title: Trends in HIV diagnoses, HIV care, and uptake of antiretroviral therapy among heterosexual adults in England, Wales, and Northern Ireland.
abstract: OBJECTIVE
  To examine epidemiological trends among heterosexual adults (≥15 years) in England, Wales, and Northern Ireland (E,W&NI) newly diagnosed as having HIV between 1992 and 2011, or seen for HIV care in 2011.
  
  
  METHODS
  Trend analyses of heterosexual adults newly diagnosed as having HIV in E,W&NI in 1992 to 2011 was performed, as well as univariate and multivariate analyses examining the late diagnosis of HIV, integration into care, AIDS, uptake of antiretroviral therapy, and mortality in 2002 to 2011. Data are as reported to the national HIV and AIDS Reporting System.
  
  
  RESULTS
  The number of heterosexual adults newly diagnosed as having HIV in E,W&NI increased steadily between 1992 (731) and 2004 (4676), before declining (2631 in 2011). Nonetheless, in 2011, heterosexuals accounted for 49% (2631/5423) of all newly diagnosed adults in E,W&NI. Of 38,228 heterosexual adults as having HIV between 2002 and 2011, 72% were black African, of whom 99% were born abroad. Over the decade, there was an increase in the percentage of HIV diagnosed heterosexuals integrated into care within 28 days of diagnosis (61%-78%) and in receipt of antiretroviral therapy within 1 year of diagnosis (45%-52%) and a decline in the percentage with AIDS (16%-7%; all, P < 0.01). Late HIV diagnoses (CD4 <350 mm) among heterosexuals exceeded 60% in all years.
  
  
  CONCLUSIONS
  Our analyses highlight the impact of migration on the epidemiology of heterosexually acquired HIV in E,W&NI. Although there was evidence of an improvement in clinical care over time, continued high rates of late diagnosis suggest that current testing policies are failing among heterosexuals.
authors.affiliation: From the *Public Health England, Colindale, London, UK; and †City University London, UK.
authors.forename: Brian
authors.initials: B
authors.lastname: Rice
authors.forename: Jonathan
authors.initials: J
authors.lastname: Elford
authors.forename: Zheng
authors.initials: Z
authors.lastname: Yin
authors.forename: Sara
authors.initials: S
authors.lastname: Croxford
authors.forename: Alison
authors.initials: A
authors.lastname: Brown
authors.forename: Valerie
authors.initials: V
authors.lastname: Delpech
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D044383:Black People; D057210:Delayed Diagnosis / Q000706:statistics & numerical data / Q000639:trends*; D018450:Disease Progression; D004739:England / Q000453:epidemiology; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D006297:Health Services Accessibility / Q000639:trends*; D020010:Heterosexuality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011159:Population Surveillance; D015995:Prevalence; D011787:Quality of Health Care / Q000639:trends*; D012307:Risk Factors; D012737:Sex Factors; D014852:Wales / Q000453:epidemiology; D044465:White People
chemical_list: D019380:Anti-HIV Agents