AIDS cases presenting in the North West for
treatment in 2001, categorised by infection route of HIV. Sex between men remains the most common
route of infection among people with HIV in the North West (65% of all cases). The proportion of
people infected through heterosexual sex continues to increase, from 15% in 1996 to 24% in 2001.
It is anticipated that the proportion of individuals infected by heterosexual sex will continue to increase
in view of the increasing proportion of new cases who have been heterosexually infected (38% in 2001:
section 2, figure 2.1). Correspondingly, there is likely to be an increase in the number of babies born
with HIV: infants newly reported in 2001 represent 32% of all children infected by mother to child
transmission. Conversely, the proportion of all homosexually infected people who are newly reported
in 2001 is lower at 18%.
Of those aged 50 years and over, the proportion infected by heterosexual sex is greater, at 34%.
The number of individuals exposed to HIV via injecting drug use remains low at 4%, with the most
common age group being 35 to 39 years (34% of cases). The proportion of people infected by
contaminated blood or tissue and vertical transmission remains also relatively low (5%).
Table 3.2a: Residential distribution of total HIV and AIDS cases by stage of HIV disease,
January-December 2001: strategic health authority (All cases seen during 2001 including those
who died during the year)
SHA OF
RESIDENCE
Asymptomatic
Symptomatic
AIDS
AIDS
Related
Death
121 (30.8%)
145 (36.9%)
111 (28.2%)
5 (1.3%)
2 (0.5%)
Cheshire & Merseyside 126 (34.1%)
Death
unrelated Unknown
to AIDS
Total
(100%)
9 (2.3%)
393
4 (0.4%)
1103
135 (36.6%)
100 (27.1%)
7 (1.9%)
1 (0.3%)
319 (28.9%)
468 (42.4%)
292 (26.5%)
17 (1.5%)
3 (0.3%)
1 (100%)
1
4 (36.4%)
4 (36.4%)
3 (27.3%)
11
London
3 (42.9%)
3 (42.9%)
1 (14.3%)
7
10 (43.5%)
7 (30.4%)
6 (26.1%)
23
1 (33.3%)
2 (66.7%)
South West
1 (50.0%)
1 (50.0%)
Trent
6 (40.0%)
4 (26.7%)
5 (33.3%)
Wales
6 (33.3%)
2 (11.1%)
9 (50.0%)
West Midlands
5 (45.5%)
2 (18.2%)
4 (36.4%)
Unknown
4 (80.0%)
Abroad
1 (33.3%)
Greater Manchester
Eastern
Isle of Man
South East
Total
369
3
2
15
1 (5.6%)
18
11
1 (20.0%)
2 (66.7%)
606 (30.9%) 774 (39.4%) 534 (27.2%)
5
3
30 (1.5%)
6 (0.3%)
14 (0.7%)
1964
62
Table 3.2b: Residential distribution of total HIV and AIDS cases by stage of HIV disease,
January-December 2001: Cumbria & Lancashire primary care trusts (All cases seen during
2001 including those who died during the year)
STAGE
PCT
OF RESIDENCE
Asymptomatic
Symptomatic
AIDS
Carlisle & District
5 (35.7%)
1 (7.1%)
5 (35.7%)
Eden Valley
6 (85.7%)
West Cumbria
8 (61.5%)
Morecambe Bay
AIDS
Death
Related unrelated Unknown
Death
to AIDS
2 (14.3%)
1 (7.1%)
Total
(100%)
14
1 (14.3%)
7
2 (15.4%)
3 (23.1%)
13
13 (44.8%)
8 (27.6%)
8 (27.6%)
29
Blackpool
33 (23.7%)
56 (40.3%)
42 (30.2%)
Fylde
4 (21.1%)
6 (31.6%)
Wyre
8 (38.1%)
Preston
5 (3.6%)
139
7 (36.8%)
2 (10.5%)
19
5 (23.8%)
7 (33.3%)
1 (4.8%)
21
21 (39.6%)
17 (32.1%)
14 (26.4%)
4 (28.6%)
9 (64.3%)
1 (7.1%)
5 (20.8%)
14 (58.3%)
4 (16.7%)
3 (17.6%)
10 (58.8%)
4 (23.5%)
17
3 (14.3%)
8 (38.1%)
10 (47.6%)
21
West Lancashire
5 (35.7%)
6 (42.9%)
3 (21.4%)
14
Unknown
3 (37.5%)
3 (37.5%)
2 (25.0%)
8
Total
121 (30.8%) 145 (36.9%)
111 (28.2%)
1 (0.7%)
2 (1.4%)
1 (1.9%)
53
14
1 (4.2%)
5 (1.3%)
24
2 (0.5%)
9 (2.3%)
393
Individuals who reside in Cumbria & Lancashire, but whose primary care trust of residence is not known, are labelled as unknown.
Table 3.2a illustrates the strategic health authority of residence and clinical stage of HIV disease for
all HIV positive and AIDS cases presenting to a North West treatment centre in 2001. The figures
refer to the clinical condition of individuals when last seen in 2001; individuals who died are presented
in separate categories. The highest number of people with HIV live in Greater Manchester Strategic
Health Authority (56%). As in previous years, the vast majority of people treated in the North West
were also resident in the North West (95%).
The proportion of people at different stages of HIV disease has consequences for the funding of HIV
treatment and care, since those at a more advanced stage require more hospital care (see table 3.24)36.
Overall, 31% were asymptomatic, 39% were symptomatic and 27% were classified as having AIDS.
All Cases 2001
63
Table 3.2c: Residential distribution of total HIV and AIDS cases by stage of HIV disease,
January-December 2001: Cheshire & Merseyside primary care trusts (All cases seen during
PCT
OF RESIDENCE
AIDS
Related
Death
Death
unrelated
to AIDS
Total
(100%)
Asymptomatic
Symptomatic
AIDS
Southport & Formby
7 (36.8%)
7 (36.8%)
5 (26.3%)
19
South Sefton
4 (23.5%)
6 (35.3%)
7 (41.2%)
17
North Liverpool
Central Liverpool
1 (100%)
30 (30.9%)
South Liverpool
1
36 (37.1%)
30 (30.9%)
1 (1.0%)
97
7 (77.8%)
1 (11.1%)
1 (11.1%)
9
Knowsley
4 (36.4%)
5 (45.5%)
2 (18.2%)
11
St Helens
4 (25.0%)
7 (43.8%)
5 (31.3%)
16
Halton
5 (27.8%)
6 (33.3%)
6 (33.3%)
Warrington
12 (46.2%)
10 (38.5%)
4 (15.4%)
13 (31.0%)
16 (38.1%)
12 (28.6%)
3 (37.5%)
3 (37.5%)
2 (25.0%)
8
8 (72.7%)
2 (18.2%)
1 (9.1%)
11
Cheshire West
16 (61.5%)
8 (30.8%)
2 (7.7%)
26
Central Cheshire
8 (27.6%)
9 (31.0%)
10 (34.5%)
1 (3.4%)
Eastern Cheshire
9 (34.6%)
8 (30.8%)
8 (30.8%)
1 (3.8%)
26
Unknown
3 (23.1%)
4 (30.8%)
5 (38.5%)
1 (7.7%)
13
Total
126 (34.1%)
135 (36.6%) 100 (27.1%)
1 (5.6%)
18
26
1 (2.4%)
7 (1.9%)
42
1 (3.4%)
1 (0.3%)
29
369
Tables 3.2b, c and d present the breakdown of stage of disease by primary care trust within each
table 3.2c; and Greater Manchester, table 3.2d). There is variation among primary care trusts as
to the proportion of individuals with AIDS, from only 8% in Cheshire West to 45% in Rochdale,
47% in Oldham and 48% in Chorley & South Ribble.
64
Table 3.2d: Residential distribution of total HIV and AIDS cases by stage of HIV disease,
January-December 2001: Greater Manchester primary care trusts (All cases seen during
PCT
OF RESIDENCE
Asymptomatic
Symptomatic
AIDS
AIDS
Death
Related unrelated Unknown
Death
to AIDS
1 (3.7%)
Total
(100%)
8 (29.6%)
15 (55.6%)
3 (11.1%)
Bolton
21 (30.9%)
24 (35.3%)
23 (33.8%)
27
Bury
7 (13.7%)
24 (47.1%)
17 (33.3%)
Heywood & Middleton
3 (17.6%)
8 (47.1%)
6 (35.3%)
Rochdale
4 (12.9%)
13 (41.9%)
14 (45.2%)
Salford
48 (35.3%)
63 (46.3%)
23 (16.9%)
Trafford North
6 (20.7%)
13 (44.8%)
10 (34.5%)
Trafford South
10 (27.0%)
17 (45.9%)
10 (27.0%)
North Manchester
66 (30.0%)
107 (48.6%)
43 (19.5%)
Central Manchester
88 (32.8%)
100 (37.3%)
75 (28.0%)
3 (1.1%)
South Manchester
14 (25.9%)
16 (29.6%)
21 (38.9%)
3 (5.6%)
54
68
2 (3.9%)
1 (2.0%)
51
17
31
2 (1.5%)
136
29
37
2 (0.9%)
2 (0.9%)
220
1 (0.4%)
1 (0.4%)
268
Oldham
6 (16.7%)
12 (33.3%)
17 (47.2%)
1 (2.8%)
36
Tameside & Glossop
13 (23.2%)
28 (50.0%)
12 (21.4%)
3 (5.4%)
56
Stockport
19 (29.7%)
26 (40.6%)
18 (28.1%)
1 (1.6%)
64
Unknown
6 (66.7%)
2 (22.2%)
1 (11.1%)
9
Total
319 (28.9%) 468 (42.4%) 292 (26.5%) 17 (1.5%)
3 (0.3%)
4 (0.4%)
1103
All Cases 2001
65
Table 3.3a: Residential distribution of total HIV and AIDS cases by infection route of HIV,
January-December 2001: strategic health authority (All cases seen during 2001 including those
INFECTION ROUTE
SHA OF
RESIDENCE
Homo/
Bisexual
Injecting
Drug Use
Heterosexual
Blood/
Tissue
Mother
to Child
Undetermined
Total
(100%)
253 (64.4%)
14 (3.6%)
91 (23.2%)
15 (3.8%)
11 (2.8%)
9 (2.3%)
393
16 (4.3%)
117 (31.7%)
23 (6.2%)
3 (0.8%)
9 (2.4%)
369
48 (4.4%)
226 (20.5%)
23 (2.1%)
17 (1.5%)
18 (1.6%)
1103
Greater Manchester
771 (69.9%)
Eastern
1 (100%)
Isle of Man
2 (18.2%)
9 (81.8%)
London
4 (57.1%)
1 (14.3%)
14 (60.9%)
9 (39.1%)
1
11
2 (28.6%)
7
23
South East
1 (33.3%)
2 (66.7%)
3
South West
1 (50.0%)
1 (50.0%)
2
Trent
11 (73.3%)
Wales
7 (38.9%)
5 (27.8%)
3 (16.7%)
1 (5.6%)
2 (11.1%)
18
West Midlands
2 (18.2%)
5 (45.5%)
1 (9.1%)
2 (18.2%)
1 (9.1%)
11
Unknown
5 (100.0%)
Abroad
2 (66.7%)
Total
1275 (64.9%)
1 (6.7%)
3 (20.0%)
15
5
1 (33.3%)
79 (4.0%)
470 (23.9%)
3
65 (3.3%)
34 (1.7%)
41 (2.1%)
1964
Table 3.3b: Residential distribution of total HIV and AIDS cases by infection route of HIV,
INFECTION ROUTE
PCT OF
RESIDENCE
Carlisle & District
Homo/
Bisexual
Injecting
Drug Use
Heterosexual
8 (57.1%)
1 (7.1%)
5 (35.7%)
Eden Valley
3 (42.9%)
4 (57.1%)
West Cumbria
5 (38.5%)
5 (38.5%)
Morecambe Bay
13 (44.8%)
3 (10.3%)
13 (44.8%)
Blackpool
121 (87.1%)
3 (2.2%)
8 (5.8%)
1 (4.8%)
4 (19.0%)
Fylde
13 (68.4%)
Wyre
16 (76.2%)
Blood/
Tissue
Mother
to Child
Undetermined
Total
(100%)
14
7
1 (7.7%)
1 (7.7%)
1 (7.7%)
13
4 (2.9%)
1 (0.7%)
2 (1.4%)
139
1 (5.3%)
1 (5.3%)
29
4 (21.1%)
19
21
Preston
18 (34.0%)
25 (47.2%)
2 (3.8%)
9 (64.3%)
1 (7.1%)
3 (21.4%)
1 (7.1%)
15 (62.5%)
2 (8.3%)
3 (12.5%)
3 (12.5%)
9 (52.9%)
1 (5.9%)
5 (29.4%)
1 (5.9%)
11 (52.4%)
1 (4.8%)
6 (28.6%)
1 (4.8%)
West Lancashire
8 (57.1%)
4 (28.6%)
1 (7.1%)
Unknown
4 (50.0%)
1 (12.5%)
2 (25.0%)
1 (12.5%)
Total
253 (64.4%)
14 (3.6%)
91 (23.2%)
7 (13.2%)
1 (1.9%)
53
1 (4.2%)
24
14
1 (4.8%)
15 (3.8%) 11 (2.8%)
1 (5.9%)
17
1 (4.8%)
21
1 (7.1%)
14
9 (2.3%)
393
8
Individuals who reside in Cumbria & Lancashire, but whose primary care trust of residence is not known, are labelled as unknown
66
Table 3.3c: Residential distribution of total HIV and AIDS cases by infection route of HIV,
January-December 2001: Cheshire & Merseyside primary care trusts (All cases seen during
INFECTION ROUTE
PCT OF
RESIDENCE
Mother
to Child
Undetermined
Total
(100%)
Homo/
Bisexual
Injecting
Drug Use
Heterosexual
Blood/
Tissue
Southport & Formby
8 (42.1%)
1 (5.3%)
7 (36.8%)
1 (5.3%)
2 (10.5%)
19
South Sefton
7 (41.2%)
5 (29.4%)
4 (23.5%)
1 (5.9%)
17
North Liverpool
1 (100%)
Central Liverpool
46 (47.4%)
4 (4.1%)
40 (41.2%)
6 (6.2%)
South Liverpool
3 (33.3%)
1 (11.1%)
4 (44.4%)
1 (11.1%)
Knowsley
7 (63.6%)
1 (9.1%)
2 (18.2%)
St Helens
12 (75.0%)
Halton
9 (50.0%)
Warrington
15 (57.7%)
24 (57.1%)
5 (62.5%)
3 (37.5%)
3 (27.3%)
7 (63.6%)
Cheshire West
20 (76.9%)
4 (15.4%)
1
1 (1.0%)
9
1 (9.1%)
4 (25.0%)
1 (5.6%)
4 (9.5%)
97
11
16
5 (27.8%)
1 (5.6%)
10 (38.5%)
1 (3.8%)
11 (26.2%)
2 (4.8%)
1 (5.6%)
1 (5.6%)
18
26
1 (2.4%)
42
8
1 (9.1%)
11
2 (7.7%)
26
Central Cheshire
22 (75.9%)
1 (3.4%)
4 (13.8%)
1 (3.4%)
1 (3.4%)
29
Eastern Cheshire
12 (46.2%)
1 (3.8%)
8 (30.8%)
4 (15.4%)
1 (3.8%)
26
Unknown
7 (53.8%)
2 (15.4%)
3 (23.1%)
1 (7.7%)
13
Total
201 (54.5%)
16 (4.3%)
9 (2.4%)
369
117 (31.7%) 23 (6.2%)
3 (0.8%)
Individuals who reside in Cheshire & Merseyside, but whose primary care trust of residence is not known, are labelled as unknown
Table 3.3a displays the route of transmission of HIV for all HIV positive and AIDS cases presenting
in the North West for treatment in 2001, by strategic health authority of residence. Homosexual sex
continues to be the dominant mode of HIV transmission (65%). However, there are considerable
variations within the North West, with 70% of the HIV positive residents of Greater Manchester
compared to only 55% of Cheshire & Merseyside residents having been infected by sex between men.
Tables 3.3b, c and d present the breakdown of route of infection by primary care trust within each
table 3.3c; and Greater Manchester, table 3.3d). Considerable variation in the proportions of residents
infected by homosexual sex can be seen across primary care trusts, for example from only 34%
in Preston to 87% in Blackpool. Greater Manchester continues to report by far the highest number
of HIV positive injecting drug users, accounting for 61% of all residents of the North West infected
by this route.
All Cases 2001
67
Table 3.3d: Residential distribution of total HIV and AIDS cases by infection route of HIV,
INFECTION ROUTE
PCT OF
RESIDENCE
Homo/
Bisexual
17 (63.0%)
Bolton
35 (51.5%)
Bury
Heywood & Midddleton
Injecting
Drug Use
Heterosexual
Blood/
Tissue
Mother
to Child
7 (25.9%)
2 (7.4%)
3 (4.4%)
25 (36.8%)
2 (2.9%)
3 (4.4%)
28 (54.9%)
1 (2.0%)
15 (29.4%)
5 (9.8%)
1 (2.0%)
13 (76.5%)
2 (11.8%)
Rochdale
16 (51.6%)
4 (12.9%)
6 (19.4%)
2 (6.5%)
Salford
117 (86.0%)
2 (1.5%)
15 (11.0%)
1 (0.7%)
Trafford North
23 (79.3%)
1 (3.4%)
4 (13.8%)
Total
Undeter- (100%)
mined
1 (3.7%)
27
68
1 (2.0%)
51
2 (11.8%)
17
3 (9.7%)
31
1 (0.7%)
136
1 (3.4%)
29
Trafford South
25 (67.6%)
5 (13.5%)
5 (13.5%)
2 (5.4%)
North Manchester
171 (77.7%)
7 (3.2%)
35 (15.9%)
1 (0.5%)
1 (0.5%)
5 (2.3%)
220
Central Manchester
187 (69.8%)
9 (3.4%)
63 (23.5%)
1 (0.4%)
5 (1.9%)
3 (1.1%)
268
South Manchester
37 (68.5%)
6 (11.1%)
10 (18.5%)
1 (1.9%)
54
Oldham
20 (55.6%)
4 (11.1%)
8 (22.2%)
Tameside & Glossop
40 (71.4%)
2 (3.6%)
13 (23.2%)
Stockport
36 (56.3%)
2 (3.1%)
18 (28.1%)
Unknown
6 (66.7%)
Total
771 (70.0%)
37
2 (5.6%)
3 (4.7%)
3 (4.7%)
2 (22.2%)
48 (4.4%)
226 (20.5%) 23 (2.1%)
17 (1.5%)
2 (5.6%)
36
1 (1.8%)
56
2 (3.1%)
64
1 (11.1%)
9
18 (1.5%)
1103
Individuals who reside in Greater Manchester, but whose primary care trust of residence is not known, are labelled as unknown
Table 3.4 shows the sex and strategic health authority of residence of all HIV and AIDS cases
presenting in the North West for treatment in 2001. As in previous years, the vast majority of
all cases are male (84%), primarily due to the relatively high number of individuals exposed to HIV
via homosexual or bisexual sex (table 3.3a). The proportion of women has increased steadily from
11% in 1996 to 16% this year. As would be expected, the highest proportion of females is found in
Cheshire & Merseyside (18%), the strategic health authority with the highest proportion of
heterosexual HIV infections.
68
Table 3.4: Residential distribution of total HIV and AIDS cases by sex,
SEX
SHA OF
RESIDENCE
Male
Female
Total
332 (84.5%)
61 (15.5%)
393
301 (81.6%)
68 (18.4%)
369
Greater Manchester
947 (85.9%)
156 (14.1%)
1103
Eastern
1 (100%)
Isle of Man
7 (63.6%)
4 (36.4%)
11
1
London
6 (85.7%)
1 (14.3%)
7
15 (65,2%)
8 (34.8%)
23
South East
3 (100%)
3
South West
2 (100%)
2
Trent
13 (86.7%)
2 (13.3%)
Wales
15 (83.3%)
3 (16.7%)
18
West Midlands
8 (72.7%)
3 (27.3%)
11
Unknown
5 (100%)
5
Abroad
3 (100%)
3
Total (100%)
1658 (84.4%)
306 (15.6)
15
1964
For a breakdown of sex by primary care trust, please see the North West Public Health Observatory website:
Table 3.5: Infection route of HIV of total HIV and AIDS cases by sex, January-December 2001
(All cases and new cases seen during 2001 including those who died during the year)
SEX
INFECTION
ROUTE
Male
Homo/Bisexual
1275 (76.9%)
Female
Total
1275 (64.9%)
Injecting Drug Use
54 (3.3%)
25 (8.2%)
79 (4.0%)
Heterosexual
219 (13.2%)
251(82.0%)
470 (23.9%)
Blood/Tissue
57 (3.4%)
8 (2.6%)
65 (3.3%)
Mother to Child
16 (1.0%)
18 (5.9%)
34 (1.7%)
Undetermined
37 (2.2%)
4 (1.3%)
41 (2.1%)
Total (100%)
1658
306
1964
Men who have had homo/bisexual exposure and who are also injecting drug users are included in the homo/bisexual category.
All Cases 2001
69
Table 3.5 illustrates the sex and route of transmission of all HIV and AIDS cases presenting for
treatment in the North West in 2001. Amongst men, the largest category of individuals living
with HIV was those infected by sex between men (77%), while most women had been infected
by heterosexual sex (82%). An even greater proportion of female new cases (90%) were infected by
this route (section 2, table 2.5), highlighting the growing issue of heterosexual transmission of HIV.
Around half of those infected by heterosexual sex are male. As in previous years, the majority of
injecting drug users are male (68%).
Table 3.6: Residential distribution of total HIV and AIDS cases by age category,
60+
3
3
(0.8%)
10
(2.7%)
16
(1.5%)
3
(0.3%)
48
(4.4%)
Greater Manchester
55-59
Cheshire&Merseyside (0.8%)
63
47
(16.0%) (12.0%)
27
(6.9%)
17
(4.3%)
14
(3.6%)
393
42
84
87
(11.4%) (22.8%) (23.6%)
53
(14.4%)
33
(8.9%)
26
(7.0%)
11
(3.0%)
17
(4.6%)
369
155
230
256
(14.1%) (20.9%) (23.2%)
191
(17.3%)
106
(9.6%)
58
(5.3%)
21
(1.9%)
19
(1.7%)
1103
1
(100.0%)
1
74
94
(18.8%) (23.9%)
Eastern
5
(45.5%)
Isle of Man
London
1
(4.3%)
South East
1
(33.3%)
1
(50.0%)
South West
Trent
Wales
1
(5.6%)
West Midlands
2
(18.2%)
Unknown
Abroad
Total
1
(5.6%)
4
(36.4%)
1
(9.1%)
2
2
(28.6%) (28.6%)
1
2
(14.3%) (28.6%)
4
7
(17.4%) (30.4%)
4
(17.4%)
2
(8.7%)
1
(9.1%)
11
7
2
(8.7%)
1
(4.3%)
1
(33.3%)
2
(8.7%)
23
1
(33.3%)
3
1
(50.0%)
2
2
2
5
(13.3%) (13.3%) (33.3%)
1
(6.7%)
1
(5.6%)
3
(16.7%)
3
4
(16.7%) (22.2%)
2
3
(13.3%) (20.0%)
1
(20.0%)
1
(33.3%)
15
4
(22.2%)
3
2
3
(27.3%) (18.2%) (27.3%)
3
(60.0%)
Total
(100%)
50-54
25-29
32
(8.1%)
45-49
20-24
11
(2.8%)
40-44
15-19
3
(0.8%)
35-39
0-14
11
(2.8%)
30-34
AGE GROUP
SHA OF
RESIDENCE
1
(5.6%)
18
1
(9.1%)
11
1
(20.0%)
5
2
(66.7%)
33
9
74
239
401
465
320
196
117
54
56
(1.7%) (0.5%) (3.8%) (12.2%) (20.4%) (23.7%) (16.3%) (10.0%) (6.0%) (2.7%) (2.9%)
3
1964
Age ranges refer to the age of individuals at end of December 2001, or at death. For a breakdown of age by primary care trust,
please see the North West Public Health Observatory website: www.nwpho.org.uk/hiv2001/table3-6.htm
Table 3.6 shows the strategic health authority of residence of all HIV and AIDS cases presenting
for treatment in the North West in 2001, categorised by age group. The proportion of HIV positive
individuals who are under 25 years of age has remained relatively static over the last four years
and was 6% in 2001. The age group with the largest number of individuals is 35 to 39 years in 2001.
The proportion of HIV positive people in the older age groups (50 years and over) continues to
increase, from 7% in 1996 to 12% in 2001, suggesting an ageing cohort of HIV positive individuals
in the North West.
70
Table 3.7: Residential distribution of total HIV and AIDS cases by ethnic group,
323 (87.5%)
2 (0.5%)
32 (8.7%)
Greater Manchester
905 (82.0%)
6 (0.5%)
127 (11.5%)
Eastern
1 (100.0%)
Isle of Man
10 (90.9%)
1 (9.1%)
London
5 (71.4%)
1 (14.3%)
19 (82.6%)
3 (13.0%)
South East
1 (33.3%)
1 (33.3%)
1 (50.0%)
Trent
14 (93.3%)
8 (2.0%)
5 (1.3%)
2 (0.5%)
393
1 (0.3%)
8 (2.2%)
1 (0.3%)
2 (0.5%)
369
13 (1.2%)
13 (1.2%)
16 (1.5%)
18 (1.6%)
1103
11
1 (14.3%)
1 (4.3%)
1 (33.3%)
3
1 (50.0%)
2
15
Wales
17 (94.4%)
1 (5.6%)
8 (72.7%)
2 (18.2%)
Unknown
4 (80.0%)
Abroad
1 (33.3%)
1651(84.1%) 13 (0.7%)
7
23
1 (6.7%)
West Midlands
Total
7 (1.8%)
Total
(100%)
1
South West
5 (0.5%)
Unknown
25 (6.4%)
Other Asian
/Oriental
4 (1.0%)
Other/
Mixed
Black
African
342 (87.0%)
Indian/
Pakistani/
Bangladeshi
Black
Caribbean
Black
Other
SHA OF
RESIDENCE
White
ETHNICITY
18
1 (9.1%)
11
1 (20.0%)
5
1 (33.3%)
195 (9.9%)
1 (33.3%)
5 (0.3%)
22 (1.1%)
31 (1.6%)
24 (1.2%)
3
23 (1.2%)
1964
For a breakdown of ethnicity by primary care trust, please see the North West Public Health Observatory website:
Table 3.7 shows a breakdown of ethnicity by strategic health authority for all those individuals with
HIV or AIDS who attended statutory treatment centres in the North West in 2001. Ethnic group
classifications are adapted from the 1991 census questionnaire and are those utilised by the
Public Health Laboratory Service AIDS and STD Centre, for the Survey of Prevalent Diagnosed
HIV Infections (SOPHID). This year a new category, ‘Other Asian/Oriental’, has been added,
and accounts for 24 cases (1.2%) of the total.
The self-classification of ethnicity was recorded for 99% of cases, most of whom (85%) were white.
The remaining 15% were from black and ethnic minority communities, and this proportion has increased
from 12% last year. This is a reflection of the increasing proportion of new cases from black and ethnic
minority communities (from 19% in 2000 to 29% in 2001: section 2, table 2.6). These data show an
increase in the number of individuals from black and ethnic minority groups presenting for treatment
and care in the North West of England. Moreover, individuals from black and ethnic minority
communities are substantially over represented among the HIV positive population when compared
to their proportion in the North West population as a whole (3.8%)132. Thus, individuals from black
and ethnic minority groups in the North West are 4.4 times more likely to be HIV positive than are
their white counterparts.
HIV positive individuals classified as black African comprise the largest ethnic minority group,
at 10% of all cases and 67% of non-white individuals. This proportion from black African communities
has been increasing over the years, from 3% in 1998, to 6% in 2000. These data highlight the need for
specific HIV prevention initiatives within black and ethnic minority communities. However, the black
African community is not homogenous and requires a culturally sensitive and diverse approach84.
All Cases 2001
71
Table 3.8: Ethnic distribution of total HIV and AIDS cases by sex, January-December 2001
(All cases seen during 2001 including those who died during the year)
SEX
ETHNICITY
Male
Female
Total
(100%)
White
1503 (91.0%)
148 (9.0%)
1651
Black Caribbean
11 (84.6%)
2 (15.4%)
13
Black African
69 (35.4%)
126 (64.6%)
195
Black Other/Black Unspecified
3 (60.0%)
2 (40.0%)
5
Indian/Pakistani/Bangladeshi
15 (68.2%)
7 (31.8%)
22
Other/Mixed
22 (71.0%)
9 (29.0%)
31
15 (62.5%)
9 (37.5%)
24
Unknown
20 (87.0%)
3 (13.0%)
23
Total (100%)
1658 (84.4%)
306 (15.6)
1964
Table 3.8 shows the ethnic group and sex of all individuals with HIV presenting in the North West for
treatment in 2001. The vast majority of HIV and AIDS cases were male (84%). However, this is not
the case for members of black and ethnic minority communities, where cases are much more evenly
distributed between the sexes. Over half of all HIV positive individuals from ethnic minorities were
female (53%). This higher proportion of females with HIV is largely due to the predominance of
heterosexual sex, rather than sex between men, as the route of transmission in black and ethnic
minority groups (table 3.9). Sixty five percent of diagnosed HIV positive black Africans are female.
This female bias may be explained if females are more at risk of acquiring HIV through heterosexual
sex, or more likely to present to treatment centres for diagnosis and treatment, or both.
Table 3.9: Ethnic distribution of total HIV and AIDS cases by infection route of HIV,
January-December 2001(All cases seen during 2001 including those who died during the year)
INFECTION ROUTE
ETHNICITY
Homo/
Bisexual
Injecting
Drug Use
Heterosexual
Blood/
Tissue
Mother
to Child
Undetermined
75 (4.5%)
13 (0.8%)
35 (2.1%)
White
1221 (74.0%)
246 (14.9%)
61 (3.7%)
Black Caribbean
6 (46.2%)
6 (46.2%)
1 (7.7%)
Black African
4 (2.1%)
177 (90.8%)
4 (80.0%)
Black Other
1 (20.0%)
Bangladeshi
8 (36.4%)
1 (4.5%)
Other / Mixed
13 (41.9%)
2 (6.5%)
Other Asian / Oriental
6 (25.0%)
Not Known
Total
16 (69.6%)
8 (36.4%)
1 (4.3%)
1651
13
13 (6.7%)
1 (0.5%)
195
5
3 (13.6%)
9 (29.0%)
1 (4.5%)
34 (1.7%)
22
31
2 (8.3%)
4 (17.4%)
470 (23.9%) 65 (3.3%)
1 (4.5%)
7 (22.6%)
16 (66.7%)
1275(64.9%) 79 (4.0%)
Total
(100%)
24
2 (8.7%)
23
41 (2.1%)
1964
Men who have had homosexual or bisexual exposure and who are also injecting drug users are included in the homo/bisexual category
72
Table 3.9 illustrates the ethnic group and route of transmission of HIV and AIDS cases presenting in
the North West in 2001. Although most individuals with HIV were infected by sex between men (65%),
this is not the case among black and ethnic minority communities where homosexual sex accounted
for only 13% of cases and heterosexual sex was the main route of transmission (76% of cases).
Within black African communities, this situation is even more apparent, with heterosexual sex
accounting for 91% of cases. Because of the high proportion of HIV positive black Africans who are
female (table 3.8) there is a correspondingly high proportion of mother to child transmission of HIV.
Table 3.10: Ethnic distribution of total HIV and AIDS cases by age group,
50-54
55-59
60+
285
172
(17.3%) (10.4%)
107
(6.5%)
49
(3.0%)
51
(3.1%)
3
(23.1%)
5
(38.5%)
1
(7.7%)
2
(15.4%)
1
(7.7%)
37
52
40
(19.0%) (26.7%) (20.5%)
19
(9.7%)
10
(5.1%)
8
(4.1%)
3
1
(60.0%) (20.0%)
1
(20.0%)
1
(4.5%)
3
6
4
(13.6%) (27.3%) (18.2%)
3
(13.6%)
2
(9.1%)
2
(6.5%)
6
4
5
(19.4%) (12.9%) (16.1%)
5
(16.1%)
1
(3.2%)
4
5
(16.7%) (20.8%)
5
7
(20.8%) (29.2%)
Black Caribbean
Black African
13
(6.7%)
7
(3.6%)
Black Other
Indian/Pakistani/
Bangladeshi
1
(4.5%)
Other/Mixed
7
(22.6%)
Unknown
Total
1
(4.5%)
1
(4.2%)
2
(8.7%)
2
(8.3%)
3
8
7
(13.0%) (34.8%) (30.4%)
1
(4.3%)
45-49
183
322
401
(11.1%) (19.5%) (24.3%)
1
(7.7%)
40-44
62
(3.8%)
35-39
7
(0.4%)
30-34
12
(0.7%)
25-29
20-24
White
15-19
ETHNICITY
0-14
AGE GROUP
Total
(100%)
1651
13
5
(2.6%)
4
(2.1%)
195
5
1
(4.5%)
1
(3.2%)
2
(8.7%)
33
9
74
239
401
465
320
196
117
54
56
(1.7%) (0.5%) (3.8%) (12.2%) (20.4%) (23.7%) (16.3%) (10.0%) (6.0%) (2.7%) (2.9%)
22
31
24
23
1964
Table 3.10 displays the ethnicity and age group of HIV and AIDS cases presenting for treatment
in the North West in 2001. White individuals tended to be older, with a median age of 38 years
(with 90% of the population lying between the range 25 to 57 years) while black African were on
average 33 years (90% in the range 10 to 55 years). The fact that those from black and ethnic minority
groups tend to be younger and infected by heterosexual sex suggests that in the future the rates of
mother to child transmission may increase. The higher proportion of black Africans and those classified
as ‘Other/mixed’ in the 0-14 year age group (7% and 23% respectively) compared to white individuals
(1%) are a reflection of the higher rates of mother to child transmission in these groups (table 3.9).
Figure 3.2 illustrates exposure abroad and the route of infection of all HIV and AIDS cases who
presented for treatment and care in the North West in 2001. These data show the significant influence
of global trends of the pandemic on the epidemiology of HIV in the North West Region. A quarter of
all cases were reported to have been exposed to HIV infection abroad. The role that exposure abroad
plays in the epidemiology of HIV in the North West appears to be increasing in importance, with the
proportion of people infected abroad having increased from 19% in 1998. However, part of this
increase may be due to the fact that there has also been an improved level of reporting, with the
proportion of cases for whom data on exposure abroad are available increasing from 48% (1997),
79% (1999) to 91% in 2001. Heterosexual sex continued to be the predominant mode of transmission
of those HIV positive individuals who were infected abroad (60%) compared to only 12% of those
known to be infected in the UK.
All Cases 2001
73
Figure 3.2: The role of contact abroad in exposure to HIV of total HIV and AIDS cases,
EXPOSED ABROAD
Blood/Tissue
1.0%
Heterosexual
59.7%
Mother to Child
2.4%
Injecting Drug Use
4.2%
Undertermined
2.4%
Homo/Bisexual
30.3%
EXPOSED IN UK
Homo/Bisexual
76.6%
Injecting Drug Use
4.1%
Undertermined
1.1%
Mother to Child
1.5%
Heterosexual
12.1%
Blood/Tissue
4.6%
UNDETERMINED
Homo/Bisexual
78.0%
Injecting Drug Use
3.0%
Undertermined
8.9%
Mother to Child
1.2%
Heterosexual
8.9%
INFECTION ROUTE
HIV EXPOSURE
ABROAD
Total
(100%)
Homo/
Bisexual
Injecting
Drug Use
Heterosexual
Blood/
Tissue
Mother
to Child
Undetermined
Yes
151 (30.3%)
21 (4.2%)
298 (59.7%)
5 (1.0%)
12 (2.4%)
12 (2.4%)
499
No
993 (76.6%)
53 (4.1%)
157 (12.1%)
60 (4.6%)
20 (1.5%)
14 (1.1%)
1297
Undetermined
131 (78.0%)
5 (3.0%)
15 (8.9%)
2 (1.2%)
15 (8.9%)
168
34 (1.7%)
41 (2.1%)
1964
Total
1275(64.9%) 79 (4.0%)
470 (23.9%) 65 (3.3%)
74
Figure 3.3: Global region and country of total HIV and AIDS cases who probably
acquired their infection outside the UK, January-December 2001 (All cases seen during
Total : 499
Europe
83 (16.6%)
North America
34 (6.8%)
Middle East
4 (0.8%)
Caribbean
9 (1.8%)
Africa
254 (50.9%)
South &
South-East Asia
51 (10.2%)
Latin America
8 (1.6%)
Australia &
New Zealand
10 (2.0%)
Unknown 46 (9.2%)
Africa
254 (50.9%)
Unknown
Angola
3 (0.6%)
Australia &
Botswana
9 (1.8%)
New Zealand
28 (5.6%)
10 (2.0%)
Latin America
8 (1.6%)
Argentina
1 (0.2%)
Brazil
2 (0.4%)
1 (0.2%)
Burundi
2 (0.4%)
Australia
9 (1.8%)
Colombia
Cameroon
1 (0.2%)
New Zealand
1 (0.2%)
Guatemala
1 (0.2%)
Dem. Rep. of Congo
16 (3.2%)
Caribbean
9 (1.8%)
Guyana
1 (0.2%)
Egypt
2 (0.4%)
Jamaica
7 (1.4%)
Mexico
1 (0.2%)
Eritrea
1 (0.2%)
Unknown
2 (0.4%)
Peru
1 (0.2%)
Ethiopia
4 (0.8%)
Europe
83 (16.6%)
Middle East
4 (0.8%)
Gabon
1 (0.2%)
Austria
1 (0.2%)
Iran
1 (0.2%)
Gambia
2 (0.4%)
Belgium
2 (0.4%)
Israel
1 (0.2%)
Ghana
6 (1.2%)
Croatia
1 (0.2%)
Saudi Arabia
1 (0.2%)
Guinea
1 (0.2%)
Cyprus
2 (0.4%)
United Arab Emirates
1 (0.2%)
34 (6.8%)
Kenya
16 (3.2%)
Eire
7 (1.4%)
North America
Malawi
11 (2.2%)
France
5 (1.0%)
Canada
3 (0.6%)
Nigeria
11 (2.2%)
Germany
7 (1.4%)
USA
31 (6.2%)
Rwanda
4 (0.8%)
Gibraltar
1 (0.2%)
South &
Sierra Leone
1 (0.2%)
Gran Canaria
3 (0.6%)
South East Asia
51 (10.2%)
Somalia
10 (2.0%)
Italy
7 (1.4%)
India
3 (0.6%)
South Africa
34 (6.8%)
Majorca
1 (0.2%)
Malaysia
1 (0.2%)
Sudan
5 (1.0%)
Malta
1 (0.2%)
Pakistan
9 (1.8%)
Swaziland
1 (0.2%)
Netherlands
6 (1.2%)
Philippines
3 (0.6%)
Tanzania
6 (1.2%)
Portugal
6 (1.2%)
Singapore
1 (0.2%)
Uganda
16 (3.2%)
Slovakia
1 (0.2%)
Taiwan
1 (0.2%)
30 (6.0%)
Zaire
1 (0.2%)
Spain
24 (4.8%)
Thailand
Zambia
24 (4.8%)
Tenerife
2 (0.4%)
Unknown
3 (0.6%)
Zimbabwe
38 (7.6%)
Unknown
6 (1.2%)
Unknown
46 (9.2%)
Total
499 (100.0%)
All Cases 2001
75
Figure 3.3 illustrates the global region and country of infection for those 499 HIV positive individuals
presenting for treatment in the North West in 2001 who were probably infected abroad. Of all the
infections contracted outside the United Kingdom, 51% were infected in Africa. This high proportion
reflects the impact of the pandemic, particularly in sub-Saharan Africa, where the prevalence of HIV
is extremely high12. A further 17% of people who were infected abroad were infected in Europe and
10% in South and South East Asia.
Of the 499 individuals who were probably infected abroad, the country of infection is known for 414
individuals (83%). A total of 66 different countries have been named for those HIV positive people
infected abroad, with Zimbabwe representing the country where the largest number of infections
were contracted (9% of those where the country is known). Exposure in Africa was spread across
26 countries. The vast majority of those exposed in Africa were exposed in sub-Saharan Africa
(97% of cases where the African country of infection was known). However, the African country of
infection was unknown in a high proportion (11%) of cases. Of those exposed in Europe, 29% were
infected in Spain, reflecting the extent of the epidemic in that country 64, the large number of people
that travel between the United Kingdom and Spain, and the increased propensity to take risks
when on holiday 66,128.
Table 3.11: Global region and infection route of HIV cases who probably acquired their
infection outside the UK, January-December 2001 (All cases seen during 2001 including those
INFECTION ROUTE
GLOBAL
REGION
Homo/
Bisexual
Injecting
Drug Use
Heterosexual
Blood/
Tissue
Mother
to Child
Undetermined
Africa
13 (5.1%)
1 (0.4%)
223 (87.8%)
1 (0.4%)
11 (4.3%)
5 (2.0%)
Australia & New Zealand
10 (100%)
9 (100%)
9
Europe
43 (51.8%)
18 (21.7%)
18 (21.7%)
Latin America
4 (50.0%)
1 (12.5%)
3 (37.5%)
27 (79.4%)
1 (2.9%)
4 (11.8%)
2 (5.9%)
1 (2.0%)
Middle East
1 (1.2%)
1 (1.2%)
17 (33.3%)
31 (60.8%)
Unknown
37 (80.4%)
7 (15.2%)
151 (30.3%) 21 (4.2%) 298 (59.7%)
2 (2.4%)
83
8
3 (75.0%)
South & South-East Asia
Total
254
10
Caribbean
North America
Total
(100%)
1 (25.0%)
5 (1.0%)
4
34
12 (2.4%)
2 (3.9%)
51
2 (4.3%)
46
12 (2.4%)
499
Table 3.11 shows the route of infection of those infected abroad categorised by the global region
of their exposure. Of all HIV infections acquired abroad, most were exposed via heterosexual sex
(60%). For those exposed in Africa (51% of all those infected abroad), the proportion infected by this
route is much higher, at 88%. Seventeen percent of those infected abroad were infected in Europe,
over a fifth of whom were infected by sharing injecting equipment. Eighty six percent of all injecting
drug users who were exposed abroad were infected in Europe, with the largest number of these
having been exposed in Spain (seven individuals). This is a reflection of the fact that the drug using
community remains the focus of the HIV epidemic in Spain, as in much of the rest of Western
Europe (in particular Mediterranean Europe).
76
Table 3.12: The role of contact abroad in exposure to HIV of total HIV and AIDS cases
by ethnicity, January-December 2001 (All cases seen during 2001 including those who died
during the year)
Other Asian
/Oriental
6 (1.2%)
178 (35.7%)
2 (0.4%)
11 (2.2%)
13 (2.6%)
18 (3.6%)
3 (0.6%)
499 (100%)
1234 (95.1%)
5 (0.4%)
13 (1.0%)
3 (0.2%)
11 (0.8%)
17 (1.3%)
4 (0.3%)
10 (0.8%)
1297 (100%)
1 (0.6%)
2 (1.2%)
10 (6.0%)
168 (100%)
5 (0.3%)
22 (1.1%)
31 (1.6%)
24 (1.2%)
23 (1.2%)
1964 (100%)
White
Unknown
149 (88.7%)
2 (1.2%)
4 (2.4%)
Total
1651(84.1%)
13 (0.7%)
195(9.9%)
Unknown
Other/
Mixed
268 (53.7%)
No
Indian/
Pakistani/
Bangladeshi
Black
African
Yes
HIV
EXPOSURE
ABROAD
Black
Other
Black
Caribbean
ETHNICITY
Total
(100%)
Table 3.12 displays ethnicity and whether or not individuals were exposed to HIV abroad for all HIV
and AIDS cases presenting for treatment in the North West in 2001. A quarter of all cases were
reported to have been exposed abroad. However, there were considerable differences between ethnic
groups. While the majority of white HIV positive individuals (75%) are thought to have been exposed in
the United Kingdom, this was only true for 7% of black Africans. The high proportion of white
individuals for whom exposure abroad is unknown (9%, compared to 3% for ethnic minority groups)
may reflect reluctance to pursue this topic with white individuals.
Table 3.13: Residential distribution of total HIV and AIDS cases by level of
antiretroviral therapy, January-December 2001(All cases seen during 2001 including
those who died during the year)
ANTIRETROVIRAL THERAPY
SHA OF
RESIDENCE
None
Dual
Triple
Quadruple
or More
Total
(100%)
116 (29.5%)
9 (2.3%)
219 (55.7%)
49 (12.5%)
393
128 (34.7%)
4 (1.1%)
198 (53.7%)
39 (10.6%)
369
Greater Manchester
403 (36.5%)
1 (0.1%)
566 (51.3%)
133 (12.1%)
1103
1 (9.1%)
11
Eastern
1 (100%)
Isle of Man
5 (45.5%)
5 (45.5%)
London
6 (85.7%)
1 (14.3%)
1 (4.3%)
2 (8.7%)
South East
16 (69.6%)
1
7
4 (17.4%)
23
3 (100%)
3
1 (50.0%)
2
South West
1 (50.0%)
Trent
5 (33.3%)
9 (60.0%)
1 (6.7%)
15
Wales
4 (22.2%)
11 (61.1%)
3 (16.7%)
18
4 (36.4%)
11
West Midlands
1 (9.1%)
6 (54.5%)
Unknown
4 (80.0%)
1 (20.0%)
Abroad
1 (33.3%)
Total
675 (34.4%)
5
2 (66.7%)
16 (0.8%)
1039 (52.9%)
3
234 (11.9%)
1964
For a breakdown of level of antiretroviral therapy by primary care trust, please see the North West Public Health Observatory
website: www.nwpho.org.uk/hiv2001/table3-13.htm
All Cases 2001
77
Table 3.13 shows the level of antiretroviral therapy received by individuals attending for treatment
for HIV or AIDS in the North West in 2001, broken down by strategic health authority of residence.
Individuals are categorised by the highest level of combination therapy they received from any
treatment centre in the North West during 2001. Nearly two thirds (65%) of HIV positive individuals
were receiving triple or more combination therapy in the year 2001. The proportion of people receiving
four or more drugs remains about the same (12%). A third of HIV positive individuals were not on any
antiretroviral therapy, a comparable proportion to 2000. Seventy four percent of those not resident
in the region, but who access treatment in the North West received antiretroviral therapy. In line
130
with British HIV Association Guidelines , use of mono or dual therapy was rare. In 2001,
no individuals received mono therapy and only 1% received dual therapy.
Table 3.14: Stage of HIV disease of total HIV and AIDS cases by level of
antiretrovival therapy, January-December 2001 (All cases seen during 2001 including
Total
(100%)
STAGE OF HIV
DISEASE
None
Dual
Triple
Quadruple
or More
Asymptomatic
379 (62.5%)
2 (0.3%)
205 (33.8%)
20 (3.3%)
606
Symptomatic
211 (27.3%)
11 (1.4%)
457 (59.0%)
95 (12.3%)
774
AIDS
61 (11.4%)
2 (0.4%)
362 (67.8%)
109 (20.4%)
534
12 (40.0%)
10 (33.3%)
30
AIDS Related Death
8 (26.7%)
Death unrelated to AIDS
3 (50.0%)
Unknown
13 (92.9%)
Total
675 (34.4%)
1 (16.7%)
2 (33.3%)
16 (0.8%)
1039 (52.9%)
6
1 (7.1%)
14
234 (11.9%)
1964
Table 3.14 refers to the clinical condition of individuals when last seen in 2001; individuals who died
are presented in separate categories. Individuals are categorised by the highest level of antiretroviral
therapy they received from any treatment centre in the North West during 2001. The vast majority
(88%) of those categorised as having AIDS received triple or more combination therapy, whilst 71%
of those who were symptomatic received this level of therapy. In contrast, most asymptomatic
individuals (63%) were not receiving any antiretroviral therapy. This has implications for the future
demand for drug therapy, since these individuals may require drug treatment when their HIV
disease progresses.
Table 3.15 refers to the level of antiretroviral therapy prescribed by specific treatment centres
when HIV positive individuals last presented for treatment and care in the North West during 2001.
The data illustrate a variation in the level of antiretroviral therapy prescribed across treatment centres
in the region. For those receiving antiretroviral therapy, the most common level was triple therapy.
No individuals received mono therapy and the level of dual therapy remains low across treatment
centres in the North West. Individuals currently receiving dual therapy may be those whose HIV
infection has been successfully managed for many years on dual therapy. Patients newly commencing
treatment are more likely to be prescribed triple or more therapy (see section 2, table 2.11).
78
Table 3.15: Distribution of treatment for total HIV and AIDS cases by level of
antiretrovival therapy, January-December 2001 (All cases seen during 2001 including those
TREATMENT
CENTRE
None
AHC
APH
1 (16.7%)
ARM
7 (100.0%)
64 (38.8%)
BLK
BOLG
19 (26.0%)
3 (100.0%)
BURG
4 (30.8%)
BURY
23 (100.0%)
CHR
22 (51.2%)
Quadruple
or More
Total
(100%)
2 (33.3%)
3 (50.0%)
6
1 (3.7%)
27
5 (3.0%)
83 (50.3%)
13 (7.9%)
165
1 (33.3%)
2 (66.7%)
7 (63.6%)
2 (18.2%)
11
42 (57.5%)
11 (15.1%)
73
8 (61.5%)
1 (7.7%)
13
18 (41.9%)
3 (7.0%)
43
7
2 (18.2%)
BOOT
Triple
14 (51.9%)
12 (44.4%)
BLAG
BLKG
Dual
1 (1.4%)
3
3
23
CPED
1 (100.0%)
1
CUM
5 (21.7%)
15 (65.2%)
3 (13.0%)
23
FAZ
22 (31.0%)
45 (63.4%)
4 (5.6%)
71
FGH
5 (62.5%)
3 (37.5%)
8
1 (100.0%)
1
7
HAL
LEI
1 (14.3%)
6 (85.7%)
LEII
3 (37.5%)
5 (62.5%)
MAC
6 (28.6%)
10 (47.6%)
5 (23.8%)
21
MGP
144 (100.0%)
MRI
41 (33.6%)
62 (50.8%)
19 (15.6%)
122
MRIG
77 (61.1%)
126
MRIH
8 (18.2%)
NMG
220 (28.7%)
NMGG
NOB
OLDG
2 (100.0%)
PG
23 (31.5%)
8
144
1 (0.8%)
44 (34.9%)
4 (3.2%)
33 (75.0%)
3 (6.8%)
44
437 (57.0%)
108 (14.1%)
767
75 (78.9%)
19 (20.0%)
1 (1.1%)
95
3 (50.0%)
3 (50.0%)
2 (0.3%)
6
2
3 (4.1%)
32 (43.8%)
15 (20.5%)
PP
4 (57.1%)
QSC
76 (100.0%)
RLG
68 (31.8%)
120 (56.1%)
24 (11.2%)
214
RLH
5 (31.3%)
10 (62.5%)
1 (6.3%)
16
RLI
6 (42.9%)
8 (57.1%)
ROCG
12 (46.2%)
12 (46.2%)
2 (7.7%)
26
SALG
8 (34.8%)
15 (65.2%)
SHH
1 (25.0%)
2 (50.0%)
1 (25.0%)
4
SPG
12 (57.1%)
5 (23.8%)
4 (19.0%)
21
29 (51.8%)
6 (10.7%)
56
STP
21 (37.5%)
TAMG
3 (100.0%)
TRAG
4 (100.0%)
WAR
1 (33.3%)
3 (42.9%)
73
7
76
2 (0.9%)
14
23
3
4
2 (66.7%)
3
WGH
5 (100.0%)
5
WHIT
4 (100.0%)
4
WIGG
2 (100.0%)
WITG
43 (51.8%)
32 (38.6%)
8 (9.6%)
83
2
WORK
2 (33.3%)
3 (50.0%)
1 (16.7%)
6
For a definition of the abbreviated treatment centres please refer to the glossary at the back of the report. Columns cannot be
totalled vertically as some individuals may appear in more than one row (i.e. those attending two or more treatment locations), thus
exaggerating the totals.
All Cases 2001
79
GREATER MANCHESTER
8
MAC
LEII
HAL
FGH
FAZ
CUM
CPED
CHR
BURY
BURG
BOOT
BOLG
BLKG
BLK
BLAG
ARM
APH
6
14
7
1
2
7
123
13
2
17
3
1
2
1
1
1
1
1
9
1
8
1
2
1
1
2
3
1
1
1
5
1
5
20
2
4
1
1
1
13
3
1
1
1
6
3
3
2
8
1
3
1
7
1
20
1
1
1
3
12
9
1
4
Bolton
Bury
Heywood & Middleton
Rochdale
Salford
Trafford North
Trafford South
North Manchester
Central Manchester
South Manchester
Oldham
Tameside & Glossop
Stockport
Unknown
Out of Region
Unknown
Total
80
1
LEI
Southport & Formby
South Sefton
North Liverpool
Central Liverpool
South Liverpool
Knowsley
St Helens
Halton
Warrington
Cheshire West
Central Cheshire
Eastern Cheshire
Unknown
AHC
SHA
Carlisle & District
Eden Valley
West Cumbria
Morecambe Bay
Blackpool
Fylde
Wyre
Preston
Hyndburn & Ribble Valley
Burnley, Pendle & Rossendale
West Lancashire
Unknown
CHESHIRE & MERSEYSIDE
PCT OF RESIDENCE
CUMBRIA & LANCASHIRE
Table 3.16: Residential distribution of total HIV and AIDS cases by treatment centre,
January to December 2001 (All cases seen during 2001 including those who died during the year)
1
42
3
20
1
2
3
1
1
2
3
1
1
1
1
1
1
3
0
0
1
1
0
13
0
0
0
6
0
0
9
1
0
0
0
5
8
21
1
6
27
7
165
3
11
73
3
13
23
43
1
23
71
8
1
7
3
5
1
8
4
64
2
3
3
2
1
2
2
5
13
2
4
1
1
7
6
2
3
40
3
2
1
2
1
14
1
3
WORK
WITG
WIGG
4
12
5
WHIT
WGH
WAR
TRAG
TAMG
STP
SPG
SHH
SALG
ROCG
RLI
RLH
RLG
QSC
PP
PG
OLDG
NOB
NMGG
NMG
MRIH
MRIG
MRI
MGP
1
1
6
5
1
6
1
1
1
5
1
1
1
1
3
1
2
5
1
13
13
2
1
1
1
1
84
5
7
1
2
9
1
4
3
1
2
1
9
2
12
9
1
2
1
1
6
2
2
25
1
1
4
4
2
2
1
1
2
3
2
1
10
2
4
1
1
1
3
2
4
2
2
2
1
2
1
2
39
12
8
1
6
4
2
10
4
3
2
29
1
1
5
34
3
2
2
13
1
2
3
17
1
83
18
17
1
1
1
5
1
21
16
31
1
146 29
3
53
53
56
1
146 11
1
8
2
3
6
6
1
1
1
0
3
2
1
0
2
3
2
1
1
13
45
31
2
19
1
1
1
1
6
1
1
7
1
2
1
3
1
2
3
5
26
1
18
28
3
3
3
30
2
31
3
4
29
1
144 122 126 44 767 95
1
1
6
1
1
0
1
6
2
3
1
46
1
9
3
73
0
16
2
0
1
0
76
1
4
1
0
0
1
7
1
7
0
0
0
0
0
0
1
0
3
4
3
5
4
2
83
6
1
214 16
14
26
23
4
21
56
For a definition of the abbreviated treatment centres please refer to the glossary at the back of the report. Individuals living outside
of the North West Region are grouped by region, and the Isle of Man is organised as a distinct category. Rows cannot be totalled
horizontally as some individuals may appear in more than one column (i.e. those attending two or more treatment locations), thus
All Cases 2001
81
Table 3.16 illustrates the residential distribution of all HIV and AIDS cases presenting to treatment
centres in the North West in 2001. Most individuals with HIV or AIDS present to treatment centres
close to where they live. The Infectious Disease Unit at North Manchester General Hospital (NMG)
saw the largest number of people (767), and the largest number of residents outside the North West
Region (29, 4% of its patients). However, some of the other treatment centres had higher proportions
of residents from outside the region, for example Alder Hey Children’s Hospital (AHC) at 50% and
the Royal Bolton Hospital (BOLG) at 18%.
Table 3.17 illustrates the clinical stage of all HIV and AIDS cases presenting for treatment in the
North West during 2001, by treatment centre. The figures refer to the clinical condition of individuals
when last seen in the year 2001; HIV positive individuals who died are presented in separate
categories to other cases. In the North West, the treatment of HIV and AIDS cases is divided primarily
between the large infectious disease unit, genitourinary medicine clinics and haematology clinics.
Care is also provided by a number of other hospital units and a specialist general practice.
Thirty nine percent of all HIV and AIDS individuals presenting for treatment in the North West during
2001 were categorised as symptomatic, with 27% classed as AIDS (table 3.2a). The largest HIV and
AIDS treatment centre in the North West, the Infectious Disease Unit at North Manchester General
Hospital (NMG), provides care for 39% of all HIV positive individuals presenting in the North West,
including 53% of those individuals who died during the year.
There are significant differences between treatment centres in the proportion of individuals
categorised as asymptomatic, symptomatic and AIDS. Although this variation may represent real
differences, the distinction between stages of disease can be unclear, particularly in the light of
developments in combination antiretroviral therapy.
Table 3.18 illustrates the infection route of all HIV and AIDS cases presenting for treatment in the
North West in 2001, by treatment centre. There are considerable variations in the proportions of
method of exposure to HIV between different treatment centres. Ninety six percent of individuals
attending a specialist general practice in Manchester (MGP) had been exposed to HIV via homosexual
sex compared to an overall rate of 65% of all HIV and AIDS cases within the region (table 3.3a).
Treatment of individuals exposed through contaminated blood or blood products is primarily
undertaken by specialist haematology units at Manchester Royal Infirmary (MRIH) and Royal
Liverpool University Hospital (RLH).
The Infectious Disease Unit at North Manchester General Hospital (NMG) provides care for the
highest number of HIV positive individuals in the North West (767), representing a 14% increase on
the previous year. A number of other treatment centres have seen sharper increases: Victoria Hospital
in Blackpool (BLAG) with 25%, Royal Preston Hospital with 35% and Royal Bolton Hospital seeing a
62% increase. The main provider of HIV treatment and care in Cheshire & Merseyside, the Royal
Liverpool University Hospital Department of Genito-Urinary Medicine (RLG) has also seen a large
increase (by 43%, from 150 in 2000 to 214 in 2001), explained at least in part by their having taken
over the care of HIV positive individuals from the Infectious Disease Unit of University Hospital
Aintree (FAZ) during 2001.
Table 3.19 illustrates the age distribution of all HIV and AIDS cases presenting for treatment in
the North West during 2001, by treatment centre. The age distribution of HIV cases remains (as in
previous years) concentrated in the 30-39 age range, accounting for 44% of all cases (table 3.1).
Age ranges are proportionally represented throughout most treatment sites, with the exception of
centres specialising in paediatric care, in particular Alder Hey Children’s Hospital (AHC), Booth Hall
Children’s Hospital (BOOT) and the paediatric department at the Royal Preston Hospital (PP),
where all individuals are aged under 15 years.
82
Table 3.17: Distribution of treatment for total HIV and AIDS cases by stage of HIV
disease, January-December 2001 (All cases seen during 2001 including those who died
during the year)
TREATMENT
CENTRE
AIDS
AHC
1 (16.7%)
2 (33.3%)
3 (50.0%)
APH
10 (37.0%)
5 (18.5%)
10 (37.0%)
ARM
2 (28.6%)
1 (14.3%)
4 (57.1%)
BLAG
46 (27.9%)
63 (38.2%)
49 (29.7%)
2 (66.7%)
1 (33.3%)
BLK
BLKG
4 (36.4%)
7 (63.6%)
20 (27.4%)
BOLG
29 (39.7%)
BOOT
1 (33.3%)
BURG
2 (15.4%)
BURY
CHR
CPED
1 (100.0%)
CUM
AIDS Related
Death
Death unrelated Unknown
to AIDS
Total
(100%)
6
2 (7.4%)
27
7
2 (1.2%)
2 (1.2%)
3 (1.8%)
165
3
11
24 (32.9%)
73
2 (66.7%)
3
8 (61.5%)
3 (23.1%)
13
2 (8.7%)
13 (56.5%)
6 (26.1%)
32 (74.4%)
7 (16.3%)
4 (9.3%)
12 (52.2%)
2 (8.7%)
6 (26.1%)
2 (8.7%)
FAZ
20 (28.2%)
23 (32.4%)
26 (36.6%)
2 (2.8%)
FGH
2 (25.0%)
2 (25.0%)
4 (50.0%)
HAL
1 (4.3%)
1 (4.3%)
23
43
1
1 (4.3%)
23
71
8
1 (100.0%)
1
LEI
3 (42.9%)
1 (14.3%)
3 (42.9%)
LEII
3 (37.5%)
1 (12.5%)
3 (37.5%)
MAC
12 (57.1%)
4 (19.0%)
5 (23.8%)
MGP
42 (29.2%)
71 (49.3%)
27 (18.8%)
7
1 (12.5%)
8
21
1 (0.7%)
1 (0.7%)
2 (1.4%)
144
MRI
35 (28.7%)
54 (44.3%)
33 (27.0%)
MRIG
70 (55.6%)
38 (30.2%)
16 (12.7%)
MRIH
5 (11.4%)
28 (63.6%)
9 (20.5%)
2 (4.5%)
NMG
134 (17.5%)
354 (46.2%)
260 (33.9%)
16 (2.1%)
NMGG
41 (43.2%)
42 (44.2%)
11 (11.6%)
1 (1.1%)
NOB
3 (50.0%)
2 (33.3%)
1 (16.7%)
6
OLDG
1 (50.0%)
1 (50.0%)
2
PG
22 (30.1%)
24 (32.9%)
24 (32.9%)
PP
4 (57.1%)
2 (28.6%)
1 (14.3%)
QSC
15 (19.7%)
27 (35.5%)
24 (31.6%)
2 (2.6%)
RLG
54 (25.2%)
94 (43.9%)
65 (30.4%)
1 (0.5%)
RLH
8 (50.0%)
4 (25.0%)
3 (18.8%)
RLI
10 (71.4%)
2 (14.3%)
2 (14.3%)
14
ROCG
3 (11.5%)
18 (69.2%)
5 (19.2%)
26
SALG
10 (43.5%)
10 (43.5%)
3 (13.0%)
23
SHH
3 (75.0%)
1 (25.0%)
SPG
9 (42.9%)
3 (14.3%)
9 (42.9%)
21
20 (35.7%)
STP
18 (32.1%)
17 (30.4%)
TAMG
2 (66.7%)
1 (33.3%)
TRAG
3 (75.0%)
1 (25.0%)
WAR
122
2 (1.6%)
126
44
3 (0.4%)
767
95
2 (2.7%)
1 (1.4%)
73
6 (7.9%)
76
7
2 (2.6%)
214
1 (6.3%)
16
4
1 (1.8%)
56
3
4
2 (66.7%)
1 (33.3%)
3
2 (40.0%)
2 (40.0%)
5
2 (50.0%)
4
WGH
1 (20.0%)
WHIT
2 (50.0%)
WIGG
1 (50.0%)
1 (50.0%)
WITG
37 (44.6%)
29 (34.9%)
17 (20.5%)
83
WORK
4 (66.7%)
1 (16.7%)
1 (16.7%)
6
2
totalled vertically as some individuals may appear in more than one row (i.e. those attending two or more treatment locations),
thus exaggerating the totals.
All Cases 2001
83
Table 3.18: Distribution of treatment for total HIV and AIDS cases by infection route of HIV,
INFECTION ROUTE
TREATMENT
CENTRE
Homo/
Bisexual
Injecting
Drug Use
Heterosexual
Blood/
Tissue
16 (59.3%)
1 (3.7%)
8 (29.6%)
1 (3.7%)
AHC
APH
Undetermined
6 (100%)
ARM
5 (71.4%)
1 (14.3%)
1 (14.3%)
BLAG
139 (84.2%)
5 (3.0%)
13 (7.9%)
BLK
3 (100.0%)
BLKG
7 (63.6%)
BOLG
45 (61.6%)
6
1 (3.7%)
27
2 (1.2%)
2 (1.2%)
165
3
4 (36.4%)
2 (2.7%)
11
26 (35.6%)
73
3 (100.0%)
6 (46.2%)
2 (15.4%)
BURY
12 (52.2%)
1 (4.3%)
CHR
27 (62.8%)
4 (30.8%)
8 (34.8%)
3
1 (7.7%)
1 (4.3%)
1 (4.3%)
43
1 (100.0%)
12 (52.2%)
1 (4.3%)
10 (43.5%)
13
23
16 (37.2%)
CPED
CUM
Total
(100%)
7
4 (2.4%)
BOOT
BURG
Mother
to Child
1
23
FAZ
37 (52.1%)
4 (5.6%)
26 (36.6%)
FGH
4 (50.0%)
1 (12.5%)
3 (37.5%)
2 (2.8%)
2 (2.8%)
71
HAL
1 (100.0%)
LEI
5 (71.4%)
1 (14.3%)
LEII
5 (62.5%)
1 (12.5%)
2 (25.0%)
MAC
11 (52.4%)
1 (4.8%)
7 (33.3%)
1 (4.8%)
MGP
138 (95.8%)
2 (1.4%)
3 (2.1%)
1 (0.7%)
144
MRI
102 (83.6%)
4 (3.3%)
14 (11.5%)
2 (1.6%)
122
MRIG
100 (79.4%)
2 (1.6%)
24 (19.0%)
8
1
MRIH
1 (14.3%)
7
1 (4.8%)
21
8
126
3 (6.8%)
41 (93.2%)
167 (21.8%)
4 (0.5%)
NMG
517 (67.4%)
42 (5.5%)
NMGG
80 (84.2%)
4 (4.2%)
NOB
1 (16.7%)
OLDG
2 (100.0%)
PG
31 (42.5%)
1 (1.4%)
35 (47.9%)
QSC
65 (85.5%)
3 (3.9%)
7 (9.2%)
RLG
106 (49.5%)
14 (6.5%)
83 (38.8%)
4 (1.9%)
1 (6.3%)
15 (93.8%)
44
17 (2.2%)
9 (9.5%)
20 (2.6%)
767
2 (2.1%)
95
5 (83.3%)
6
2
3 (4.1%)
PP
RLH
3 (4.1%)
73
7 (100.0%)
7
1 (1.3%)
76
7 (3.3%)
214
16
RLI
6 (42.9%)
1 (7.1%)
7 (50.0%)
14
ROCG
18 (69.2%)
3 (11.5%)
5 (19.2%)
26
5 (21.7%)
23
SALG
18 (78.3%)
SHH
4 (100.0%)
SPG
10 (47.6%)
4
9 (42.9%)
1 (1.8%)
13 (23.2%)
21
1 (1.8%)
56
STP
40 (71.4%)
TAMG
2 (66.7%)
1 (33.3%)
3
TRAG
3 (75.0%)
1 (25.0%)
4
WAR
3 (100.0%)
WGH
2 (40.0%)
2 (40.0%)
5
3
1 (20.0%)
WHIT
2 (50.0%)
WIGG
1 (50.0%)
WITG
69 (83.1%)
WORK
4 (66.7%)
1 (1.8%)
2 (9.5%)
4 (4.8%)
1 (25.0%)
1 (25.0%)
4
1 (50.0%)
2
10 (12.0%)
83
2 (33.3%)
6
For a definition of the abbreviated treatment centres please refer to the glossary at the back of the report. Men who have had
homosexual or bisexual exposure and who are also injecting drug users are included in the homo/bisexual category. Columns cannot
be totalled vertically as some individuals may appear in more than one row (i.e. those attending two or more treatment locations),
84
Table 3.19: Distribution of treatment for total HIV and AIDS cases by age category,
40-44
45-49
7 (25.9%)
5 (18.5%)
3 (11.1%)
1 (3.7%)
1 (14.3%)
2 (28.6%)
1 (14.3%)
4 (2.4%)
14 (8.5%)
36 (21.8%) 37 (22.4%) 29 (17.6%)
2 (18.2%)
1 (9.1%)
3 (27.3%)
4 (5.5%)
9 (12.3%)
14 (19.2%) 14 (19.2%) 15 (20.5%)
4 (30.8%)
1 (7.7%)
1 (14.3%)
2 (1.2%)
2 (1.2%)
BLK
2 (7.4%)
2 (7.4%)
27
7 (4.2%)
4 (2.4%)
7 (4.2%)
165
1 (33.3%)
1 (33.3%)
3
2 (18.2%)
1 (9.1%)
11
8 (11.0%)
3 (4.1%)
3 (4.1%)
2 (15.4%)
2 (15.4%)
3 (23.1%)
1 (7.7%)
13
43
2 (28.6%)
23 (13.9%)
1 (33.3%)
BOLG
2 (18.2%)
7
1 (4.3%)
3 (13.0%)
4 (17.4%)
7 (30.4%)
3 (13.0%)
3 (13.0%)
2 (8.7%)
2 (4.7%)
9 (20.9%)
11 (25.6%) 12 (27.9%)
3 (7.0%)
2 (4.7%)
2 (4.7%)
2 (4.7%)
23
1 (4.3%)
2 (8.7%)
4 (17.4%)
4 (17.4%)
5 (21.7%)
3 (13.0%)
1 (4.3%)
1 (1.4%)
3 (4.2%)
15 (21.1%) 16 (22.5%) 16 (22.5%)
7 (9.9%)
7 (9.9%)
5 (62.5%)
2 (25.0%)
1 (100.0%)
1
CUM
FAZ
1 (1.4%)
FGH
1 (12.5%)
2 (8.7%)
HAL
1 (4.3%)
23
5 (7.0%)
71
8
1 (100.0%)
LEI
1 (14.3%)
1
1 (14.3%)
1 (14.3%)
1 (14.3%)
LEII
2 (25.0%)
1 (12.5%)
1 (12.5%)
1 (12.5%)
1 (12.5%)
MAC
4 (19.0%)
5 (23.8%)
8 (38.1%)
1 (4.8%)
1 (4.8%)
1 (4.8%)
2 (28.6%)
1 (14.3%)
8
1 (4.8%)
21
3 (2.1%)
19 (13.2%)
41 (28.5%) 40 (27.8%) 24 (16.7%)
10 (6.9%)
5 (3.5%)
MRI
5 (4.1%)
19 (15.6%)
26 (21.3%) 30 (24.6%) 25 (20.5%)
6 (4.9%)
8 (6.6%)
1 (0.8%)
15 (11.9%)
33 (26.2%)
25 (19.8%) 29 (23.0%)
10 (7.9%)
6 (4.8%)
5 (4.0%)
2 (1.6%)
6 (13.6%)
9 (20.5%)
7 (15.9%)
8 (18.2%)
1 (0.8%)
MRIH
16 (2.1%)
3 (0.4%)
NMGG
16 (2.1%)
6 (6.3%)
11 (25.0%)
40 (5.2%)
14 (1.8%)
19 (20.0%)
2 (2.1%)
1 (1.1%)
24 (25.3%) 22 (23.2%) 15 (15.8%)
6 (6.3%)
3 (50.0%)
1 (16.7%)
OLDG
1 (50.0%)
PG
3 (4.1%)
PP
7 (100.0%)
QSC
1 (1.3%)
2 (33.3%)
2 (1.4%)
144
2 (1.6%)
122
126
3 (6.8%)
79 (10.3%) 144 (18.8%) 205 (26.7%) 149 (19.4%) 79 (10.3%)
NOB
7
2 (25.0%)
MGP
MRIG
73
3
CHR
NMG
3 (4.1%)
3 (100.0%)
BURG
CPED
4 (14.8%)
6
BLKG
BURY
60+
35-39
ARM
BOOT
55-59
30-34
2 (7.4%)
Total
(100%)
50-54
25-29
15-19
1 (3.7%)
6 (100.0%)
APH
BLAG
20-24
AHC
0-14
AGE GROUP
TREATMENT
CENTRE
44
22 (2.9%)
767
95
6
1 (50.0%)
2
2 (2.7%)
10 (13.7%)
11 (15.1%) 18 (24.7%) 11 (15.1%)
7 (9.6%)
4 (5.5%)
3 (4.1%)
4 (5.5%)
73
3 (3.9%)
5 (6.6%)
18 (23.7%) 16 (21.1%) 14 (18.4%)
7 (9.2%)
6 (7.9%)
1 (1.3%)
4 (5.3%)
76
7 (3.3%)
11 (5.1%)
214
7
1 (1.3%)
RLG
1 (0.5%)
6 (2.8%)
21 (9.8%)
41 (19.2%) 55 (25.7%) 38 (17.8%)
18 (8.4%)
16 (7.5%)
RLH
2 (12.5%)
1 (6.3%)
2 (12.5%)
4 (25.0%)
3 (18.8%)
2 (12.5%)
1 (6.3%)
1 (6.3%)
2 (14.3%)
1 (7.1%)
3 (21.4%)
2 (14.3%)
3 (21.4%)
1 (7.1%)
RLI
16
2 (14.3%)
14
ROCG
2 (7.7%)
4 (15.4%)
9 (34.6%)
6 (23.1%)
1 (3.8%)
2 (7.7%)
2 (7.7%)
SALG
3 (13.0%)
2 (8.7%)
7 (30.4%)
6 (26.1%)
2 (8.7%)
1 (4.3%)
1 (4.3%)
1 (4.3%)
23
SHH
1 (25.0%)
1 (25.0%)
2 (50.0%)
1 (4.8%)
10 (47.6%)
4 (19.0%)
2 (9.5%)
2 (9.5%)
1 (4.8%)
1 (4.8%)
21
9 (16.1%)
7 (12.5%)
12 (21.4%)
8 (14.3%)
7 (12.5%)
8 (14.3%)
1 (33.3%)
1 (33.3%)
SPG
STP
3 (5.4%)
TAMG
1 (33.3%)
TRAG
1 (25.0%)
WAR
1 (25.0%)
3 (75.0%)
WORK
56
3
4
1 (33.3%)
WHIT
1 (20.0%)
1 (33.3%)
2 (40.0%)
1 (20.0%)
4
1 (50.0%)
10 (12.0%)
23 (27.7%) 16 (19.3%) 12 (14.5%)
1 (16.7%)
2 (33.3%)
2 (33.3%)
1 (16.7%)
3
5
1 (25.0%)
1 (50.0%)
4 (4.8%)
2 (3.6%)
1 (25.0%)
1 (33.3%)
1 (20.0%)
WITG
4
1 (25.0%)
WGH
WIGG
26
9 (10.8%)
4 (4.8%)
2
1 (1.2%)
4 (4.8%)
83
6
totalled vertically as some individuals may appear in more than one row (i.e. those attending two or more treatment locations),
All Cases 2001
85
Table 3.20: Distribution of treatment for total HIV and AIDS cases by sex,
TREATMENT
CENTRE
SEX
Total
(100%)
Male
Female
AHC
3 (50.0%)
3 (50.0%)
6
APH
26 (96.3%)
1 (3.7%)
27
10 (6.1%)
165
ARM
7 (100.0%)
BLAG
155 (93.9%)
7
BLK
3 (100.0%)
BLKG
9 (81.8%)
2 (18.2%)
11
3
73
BOLG
52 (71.2%)
21 (28.8%)
BOOT
2 (66.7%)
1 (33.3%)
3
BURG
11 (84.6%)
2 (15.4%)
13
BURY
15 (65.2%)
8 (34.8%)
23
CHR
33 (76.7%)
10 (23.3%)
43
CPED
1 (100.0%)
1
CUM
17 (73.9%)
6 (26.1%)
23
FAZ
55 (77.5%)
16 (22.5%)
71
FGH
5 (62.5%)
3 (37.5%)
8
HAL
1 (100.0%)
1
LEI
7 (100.0%)
7
LEII
7 (87.5%)
1 (12.5%)
8
MAC
19 (90.5%)
2 (9.5%)
21
MGP
141 (97.9%)
3 (2.1%)
144
MRI
110 (90.2%)
12 (9.8%)
122
MRIG
110 (87.3%)
16 (12.7%)
126
MRIH
38 (86.4%)
6 (13.6%)
44
NMG
657 (85.7%)
110 (14.3%)
767
NMGG
88 (92.6%)
7 (7.4%)
95
NOB
4 (66.7%)
2 (33.3%)
6
OLDG
2 (100.0%)
PG
53 (72.6%)
20 (27.4%)
73
2
PP
2 (28.6%)
5 (71.4%)
7
QSC
72 (94.7%)
4 (5.3%)
76
RLG
164 (76.6%)
50 (23.4%)
214
RLH
15 (93.8%)
1 (6.3%)
16
RLI
10 (71.4%)
4 (28.6%)
14
ROCG
22 (84.6%)
4 (15.4%)
26
SALG
21 (91.3%)
2 (8.7%)
23
SHH
4 (100.0%)
SPG
18 (85.7%)
3 (14.3%)
21
56
4
STP
48 (85.7%)
8 (14.3%)
TAMG
2 (66.7%)
1 (33.3%)
TRAG
4 (100.0%)
Table 3.20 illustrates the number of
male and female HIV and AIDS cases
presenting for treatment in the North
West in 2001, by treatment centre.
The vast majority of all HIV and AIDS
cases treated in the North West were
male (84%; table 3.4), with this trend
illustrated to varying degrees at most
treatment centres. The gender
distribution at treatment centres is
influenced primarily by the proportion
of individuals whose infection route
was classed as homosexual sex. This is
most clearly illustrated at a specialist
Manchester general practice (MGP)
where homosexual exposure accounted
for 96% of cases (table 3.18) and 98%
of individuals were male. Similarly, the
Armistead Project in Liverpool (ARM)
caters specifically for gay men.
The Haematology Units in Manchester
Royal Infirmary (MRIH) and Royal
Liverpool University (RLH) also see
more males because conditions such as
haemophilia are more common among
males, and many haemophiliacs were
infected with HIV prior to screening of
blood products. Exceptions to this male
biased gender distribution occur at
treatment centres specialising in
paediatric care such as Alder Hey
Children’s Hospital (AHC) and the
Paediatric Department at Royal Preston
Hospital (PP) where males and females
are equally likely to be affected.
3
4
WAR
3 (100.0%)
WGH
4 (80.0%)
1 (20.0%)
3
5
WHIT
3 (75.0%)
1 (25.0%)
4
WIGG
1 (50.0%)
1 (50.0%)
2
WITG
78 (94.0%)
5 (6.0%)
83
WORK
4 (66.7%)
2 (33.3%)
6
For a definition of the abbreviated treatment centres please refer to the
glossary at the back of the report. Columns cannot be totalled vertically
as some individuals may appear in more than one row (i.e. those
attending two or more treatment locations), thus exaggerating the totals.
86
Table 3.21: Residential distribution of total HIV and AIDS cases by number of
treatment centres attended, January-December 2001 (All cases seen during 2001
including those who died during the year)
SHA OF
RESIDENCE
TREATMENT CENTRES ATTENDED
One
Two
Three
Four
Total
(100%)
298 (75.8%)
87 (22.1%)
8 (2.0%)
393
Merseyside & Cheshire
302 (81.8%)
65 (17.6%)
2 (0.5%)
369
Greater Manchester
827 (75.0%)
247 (22.4%)
28 (2.5%)
Eastern
1 (100.0%)
Isle of Man
7 (63.6%)
1 (0.1%)
1103
1
4 (36.4%)
11
1 (4.3%)
23
London
7 (100.0%)
22 (95.7%)
7
South East
3 (100.0%)
South West
2 (100.0%)
Trent
12 (80.0%)
2 (13.3%)
Wales
12 (66.7%)
6 (33.3%)
18
West Midlands
8 (72.7%)
3 (27.3%)
11
Unknown
5 (100.0%)
5
Abroad
3 (100.0%)
3
Total
1509 (76.8%)
3
2
415 (21.1%)
1 (6.7%)
39 (2.0%)
15
1 (0.1%)
1964
For a breakdown of number of treatment centres by primary care trust, please see the North West Public Health Observatory
website: www.nwpho.org.uk/hiv2001/table3-21.htm
Table 3.21 illustrates the residential distribution of all HIV and AIDS cases presenting in the North
West for treatment in 2001 by the number of statutory treatment centres attended. The majority
(77%) attended only one treatment centre, a comparable proportion to 2000. However, this varied
across strategic health authorities, with residents of Cheshire & Merseyside being more likely to
attend only one centre (82%) than those of Cumbria & Lancashire (76%) or Greater Manchester (75%).
It should be noted that these numbers refer only to treatment centres within the North West.
All Cases 2001
87
MGP
MAC
LEII
LEI
HAL
FGH
FAZ
CUM
CPED
CHR
BURY
BURG
BOOT
BOLG
BLKG
BLK
BLAG
ARM
MRIG
APH
MRI
AHC
APH
AHC
Table 3.22: Overlap of total HIV and AIDS cases between different centres of treatment,
1
1
6
25
1
ARM
1
94
BLAG
1
3
BLK
10
BLKG
65
BOLG
1
BOOT
10
BURG
1
BURY
39
CHR
1
1
CPED
1
CUM
21
1
FAZ
1
14
1
1
1
7
FGH
1
HAL
0
LEI
5
2
LEII
2
6
17
MAC
MGP
MRI
1
MRIG
1
MRIH
1
NMG
6
1
22
23
1
23
68
8
10
8
93
1
4
2
2
1
NMGG
19
2
2
1
1
3
1
1
2
92
30
11
10
16
2
1
NOB
OLDG
2
PG
1
1
PP
67
QSC
RLG
2
4
1
1
51
2
1
1
RLH
RLI
1
ROCG
3
1
SALG
1
SHH
SPG
STP
2
1
2
1
1
4
2
TAMG
TRAG
1
WAR
WGH
WHIT
WIGG
WITG
WORK
88
TOTAL
WORK
WITG
WIGG
WHIT
WGH
WAR
TRAG
TAMG
STP
SPG
SHH
SALG
ROCG
RLI
RLH
RLG
QSC
PP
PG
OLDG
NOB
NMGG
NMG
MRIH
6
2
27
4
1
6
2
2
67
7
1
165
3
1
4
11
1
1
1
73
2
3
2
1
19
1
1
13
3
2
23
1
43
1
1
2
1
51
23
1
1
71
1
8
1
7
8
3
1
92
2
30
16
37
3
2
11
2
2
1
1
2
8
41
144
122
126
1
1
1
3
1
3
5
1
2
44
15
3
1
1
2
2
18
767
1
95
2
6
1
2
8
2
62
3
3
4
1
1
1
3
4
2
1
515 44
1
1
1
1
3
44
2
1
1
1
73
7
7
76
145
2
2
13
1
2
1
1
214
16
12
2
14
17
5
26
17
2
1
1
1
21
1
15
1
3
1
1
23
2
4
16
21
35
1
2
3
0
2
56
0
1
1
4
0
3
5
5
2
4
2
18
1
1
1
2
56
83
6
6
The diagonal (in bold) represents the number of individuals who solely used each treatment centre in 2001. The total column
represents the total number of individuals attending each treatment centre (excluding double counting of individuals attending more
than two treatment centres). Individuals attending three or more treatment centres are counted more than once in the body of the
table. For a definition of the abbreviated treatment centres please refer to the glossary at the back of the report.
All Cases 2001
89
Table 3.22 illustrates the overlap of treatment of HIV and AIDS cases between treatment centres in
the North West during 2001. The diagonal (in bold) represents the number of individuals who used
each treatment centre as their sole provider of care during 2001, and the right hand column shows
the total numbers accessing each treatment centre. For example, although 767 individuals accessed
care from North Manchester General Infectious Disease Unit (NMG), only 67% (515) used NMG
as their sole provider of care. North Manchester General patients also attended Manchester Royal
Infirmary Outpatient Department (MRI, 30 individuals) and a specialist general practice in Manchester
(MGP, 92 individuals). The crossover of treatment may reflect individuals simultaneously accessing
treatment and care from more than one centre or may represent individuals who have transferred their
care between treatment centres during 2001. For example, all HIV positive individuals receiving care
from University Hospital Aintree (FAZ) transferred their care to Royal Liverpool University Hospital
(RLG) during 2001 and most were seen at both centres.
Table 3.23 displays the amount of outpatient days, day cases, inpatient days, inpatient episodes and
home visits attributed to HIV and AIDS cases accessing care from the statutory sector during 2001.
The data are displayed as the total number of days, episodes or visits and the mean number of days,
episodes or visits per HIV positive individual treated by that centre. This is the third year that
information on inpatient and outpatient care for the whole of the North West Region has been
collected, allowing comparisons to be made with the data from 1999 and 2000. This year, for the
first time, we have collected information on the number of home visits. These data show that each
HIV positive person in the North West received on average 1.1 home visits during the year. However,
this is likely to be an underestimate of the true level of this activity carried out by the statutory sector,
since some treatment centres were unable to provide these data this year but nonetheless did provide
home visits (for example, Withington Hospital, Department of Genito-Urinary Medicine – WITG).
We hope that a more complete picture will be provided in future years.
As was the case in 1999 and 2000, in the year 2001 North Manchester General Infectious Disease
Unit (NMG) provided the highest number of outpatient visits, day cases, inpatient episodes and
inpatient days. Outpatient visits at NMG accounted for 28% of all attendances across the region,
with the Department of Genito-Urinary Medicine at the Royal Liverpool University Hospital (RLG)
reporting the second highest number of visits, and a higher mean number of outpatient visits per
HIV positive person. The Department of Genito-Urinary Medicine at Arrowe Park Hospital (APH)
and Alder Hey Children’s Hospital (ACH) provided the highest mean number of outpatient visits per
HIV positive patient (each with 17.7 visits), over twice the overall average (7.2 visits per patient).
North Manchester General Infectious Disease Unit (NMG) also provided the highest number of
inpatient episodes (51% of the total) and inpatient days (54% of the total), with the Victoria Hospital
in Blackpool (BLAG) and the Department of Genito-Urinary Medicine at the Royal Liverpool
University Hospital (RLG) providing the next highest numbers of inpatient episodes (10% and
11% of the total respectively) and days (6% and 14%).
Some of the treatment centres provided a significant number of home visits, with the Queen Street
Clinic in Blackpool (QSC) providing the most at 270 (an average of 3.6 per HIV positive person in
their care). Bury General Hospital (BURY) and Royal Oldham Hospital (OLDG) provided the
highest number of visits per HIV positive person, at 5.8 and 6.5 respectively.
90
Table 3.23: Distribution of total and mean number of outpatient visits, day cases,
inpatient episodes, inpatient days and home visits by treatment centre, JanuaryDecember 2001 (All cases seen during 2001 including those who died during the year)
OUTPATIENT VISITS
DAY CASES
INPATIENT EPISODES
INPATIENT DAYS
HOME VISITS
Total
Mean
Total
Mean
Total
Mean
Total
Mean
Total
AHC
106
17.7
3
0.5
8
1.3
32
5.3
7
Mean
1.2
APH
478
17.7
80
3.0
15
0.6
208
7.7
0
0.0
ARM
95
13.6
0
0.0
0
0.0
0
0.0
0
0.0
BLAG
1122
6.8
38
0.2
66
0.4
463
2.8
0
0.0
BLK
18
6.0
0
0.0
0
0.0
0
0.0
0
0.0
BLKG
104
9.5
0
0.0
0
0.0
0
0.0
0
0.0
BOLG
675
9.2
0
0.0
4
0.1
18
0.2
0
0.0
BOOT
5
1.7
1
0.3
5
1.7
49
16.3
0
0.0
BURG
114
8.8
1
0.1
2
0.2
5
0.4
47
3.6
BURY
2
0.1
0
0.0
4
0.2
22
1.0
127
5.8
CHR
298
6.9
0
0.0
1
0.0
14
0.3
13
0.4
CPED
4
4.0
0
0.0
0
0.0
0
0.0
4
4.0
CUM
154
6.7
6
0.3
9
0.4
168
7.3
9
0.4
FAZ
329
4.6
1
0.0
30
0.4
375
5.3
0
0
FGH
16
2.0
0
0.0
4
0.5
55
6.9
12
1.5
HAL
8
8.0
0
0.0
2
2.0
7
7.0
0
0.0
LEI
87
12.4
1
0.1
0
0.0
0
0.0
0
0.0
0.3
LEII
39
4.9
9
1.1
2
0.3
45
5.6
2
MAC
210
10.0
0
0.0
3
0.1
29
1.4
7
0.4
MGP
847
5.9
0
0.0
0
0.0
0
0.0
6
0.0
0.0
MRI
1025
8.4
10
0.1
3
0.0
6
0.0
0
MRIG
1157
9.2
0
0.0
4
0.0
26
0.2
0
0.0
MRIH
351
8.0
24
0.5
18
0.4
174
4.0
3
0.1
NMG
5222
6.8
342
0.4
323
0.4
4000
5.2
0
0
NMGG
560
5.9
1
0.0
3
0.0
11
0.1
0
0.0
0.2
NOB
92
15.3
0
0.0
2
0.3
3
0.5
1
OLDG
1
0.5
0
0.0
0
0.0
0
0.0
13
6.5
PG
551
7.5
8
0.1
19
0.3
319
4.4
45
0.6
PP
26
3.7
1
0.1
1
0.1
3
0.4
0
0.0
QSC
590
7.8
0
0.0
0
0.0
0
0.0
270
3.6
RLG
2075
9.7
0
0.0
71
0.3
1052
4.9
0
0.0
RLH
93
5.8
2
0.1
7
0.4
52
3.3
0
0.0
RLI
33
2.4
0
0.0
0
0.0
0
0.0
50
3.8
ROCG
293
11.3
0
0.0
0
0.0
0
0.0
6
0.2
SALG
97
4.2
0
0.0
1
0.0
5
0.2
0
0.0
SHH
36
9.0
0
0.0
0
0.0
0
0.0
0
0
SPG
198
9.4
0
0.0
3
0.1
167
8.0
2
0.1
STP
356
6.4
1
0.0
14
0.3
85
1.5
10
0.2
TAMG
8
2.7
0
0.0
0
0.0
0
0.0
0
0.0
TRAG
32
8.0
0
0.0
0
0.0
0
0.0
0
0.0
WAR
4
1.3
0
0.0
1
0.3
15
5.0
1
0.5
WGH
16
3.2
0
0.0
0
0.0
0
0.0
20
4.0
WHIT
21
5.3
0
0.0
0
0.0
0
0.0
14
3.5
WIGG
12
6.0
0
0.0
0
0.0
0
0.0
7
3.5
WITG
768
9.3
0
0.0
0
0.0
0
0.0
0
0.0
WORK
40
6.7
2
0.3
6
1.0
13
2.2
12
2.0
Total
18368
7.2
531
0.2
631
0.3
7421
2.3
688
1.1
For a definition of the abbreviated treatment centres please refer to the glossary at the back of the report. The means are
calculated as the number of outpatient visits / day cases / inpatient episodes / inpatient days / home visits divided by the total
number of HIV positive individuals accessing the treatment centre.
All Cases 2001
91
Table 3.24: Distribution of total and mean number of outpatient episodes, day cases,
inpatient episodes, inpatient days and home visits by stage of HIV disease, JanuaryDecember 2001 (All cases seen during 2001 including those who died during the year)
STAGE OF
HIV DISEASE
OUTPATIENT
VISITS
DAY
CASES
INPATIENT
EPISODES
INPATIENT
DAYS
HOME
VISITS
Total
Mean
Total
Mean
Total
Mean
Total
Mean
Total
Mean
Asymptomatic
4790
7.9
47
0.1
65
0.1
401
0.7
106
0.2
Symptomatic
7460
9.6
141
0.2
196
0.3
1469
1.9
222
0.4
AIDS
5800
10.9
274
0.5
302
0.6
4256
8.0
269
0.8
AIDS Related Death
222
7.4
68
2.3
59
2.0
1057
35.2
63
4.5
Death unrelated to AIDS
36
6.0
1
0.2
7
1.2
221
36.8
19
6.3
Unknown
60
4.3
0
0.0
2
0.1
17
1.2
9
0.6
Total
18368
9.3
531
0.3
631
0.3
7421
3.8
688
0.4
The means are calculated as the number of outpatient visits / day cases / inpatient episodes / inpatient days / home visits divided
by the total number of HIV positive individuals in the clinical category.
Table 3.24 illustrates the distribution of patient care by clinical stage for all those HIV positive
individuals accessing treatment and care in the North West in 2001. The data show the increasing
level and different type of care required as HIV disease progresses. While asymptomatic individuals
required on average 7.9 outpatient visits per patient, 9.6 visits were required per symptomatic patient
rising to 10.9 visits for each patient with an AIDS diagnosis. Those who died of an AIDS related illness
during the year had an average of only 7.4 outpatient visits during 2001 but required by far the largest
amount of inpatient care, at an average of 35.2 days each. In contrast, asymptomatic, symptomatic
and AIDS patients required only 0.7, 1.9 and 8.0 days of inpatient care respectively. Levels of care
were similar in 2001 compared to 1999 and 2000, with the overall mean number of outpatient visits
dropping slightly (from 10.4 to 9.5 to 9.3 visits per HIV positive individual) and the number of inpatient
days increasing slightly from 3.5 in 1999 to 3.8 days per patient in 2000 and 2001.
Figure 3.4 illustrates the population prevalence of all HIV and AIDS cases in the North West who
attended statutory centres within the region during 2001. The population sizes for each primary
care trust used in the prevalence calculations are those published by the NHS North West Regional
Office131. For a description of the residential distribution of all HIV and AIDS cases in the North
West of England see tables 3.2 and 3.3.
92
Figure 3.4: Population prevalence of total HIV and AIDS cases by primary care trust,
N
Per 100,000
Population
<9
9 to <11
11 to <18
18 to <30
30 to <45
=>45
All Cases 2001
93
Table 3.25: Residence, infection route, ethnicity and stage of HIV disease by sex
of individuals known to be refugees, January-December 2001
SHA OF
RESIDENCE
SEX
Male
Female
Total
(100%)
1 (100.0%)
8 (42.1%)
11 (57.9%)
19
Greater Manchester
16 (40.0%)
24 (60.0%)
40
3 (100.0%)
3
Out of region
1
INFECTION ROUTE
Heterosexual
22 (38.6%)
35 (61.4%)
57
Mother to Child
2 (50.0%)
2 (50.0%)
4
Undetermined
1 (50.0%)
1 (50.0%)
2
ETHNICITY
Black Caribbean
1 (100.0%)
Black African
22 (37.3%)
Indian/Pakistani/Bangladeshi
1
37 (62.7%)
59
1 (100.0%)
1
2 (100.0%)
2
Asymptomatic
13 (48.1%)
14 (51.9%)
27
Symptomatic
5 (26.3%)
14 (73.7%)
19
AIDS
7 (43.8%)
9 (56.3%)
16
1 (100.0%)
1
25 (39.7%)
38 (60.3%)
63
AIDS Related Death
Total
Table 3.25 shows demographic information, infection route and stage of HIV disease by sex of
those individuals known to be refugees who accessed treatment and care in the North West in 2001.
This is the first year that we have attempted to collect information on refugee status, making it
possible to begin to identify this vulnerable group as a significant presence in the HIV positive
community. Of the total number of HIV positive individuals seen in 2001, 63 (3%) were known to
be refugees. For a further 115 (6%), this information was unknown. Most (66%) of the refugees
were new to the region in 2001.
Most of the known HIV positive refugees (63%) were resident in the strategic health authority
of Greater Manchester and Lancashire, with a further 30% residing in Cheshire & Merseyside.
The vast majority (90%) were infected by heterosexual sex and 6% were infected by mother to child
transmission. Most (94%) were black African, and there were more women (60%) than men (40%).
Refugees were, on average, at an earlier stage of HIV disease than were the entire population of HIV
positive individuals (table 3.2a). A greater proportion (43%) had asymptomatic HIV (compared to
31% of the entire population) and 30% had symptomatic HIV (compared to 39%). Twenty seven percent
of the refugees had an AIDS diagnosis, compared to 29% of the total population of HIV positive
individuals. Only one refugee died during the year. Thus, it appears that most refugees are accessing
services whilst still relatively healthy, and thus may benefit from life prolonging treatment.
94
4
Voluntary Agencies 2001
Voluntary organisations have long played
a fundamental role in the recognition of
HIV/AIDS and in addressing the needs of
HIV positive individuals8,133. In the North
West Region, voluntary agencies continue
to provide a wide range of services to
HIV positive individuals and their families.
Recent research into the economics of
HIV in the North West of England has
established that seven voluntary agencies
annually contribute a million pounds
worth of services over and above those
purchased by the statutory sector36.
During 2001, 1,037 HIV positive
individuals were reported to the North
West HIV/AIDS Monitoring Unit by eight
voluntary organisations in the North West.
4. VOLUNTARY AGENCIES 2001
Voluntary agencies have contributed data to the North West HIV/AIDS Monitoring Unit since 1995,
and have consistently been shown to have provided services to a broader constituency than the
statutory sector alone3-7. The year 2001 was no exception, and 17% of individuals seen by voluntary
organisations did not access care in the statutory sector, and 9% have never been known to
the statutory sector.
There has been concern in the voluntary sector following the introduction of the Sexual Health and
HIV Strategy9. In particular, the end of ring-fencing for HIV prevention funds means that in the future
HIV will have to compete with other health issues67,68. This is further complicated by restructuring of
the NHS, with the creation of primary care trusts (PCTs) from April 2002. Services will now be
commissioned by PCTs, and there are fears that commissioners at this level within the NHS may
not allocate significant resources to address a stigmatised health issue that impacts mainly on
marginalised groups (such as ethnic minorities, gay men, sex workers and injecting drug users).
A briefing paper produced by the National HIV Prevention Information Service (on behalf of the
Health Development Agency) for voluntary organisations admits that it is not clear how prevention
services will be commissioned under the new system69.
This year we are pleased to include data from Barnardo’s in Liverpool for the first time.
Barnardo’s have developed HIV services to focus on the needs of young people affected by HIV,
having recognised that most services were principally adult orientated. Barnardo’s HIV services
are available across the UK (in Leeds, Liverpool, Manchester, Newcastle, Edinburgh, Dundee and
Glasgow). The Barnardo’s project in Liverpool has been in place since 1997. Other voluntary
agencies in the region such as George House Trust and Body Positive North West have undertaken
joint work with Barnardo’s to address the needs of children.
It is important to note that not all HIV/AIDS voluntary organisations are able to provide attributable
data for the report. Organisations such as South Lancashire HEAL and Barnardo’s in Manchester are
not included in the tables, but nonetheless make a valuable contribution to the provision of care.
Similarly, the amount of attributable data provided by each voluntary organisation does not necessarily
reflect the overall service provision of that agency. Where information relating to infection route and
ethnicity was not available from the voluntary sector, data have been updated from that provided
from the statutory care providers (where available). Figure 4.1 and tables 4.1 to 4.5 illustrate key
characteristics of individuals accessing care from individual voluntary agencies, whilst figure 4.2
and table 4.6 are concerned with those HIV positive individuals accessing voluntary care as a whole.
Where appropriate, references are made to corresponding data from previous North West reports 3-7.
Figure 4.1 illustrates the proportion of HIV positive individuals presenting to voluntary agencies in
the North West during 2001, who had and had not presented at statutory agencies in the North West,
either during 2001 or prior to 2001. Four out of the seven agencies who reported last year recorded
an increase in their client base during 2001 compared with 2000 figures: Body Positive Blackpool
increased by 141%, Sahir House by 25%, George House Trust by 7% and Blackpool HEAL by 4%.
Three organisations have reduced numbers compared with 2001: BHA decreased by 47%, Body
Positive North West by 26%, Body Positive Cheshire by 11%. The overall number of individuals
seen by the voluntary sector in 2001 is higher than in 2000 (1,037 compared with 1,004).
96
Figure 4.1: The proportion of HIV and AIDS cases presenting to voluntary organisations
and the statutory sector in the North West, January-December 2001 (All cases seen during
2001 including those who died during the year).
800
Statutory Sector Attendance
700
Seen in 2000
Seen prior to 2000
600
Never seen
500
400
300
200
100
0
BARL
BHA
B’pool HEAL BP B’pool BP Chesh
BPNW
GHT
SAHIR
Voluntary Agency
STATUTORY
SECTOR
ATTENDANCE
VOLUNTARY AGENCY
B’pool
HEAL
BP
B’pool
BP
Chesh.
BPNW
GHT
SAHIR
Never seen
3 (3.9%)
3 (3.7%)
6 (14.3%)
33 (9.6%)
42 (6.3%)
7 (6.7%)
Seen prior to 2001
1 (1.3%)
5 (6.1%)
1 (2.4%)
27 (7.9%)
49 (7.4%)
3 (2.9%)
73 (94.8%)
74 (90.2%)
35 (83.3%)
77
82
42
Seen in 2001
Total (100%)
BARL
BHA
14 (100.0%) 9 (100.0%)
14
9
283 (82.5%) 575 (86.3%) 94 (90.4%)
343
666
104
For a definition of the abbreviated voluntary agencies please refer to the glossary at the back of the report. Rows cannot be totalled
as some individuals may attend more than one voluntary organisation thus exaggerating the totals.
There is variation in the proportion of voluntary sector clients also seen within the statutory sector in
2001, ranging from 83% at Body Positive Cheshire and Body Positive North West to all of those seen
by the Black Health Agency (BHA) and Barnardo’s in Liverpool (BARL). The low level of North West
statutory sector contact with Body Positive Cheshire clients may be explained by the geographical
location of the organisation. Three out of the seven Body Positive Cheshire clients not in contact with
the North West statutory sector during 2001 were reported to reside in Wales. However, the situation
is different at other voluntary agencies, where the vast majority of clients not in contact with statutory
treatment centres in 2001 (or at any time since this level of monitoring began in 1995), reside in the
North West of England (91% for Body Positive North West, 86% for George House Trust, 86% for
Sahir house and 100% for the remaining agencies). A significant number of individuals have never
been seen at statutory centres: up to 33 individuals at Body Positive North West and 42 individuals at
George House Trust. The data suggest that the voluntary sector may be the sole provider of care and
support for a substantial number of these HIV positive individuals who do not access statutory care.
97
Table 4.1. Distribution of voluntary sector care for HIV and AIDS cases by infection
route of HIV and sex, January-December 2001 (All cases seen during 2001 including those
who died during the year).
VOLUNTARY AGENCY
INFECTION
ROUTE
BARL
Homo/Bisexual
2 (14.3%)
BHA
Injecting Drug Use
1 (7.1%)
Heterosexual
9 (64.3%)
9 (100.0%)
B’pool
HEAL
BP
B’pool
BP
Chesh.
65 (84.4%)
75 (91.5%)
25 (59.5%)
3 (3.9%)
4 (4.9%)
1 (2.4%)
15 (4.4%)
6 (7.8%)
3 (3.7%)
7 (16.7%)
30 (8.7%)
1 (2.4%)
4 (1.2%)
7 (1.1%)
2 (1.9%)
1 (2.4%)
3 (0.9%)
11 (1.7%)
1 (1.0%)
7 (16.7%)
35 (10.2%)
2 (0.3%)
8 (7.7%)
314 (91.5%) 562 (84.4%) 78 (75.0%)
Blood/Tissue
Mother to Child
2 (14.3%)
3 (3.9%)
Undetermined
BPNW
GHT
SAHIR
256 (74.6%) 478 (71.8%) 48 (46.2%)
39 (5.9%)
6 (5.8%)
129 (19.4%) 39 (37.5%)
Sex
Male
5 (35.7%)
5 (55.6%)
69 (89.6%)
79 (96.3%)
35 (83.3%)
Female
9 (64.3%)
4 (44.4%)
8 (10.4%)
3 (3.7%)
7 (16.7%)
29 (8.5%)
Total (100%)
14
9
77
82
42
343
104 (15.6%) 26 (25.0%)
666
104
For a definition of the abbreviated voluntary agencies please refer to the glossary at the back of the report. Men who have had
homosexual or bisexual exposure and are also injecting drug users are included in the homo/bisexual category. Rows cannot be
totalled as some individuals may attend more than one voluntary organisation, thus exaggerating the totals.
Table 4.1 categorises individuals accessing voluntary care in 2001 according to infection route
and sex. Apart from those attending BHA and BARL, the majority of individuals presenting to
voluntary agencies were exposed to infection by homosexual sex, ranging from 46% at Sahir House
to 92% at Body Positive Blackpool. None of BHA’s clientele were infected by homosexual sex.
This reflects the specialist nature of the BHA service which addresses the needs of black and ethnic
minority communities, among whom nearly half are women (44%) and the only transmission route is
heterosexual sex. The main route of infection for Barnardo’s clients was also heterosexual sex (64%).
Barnardo’s provides support for families with children affected by HIV. In some cases the HIV positive
client is a parent, in other cases the child. Individuals accessing care from Sahir House in Liverpool
also included a large group also exposed through heterosexual sex (38%) and a correspondingly
relatively high proportion of females (25%). A relatively high proportion of George House Trust (6%)
and Sahir House clients (6%) were injecting drug users; a higher proportion than those infected by
this route attending statutory services (4%: section 3, table 3.1).
98
Table 4.2: Distribution of voluntary sector care for HIV and AIDS cases by age group,
January-December 2001 (All cases seen during 2001 including those who died during the year).
VOLUNTARY AGENCY
AGE
GROUP
BARL
0-14
2 (14.3%)
BHA
B’pool
HEAL
BP
B’pool
3 (3.9%)
15-19
BP
Chesh.
BPNW
GHT
SAHIR
1 (2.4%)
2 (0.6%)
10 (1.5%)
1 (1.0%)
1 (0.3%)
1 (0.2%)
2 (4.8%)
16 (4.7%)
19 (2.9%)
3 (2.9%)
16 (15.4%)
1 (1.3%)
20-24
5 (6.1%)
25-29
3 (21.4%)
1 (11.1%)
7 (9.1%)
12 (14.6%)
6 (14.3%)
42 (12.2%)
72 (10.8%)
30-34
1 (7.1%)
2 (22.2%)
20 (26.0%)
15 (18.3%)
9 (21.4%)
65 (19.0%)
141 (21.2%) 19 (18.3%)
35-39
6 (42.9%)
3 (33.3%)
19 (24.7%)
16 (19.5%)
9 (21.4%)
87 (25.4%)
176 (26.4%) 32 (30.8%)
40-44
1 (7.1%)
1 (11.1%)
17 (22.1%)
17 (20.7%)
9 (21.4%)
63 (18.4%)
122 (18.3%) 14 (13.5%)
1 (11.1%)
5 (6.5%)
11 (13.4%)
3 (7.1%)
30 (8.7%)
60 (9.0%)
9 (8.7%)
3 (3.9%)
2 (2.4%)
27 (7.9%)
40 (6.0%)
6 (5.8%)
2 (2.6%)
1 (1.2%)
45-49
50-54
55-59
60+
1 (7.1%)
1 (11.1%)
Total (100%)
14
9
77
7 (2.0%)
15 (2.3%)
3 (3.7%)
3 (7.1%)
3 (0.9%)
10 (1.5%)
4 (3.8%)
82
42
343
666
104
as some individuals may attend more than one voluntary organisation, thus exaggerating the totals. Age ranges refer to the age of
individuals at end December 2001, or at death.
Table 4.2 refers to HIV positive individuals accessing voluntary care during 2001, categorised
according to age group. As was the case for individuals presenting to the statutory sector during 2001,
the majority of clients at all voluntary organisations were aged between 35 and 39 years. However,
there are age differences between organisations at the upper and lower age categories. The two
voluntary organisations in Blackpool (Body Positive and HEAL) appear to attract HIV positive
individuals from different age groups. Blackpool HEAL clients have an average (median) age of 37
years (with 90% of clients aged between 17 and 54 years) compared to a median age of 38 years
(90% aged between 23 to 58 years) for Body Positive Blackpool. The organisation that sees the
highest proportion of children is Barnardo’s (14% of clients are under the age of 14 years), as would
be expected for an organisation specialising in the needs of children. The organisation that sees the
most children with HIV is George House Trust. The differing profiles and characteristics of HIV
positive clients accessing North West Voluntary agencies may in part reflect the different range
of services provided and the varying strategies used to attract HIV positive clients.
99
Table 4.3: Distribution of voluntary sector care for HIV and AIDS cases by ethnic group,
VOLUNTARY AGENCY
ETHNICITY
White
BARL
BHA
10 (71.4%)
B’pool
HEAL
BP
B’pool
BP
Chesh.
73 (94.8%)
79 (96.3%)
36 (85.7%)
4 (5.2%)
2 (2.4%)
Black Caribbean
Black African
1 (1.2%)
2 (14.3%)
9 (100.0%)
Black Other
1 (2.4%)
Bangladeshi
2 (14.3%)
3 (7.1%)
Not Known
14
9
77
82
SAHIR
1 (0.3%)
2 (0.3%)
17 (5.0%)
71 (10.7%)
15 (14.4%)
4 (0.6%)
1 (1.0%)
1 (0.3%)
7 (1.1%)
2 (0.6%)
4 (0.6%)
1 (1.0%)
5 (0.8%)
1 (1.0%)
666
104
Total (100%)
GHT
287 (83.7%) 573 (86.0%) 86 (82.7%)
1 (2.4%)
Indian/Pakistani/
Other/Mixed
BPNW
1 (2.4%)
35 (10.2%)
42
343
as some individuals may attend more than one voluntary organisation, thus exaggerating the totals.
Table 4.3 illustrates HIV positive individuals accessing North West based voluntary agencies during
2001, categorised by ethnic group. Ethnic group classifications are adapted from the 1991 Census
Questionnaire and are those used by the Public Health Laboratory Service AIDS and STD Centre, for
the Survey of Prevalent Diagnosed HIV Infections (SOPHID). This year a new category, ‘Other
Asian/Oriental’, has been added, and accounts for 1% of individuals attending George House Trust
and Sahir House.
With the exception of BHA, a specialist service for black and ethnic minority communities, the vast
majority of presentations to voluntary sector organisations were by individuals self-defined as white,
ranging from 96% at Body Positive Blackpool to 71% at Barnardo’s. Although proportionately small
(11% of their clients), George House Trust provided care for the highest number of HIV positive
individuals from black African communities (71 individuals).
Table 4.4a illustrates the residential distribution of HIV positive individuals accessing North West
based voluntary agencies during 2001. Presentations at most North West voluntary agencies were
predominantly by residents of the North West Region. The proportion of clients known to be resident
within the North West range from 86% of Body Positive Cheshire clients, 100% at BHA and
Barnardo’s. Body Positive Cheshire was the only voluntary organisation with a significant proportion
of HIV positive clients from outside the region: 14% of their clients lived in Wales, reflecting the
geographical location of this agency.
100
Table 4.4a: Residential distribution of voluntary sector care for HIV and AIDS cases,
January-December 2001: strategic health authority (All cases seen during 2001 including
VOLUNTARY AGENCY
SHA OF
RESIDENCE
BARL
BHA
B’pool
HEAL
BP
B’pool
BP
Chesh.
BPNW
GHT
SAHIR
1 (11.1%)
76 (98.7%)
67 (81.7%)
1 (2.4%)
15 (4.4%)
76 (11.4%)
2 (1.9%)
91 (87.5%)
Greater Manchester
8 (88.9%)
13 (15.9%)
34 (81.0%)
18 (5.2%)
29 (4.4%)
1 (2.4%)
299 (87.2%)
545 (81.8%)
Isle of Man
London
4 (1.2%)
1 (0.2%)
1 (0.3%)
2 (0.3%)
South East
2 (1.9%)
1 (0.2%)
Trent
1 (1.2%)
Wales
1 (1.3%)
1 (0.3%)
1 (1.2%)
6 (14.3%)
West Midlands
1 (0.3%)
Not Known
4 (1.2%)
Total (100%)
5 (4.8%)
1 (1.0%)
14
9
77
82
42
6 (0.9%)
1 (1.0%)
3 (0.5%)
2 (1.9%)
3 (0.5%)
343
666
104
as some individuals may attend more than one voluntary organisation, thus exaggerating the totals. Individuals living outside of the
North West Region are grouped by region.
Table 4.4b: Residential distribution of voluntary sector care for HIV and AIDS cases,
VOLUNTARY AGENCY
PCT OF
RESIDENCE
BHA
B’pool
HEAL
BP
B’pool
57
54
BP
Chesh.
BPNW
GHT
6
28
Morecambe Bay
2
Blackpool
Fylde
3
6
Wyre
8
2
1
3
4
Preston
5
3
1
15
Hyndburn &
Ribble Valley
1
Burnley, Pendle
& Rossendale
1
1
1
2
1
3
13
2
4
2
5
West Lancashire
1
Unknown
Total
SAHIR
1
1
76
67
1
15
1
1
76
2
For a definition of the abbreviated voluntary agencies please refer to the glossary at the back of the report. Rows cannot be
totalled as some individuals may attend more than one voluntary organisation, thus exaggerating the totals. Individuals who reside
in Cumbria & Lancashire, but whose primary care trust of residence is not known, are labelled as unknown.
101
Table 4.4c: Residential distribution of voluntary sector care for HIV and AIDS cases,
January-December 2001: Cheshire & Merseyside primary care trusts (All cases seen
during 2001 including those who died during the year)
VOLUNTARY AGENCY
PCT OF
RESIDENCE
BARL
BP
Chesh.
BPNW
Southport & Formby
South Sefton
2
Central Liverpool
7
South Liverpool
GHT
SAHIR
1
3
3
5
1
5
45
1
1
Knowsley
3
St Helens
1
2
Halton
1
2
1
3
3
1
1
11
1
2
6
Warrington
3
Ellesemere Port & Neston
1
2
Cheshire West
12
8
5
1
1
4
Eastern Cheshire
2
2
Unknown
5
4
34
18
14
7
3
Central Cheshire
Total
3
1
1
9
29
91
in Cheshire & Merseyside, but whose primary care trust of residence is not known, are labelled as unknown.
Tables 4.4b, c and d present the primary care trust of residence of individuals attending voluntary
agencies within each of the three strategic health authorities (Cumbria & Lancashire, table 4.4b;
Cheshire & Merseyside, table 4.4c; and Greater Manchester, table 4.4d). It is important to note that
the data relate to voluntary sector clients for which full attributable data have been provided (soundex
code, date of birth and sex). Therefore, the number of individuals from each primary care trust
attending voluntary agencies does not necessarily reflect the overall service activity of that
organisation within a specific primary care trust.
102
Table 4.4d: Residential distribution of voluntary sector care for HIV and AIDS cases,
VOLUNTARY AGENCY
PCT OF
RESIDENCE
BHA
BP
B’pool
BP
Chesh.
BPNW
GHT
3
10
1
Bolton
1
7
19
Bury
1
7
17
Heywood & Middleton
4
8
Rochdale
7
11
1
SAHIR
Salford
5
52
63
Trafford North
1
12
14
9
17
1
2
57
125
3
1
Trafford South
North Manchester
Central Manchester
90
159
South Manchester
6
4
17
28
Oldham
10
24
Tameside & Glossop
9
26
Stockport
10
15
Unknown
5
9
299
545
Total
8
13
1
5
in Greater Manchester, but whose primary care trust of residence is not known, are labelled as unknown.
103
Table 4.5: Distribution of statutory treatment for HIV and AIDS cases presenting to
voluntary organisations, January-December 2001 (All cases seen during 2001 including
VOLUNTARY AGENCY
TREATMENT
CENTRE
AHC
BARL
BHA
B’pool
HEAL
BP
B’pool
2
BP
Chesh.
BPNW
GHT
1
1
APH
4
ARM
BLAG
62
1
2
47
2
24
2
6
18
2
13
17
2
4
2
1
1
7
17
BLKG
BURG
5
BURY
1
1
6
1
CUM
FAZ
4
FGH
1
LEI
3
LEII
4
MAC
2
MGP
1
MRI
MRIG
2
NMG
5
9
NMGG
1
3
3
1
2
3
40
64
1
30
48
4
35
55
MRIH
4
7
6
173
361
4
2
1
26
39
2
NOB
1
1
PG
5
PP
2
QSC
38
3
1
1
13
1
1
4
15
4
16
ROCG
34
4
10
SALG
6
8
SHH
1
2
SPG
1
STP
5
8
3
RLI
70
2
TAMG
4
15
2
1
TRAG
3
WAR
WITG
1
19
OLDG
RLG
1
2
BOLG
CHR
SAHIR
1
1
1
22
28
For a definition of the abbreviated voluntary agencies and statutory treatment centres please refer to the glossary at the back
of the report. Numbers cannot be totalled as some individuals may attend more than one treatment centre or voluntary agency thus
104
Table 4.5 illustrates the crossover of care of HIV positive individuals between North West based
voluntary agencies and the statutory organisations during 2001. The distribution of statutory
treatment and care of voluntary agency clients reflects the geographical location of the voluntary
agencies. However, the Infectious Disease Unit at North Manchester General Hospital (NMG),
the largest HIV and AIDS treatment centre in the North West (section 3, table 3.15), accounts for
a significant number of presentations by individuals accessing voluntary organisations across the
whole region.
Figure 4.2: The proportion of HIV and AIDS cases presenting to the voluntary sector
and statutory sector in the North West, January-December 2001 (All cases seen during
Seen by statutory
sector in 2001
865 (83.4%)
Never seen by
statutory sector
91 (8.8%)
Seen by statutory
sector prior to 2001
81 (7.8%)
Figure 4.2 illustrates the proportion of HIV positive individuals presenting to voluntary agencies in
the North West during 2001 who had and had not presented at statutory agencies in the North West,
either during 2001 or prior to 2001. During 2001, 1,037 HIV positive individuals were reported to the
North West HIV/AIDS Monitoring Unit by eight voluntary organisations in the North West. Of these
individuals, 865 (83%) also attended statutory treatment centres during the year. Therefore, 172 (17%)
of voluntary sector clients were unknown to statutory treatment centres within the North West during
2001 and are not, therefore, included in the regional statistics provided to the Department of Health.
This may be partly explained by the fact that 12% of those individuals not accessing the statutory
sector during 2001 reside outside the North West (compared to only 2% of those who presented to
both voluntary and statutory centres for care) and may be receiving treatment and care from centres
further afield.
Of the 172 HIV positive individuals not in contact with the statutory sector in 2001, 47% (81
individuals) had attended statutory treatment centres in the North West between 1995 and 2000. A
total of 91 (9% of voluntary sector clients) had no contact with the statutory sector since North West
regional monitoring began in 1995. These data highlight the importance of collecting epidemiological
information from the voluntary sector and demonstrate the vital contribution of HIV/AIDS voluntary
agencies in the North West.
105
Table 4.6: HIV and AIDS cases presenting to the voluntary sector and statutory sector
by infection route, sex and ethnicity, January-December 2001 (All cases seen during 2001
including those who died during the year)
STATUTORY SECTOR ATTENDANCE
INFECTION
ROUTE
Never Seen
Seen prior to 2001
Seen in 2001
Homo/Bisexual
31 (64.6%)
64 (84.2%)
628 (72.9%)
4 (5.3%)
46 (5.3%)
50 (5.0%)
15 (31.1%)
8 (10.5%)
163 (18.9%)
186 (18.9%)
Injecting Drug Use
Heterosexual
Blood/Tissue
Mother to Child
2 (4.2%)
Sub Total (100%)
48
Undetermined
43
46 (76.7%)
Total
723 (73.3%)
12 (1.4%)
12 (1.2%)
13 (1.5%)
15 (1.5%)
76
862
986
5
3
51
72 (93.5%)
758 (87.7%)
876 (87.5%)
3 (0.3%)
3 (0.3%)
ETHNICITY
White
Black Caribbean
Black African
9 (15.0%)
3 (3.9%)
82 (9.5%)
94 (9.4%)
Black Other
2 (3.3%)
1 (1.3%)
2 (0.2%)
5 (0.5%)
Bangladeshi
2 (3.3%)
5 (0.6%)
7 (0.7%)
Other / Mixed
1 (1.3%)
9 (1.0%)
10 (1.0%)
5 (0.6%)
6 (0.6%)
77
864
1001
4
1
36
70 (76.9%)
76 (93.8%)
743 (85.9%)
889 (85.7%)
Female
21 (23.1%)
5 (6.2%)
122 (14.1%)
148 (14.3%)
Total (100%)
91
81
865
1037
1 (1.7%)
Sub Total (100%)
60
Undetermined
31
Male
SEX
106
Table 4.6 illustrates the infection route, sex and ethnicity of HIV positive individuals accessing the
voluntary sector in the North West in 2001 by attendance at the statutory sector during the year.
Because of the relatively high proportion of individuals for whom infection route and ethnicity are
unknown (particularly among those who have never attended the statutory sector), the percentages in
the table are calculated as percentages of those individuals for whom the information is known. The
predominant method of exposure to HIV amongst voluntary sector clients during 2001 was homosexual
sex, accounting for 73% of cases where infection route has been determined. This represents a higher
proportion than the 66% of individuals accessing the statutory sector for whom method of exposure
has been determined (section 3, table 3.1). While a similar proportion of HIV positive clients of both
the voluntary and statutory sector were exposed to HIV via injecting drug use, a lower proportion of
heterosexually exposed clients (19%) were seen at the voluntary sector compared to the statutory
sector (24%: section 3, table 3.1). The vast majority of voluntary sector clients were male (86%),
primarily due to the relatively high rates of HIV infection via homosexual sex (73%). As in those HIV
positive individuals accessing the statutory sector (section 3, table 3.7), the majority of voluntary
sector clients are self-defined as white (88%).
Table 4.6 also shows that 17% of individuals (172 out of 1,037) using voluntary services did not attend
a statutory sector service during 2001. Of those where route of infection is known, a higher proportion
of individuals exclusive to the voluntary sector in 2001 were exposed to HIV via homosexual sex (77%)
than any other exposure category. Those HIV positive individuals accessing the voluntary sector but
not the statutory sector in the North West during 2001 may represent a significant number of people
for whom the voluntary sector is the sole provider of care. The overall ethnic (86% white) and sex
distribution (85% male) of those exclusively attending voluntary agencies was similar to those
attending both types of service (88% white and 86% male). Caution is required when interpreting these
results, due to the relatively high proportion of missing data relating to those who have never had
contact with the statutory sector (e.g. data on infection route is unavailable for 47% of those who had
only ever been seen by the voluntary sector).
107
108
5
Additional providers of HIV treatment and care 2001
This is the third year that the North West
HIV/AIDS Monitoring Unit has collected
data relating to the care of HIV positive
individuals attending hospices across the
whole of the North West, which this year
includes North Cumbria. All North West
hospices that provide inpatient care were
contacted. Out of 34 hospices contacted,
27 (79%) replied and 24 (89%) of these
had not provided care for any HIV positive
individuals during 2001. Palliative care,
defined as the total (physical, emotional,
social and spiritual) care of patients with
life threatening disease and care of their
families134 was reported by three hospices
in the North West during 2001. Information
relating to HIV positive individuals
attending hospices for inpatient care is
presented in figure 5.1. Due to relatively
few individuals receiving hospice care
(three in total), the hospices have not been
named to ensure client confidentiality.
5. ADDITIONAL PROVIDERS OF HIV TREATMENT AND CARE 2001
Data relating to HIV positive individuals accessing specialist drug services in the North West, including
North Cumbria, have also been included in the North West HIV/AIDS annual report for the third year.
Community drug teams and drug dependency units in the North West were asked to provide brief
attributable data (soundex, date of birth, sex) on individuals they knew to be HIV positive who had
accessed their services during 2001. Numbers of known HIV positive injecting drug users accessing
specialist drug services in the North West are relatively low, as demonstrated in data from statutory
treatment centres (section 3, table 3.1), reflecting the successful implementation of harm reduction
strategies in the 1980s62. Information on HIV positive injecting drug users accessing specialist drug
services is presented in table 5.2.
Table 5.1: HIV and AIDS care provided by North West hospices by strategic health
authority (SHA) of residence, sex, age group, stage of HIV disease and level of
inpatient care, January-December 2001 (All cases seen during 2001 including those who
died during the year)
SHA OF HOSPICE
SHA OF
RESIDENCE
2
Total
2 (66.7%)
1
1 (33.3%)
1
2 (66.7%)
SEX
Male
1
Female
1
1 (33.3%)
AGE GROUP
35 - 39
1
40 - 44
1
1
2 (66.7%)
1 (33.3%)
CLINICAL STAGE
AIDS
1
AIDS Related Death
1
Total (100%)
2
INPATIENT
CARE
1
2 (66.7%)
1 (33.3%)
1
3
SHA OF HOSPICE
TOTAL
Episodes
2
1
3
Days
17
13
30
Table 5.1 illustrates the care provided by North West Hospices for HIV positive individuals, categorised
by strategic health authority of residence, sex, age group, clinical stage of HIV disease and level of
inpatient care provided. Three generic hospices (one in Merseyside and two in Lancashire) provided
palliative care for HIV positive individuals resident in the North West during 2001. All the individuals
receiving hospice care also attended North West statutory treatment centres during the year.
110
As identified in previous studies, the age group of HIV positive people accessing care from hospices
is often younger than other groups presenting at these services135, in this instance the mean age was
40 years (range 37 to 45 years). Of the three individuals who received inpatient care in 2001, two were
classed as having had an AIDS defining illness and one person died of an AIDS related illness during
the year. The three reporting hospices provided 30 inpatient days during 2001, an average of 10 days
per HIV positive individual seen.
Table 5.2: HIV and AIDS care provided by North West drug services by strategic health
authority (SHA) of residence, sex and age group, January-December 2001 (All cases seen
during 2001 including those who died during the year)
SHA OF DRUG SERVICE
SHA OF
RESIDENCE
10 (100.0%)
Greater Manchester
Greater Manchester
Total
10 (76.9%)
3 (100.0%)
3 (23.1%)
SEX
Male
7 (70.0%)
2 (66.7%)
9 (69.2%)
Female
3 (30.0%)
1 (33.3%)
4 (30.8%)
AGE GROUP
20 - 24
1 (10.0%)
1 (7.7%)
25 - 29
1 (10.0%)
1 (33.3%)
2 (15.4%)
30 - 34
1 (10.0%)
1 (33.3%)
2 (15.4%)
35 - 39
4 (40.0%)
4 (30.8%)
40 - 44
1 (10.0%)
1 (7.7%)
45 - 49
50 - 54
1 (10.0%)
55 - 59
1 (10.0%)
Total (100%)
10
1 (33.3%)
2 (15.4%)
1 (7.7%)
3
13
Table 5.2 illustrates the care provided by North West specialist drug agencies for HIV positive
individuals, categorised by strategic health authority of residence, sex and age group. Data relating
to drug service clients who are known to be HIV positive were provided by seven agencies, based in
Cheshire, Merseyside and Greater Manchester (contributing drugs services are listed at the end of
this report). A total of 13 HIV positive individuals were reported by drug services, with all but one also
attending statutory treatment centres during 2001.
Individuals only attended drug services in the same strategic health authority that they were
resident in. The majority of individuals that were reported lived within Cheshire & Merseyside (77%).
Nearly a third (31%) of HIV positive injecting drug users accessing drug services were female,
a similar proportion to that seen amongst those infected via injecting drug use attending the statutory
sector (32%, table 3.5). The mean age of HIV positive people accessing North West drug services was
38 years (range 21 to 55 years) compared to 39 years (range 21 to 58 years) for HIV positive injecting
drug users accessing North West statutory treatment centres during 2001 (table 3.1).
Additional providers of treatment and care 2001
111
GLOSSARY
Statutory treatment centres
112
AHC
Alder Hey Children’s Hospital, Haematology Treatment Centre, Eaton Road,
Liverpool, L12 2AP, Tel: (0151) 228 4811
APH
Arrowe Park Hospital, Department of GUM, Arrowe Park Road, Upton,
Wirral, Merseyside, CH49 5PE, Tel: (0151) 678 5111
ARM
The Armistead Project, 36 Bolton Street, Liverpool, L3 5LX, Tel: (0151) 708 7366
BLAG
Victoria Hospital, Department of GUM, Whinney Heys Road,
Blackpool, Lancashire, FY3 8NR, Tel: (01253) 300 000
BLK
Blackburn Royal Infirmary, Bolton Road, Blackburn, BB2 3LR, Tel: (0154) 263 555
BLKG
Blackburn Royal Infirmary, Department of GUM, Bolton Road,
Blackburn, BB2 3LR, Tel: (0154) 263 555
BOLG
Royal Bolton Hospital, Department of GUM, Minerva Road, Farnworth,
Bolton, BL4 0JR, Tel: (01204) 390 390
BOOT
Booth Hall Children’s Hospital, Charlestown Road, Blackley,
Manchseter, M9 7AA, Tel: (0161) 220 5095
BURG
Burnley General Hospital, Department of GUM, Casterton Avenue,
Burnley, Lancashire, BB10 2PQ, Tel: (01282) 425 071
BURY
Bury General Hospital, Walmersley Road, Bury, BL9 6PG, Tel: (0161) 764 6081
CHR
The Countess of Chester Hospital, Department of GUM, Liverpool Road,
Chester, Cheshire, CH2 1UL, Tel: (01244) 365 000
CPED
West Cumberland Hospital, Department of Paediatrics, Hensingham,
Whitehaven, Cumbria, CA28 8JG, Tel: (01900) 68737
CUM
Cumberland Infirmary, Department of GUM, Newtown Road,
Carlisle, CA2 7HY, Tel: (01228) 814 814
FAZ
University Hospital Aintree, Infectious Disease Unit, Lower Lane,
Liverpool, L9 7AL, Tel: (0151) 525 5980
FGH
Furness General Hospital, Dalton Lane, Barrow in Furness,
Cumbria, LA14 4LF, Tel: (01229) 870 870
HAL
Halton General Hospital, Department of GUM, Hospital Way,
Runcorn, Cheshire, WA7 2DA, Tel: (01928) 714 567
LEI
Leighton Hospital, Department of GUM, Middlewich Road,
Crewe, Cheshire, CW1 4QJ, Tel: (01270) 255 141
LEII
Leighton Hospital, Middlewich Road, Crewe, Cheshire, CW1 4QJ, Tel: (01270) 255 141
MAC
Macclesfield District General Hospital, Department of GUM, Victoria Road,
Macclesfield, Cheshire, SK10 3BL, Tel: (01625) 421 000
MGP
‘The Docs’ General Practice, Manchester, 55-59 Bloom Street,
Manchester, M1 3LY, Tel: (0161) 237 9490
MRI
Manchester Royal Infirmary, Outpatients Department, Oxford Road,
Manchester, M13 9WL, Tel: (0161) 276 1234
MRIG
Manchester Royal Infirmary, Department of GUM, Oxford Road,
MRIH
Manchester Royal Infirmary, Department of Haematology, Oxford Road,
NOB
Noble’s Isle of Man Hospital, Department of GUM, Westmoreland Road,
Douglas, Isle of Man, IM1 4QA, Tel: (01624) 642 479
NMG
North Manchester General Hospital, Infectious Disease Unit, Delaunays Road,
Crumpsall, Manchester, M8 5RB, Tel: (0161) 795 4567
NMGG North Manchester General Hospital, Department of GUM, Delaunays Road,
Crumpsall, Manchester, M8 5RB, Tel: (0161) 795 4567
OLDG
Royal Oldham Hospital, Department of GUM, Rochdale Road,
Oldham, Lancashire, OL1 2JH, Tel: (0161) 624 0420
PG
Royal Preston Hospital, Department of GUM, Sharoe Green Lane North,
Fulwood, Preston, PR2 9HT, Tel: (01772) 716 565
PP
Royal Preston Hospital, Paediatric Department, Sharoe Green Lane North,
Fulwood, Preston, PR2 9HT, Tel: (01772) 716 565
QSC
Queen Street Clinic, HIV Community Nursing Team, 18a Queen Street,
Blackpool, FY1 1PD, Tel: (01253) 751 144
RLG
Royal Liverpool University Hospital, Department of GUM, Prescot Street,
Liverpool, L7 8XP, Tel: (0151) 706 2000
RLH
Royal Liverpool University Hospital, Department of Haematology, Prescot Street, Liverpool,
L7 8XP, Tel: (0151) 706 2000
RLI
Royal Lancaster Infirmary, Ashton Road, Lancaster, LA1 4RP, Tel: (01524) 65944
ROCG
Baillie Street Health Centre, Department of GUM, Baillie Street,
Rochdale, OL16 1XS, Tel: (01706) 517 655
SALG
Hope Hospital, Department of GUM, Stott Lane, Salford, M6 8HD, Tel: (0161) 789 7373
SHH
St Helens General Hospital, Department of GUM, Marshalls Cross Road,
St Helens, WA9 3DA, Tel: (01744) 26633
SPG
Southport & Formby District General Hospital, Department of GUM, Town Lane,
Kew, Southport, Merseyside, PR8 6PN, Tel: (01704) 547 471
STP
Stepping Hill Hospital, Department of GUM, Poplar Grove, Stockport,
Cheshire SK2 7JE, Tel: (0161) 483 1010
TAMG
Tameside General Hospital, Department of GUM, Fountain Street,
Ashton-under-Lyne, Lancashire, OL6 9RW, Tel: (0161) 331 5151
TRAG
Trafford General Hospital, Department of GUM, Moorside Road, Urmston,
Manchester, M41 5SL, Tel: (0161) 748 4022
WAR
Warrington Hospital, Department of GUM, Lovely Lane,
Warrington, Cheshire, WA5 1QG, Tel: (01925) 635 911
WGH
Westmorland General Hospital, Outpatients Department, Burton Road,
Kendal, Cumbria, LA9 7RG, Tel: (01539) 732 288
WHIT
West Cumberland Hospital, Department of Haematology, Hensingham,
Whitehaven, Cumbria, CA28 8JG, Tel: (01946) 523 426
WIGG
Royal Albert Edward Infirmary, Department of GUM, Wigan Lane,
Wigan, WN1 2NN, Tel: (01942) 244 000
WITG
Withington Hospital, Department of GUM, Nell Lane,
Manchester, M20 2LR, Tel: (0161) 445 8111
WORK Workington Infirmary, Department of GUM, Infirmary Road, Workington,
Cumbria, CA14 2UN, Tel: (01900) 68737
Glossary
113
Voluntary Agencies
BARL
Barnado’s (Liverpool) Tel: (0151) 708 7323
BHA
Black Health Agency Tel: (0161) 226 9145
B’pool HEAL
Blackpool HEAL (Health Education AIDS Liaison) Tel: (01253) 290 052
BP B’pool
Body Positive Blackpool Tel: (01253) 296 887
BP Chesh.
Body Positive Cheshire Tel: (01244) 400 415
BP NW
Body Positive North West Tel: (0161) 873 8100
GHT
George House Trust Tel: (0161) 274 4499
SAHIR
Sahir House (Mersey Body Positive & Merseyside AIDS Support Group)
Tel: (0151) 708 9080
Drug services
114
Drugs North West
Tel: (0161) 772 3537
Lancaster and District CDT
Tel: (01524) 389 851
Liverpool DDU
Tel: (0151) 709 0516
Oldham CDT
Tel: (0161) 624 9595
Tameside CDT
Tel: (0161) 344 5365
Warrington CDT
Tel: (01925) 415 176
Wirral Drug Service
Tel: (0151) 653 3871
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HIV
AIDS
IN THE NORTH WEST OF ENGLAND
2
0
0
1
PENNY A. COOK ANDY TOWLE PAULINE RIMMER
SUZY MITCHELL QUTUB SYED MARK A. BELLIS
Published by North West HIV/AIDS Monitoring Unit,
Faculty of Health and Applied Social Sciences,
Liverpool John Moores University,
70 Great Crosshall Street, Liverpool L3 2AB
Tel: +44 (0)151 231 4315/4316
Fax: +44 (0)151 231 4320
July 2002
ISBN 1-902051-39-4
British Library Catalogue in Publication Data
A Catalogue record for this book is available from the British Library
North West HIV/AIDS Monitoring Unit,
www.nwpho.org.uk

HIV and AIDS - Public Health Observatory

Transcription

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