Sexually Transmitted Infections

This topic area covers statistics and information relating to sexually transmitted infections in Hull including local strategic need and service provision. Further information relating to Sexual and Reproductive Health is given under Health Factors within Adults.

This page contains information from the Office for Health Improvement & Disparities’ Fingertips. Information is taken ‘live’ from the site so uses the latest available data from Fingertips and displays it on this page. As a result, some comments on this page may relate to an earlier period of time until this page is next updated (see review dates at the end of this page).

Headlines

• In many cases, people with a sexually transmitted infection (STI) do not have symptoms. Most STIs are treated effectively if treated early, but if left untreated can cause health problems including infertility and in a small number of cases can cause death. STIs can also have major health implications for newborns if pregnant women have an STI.
• The number of tests undertaken among those attending a clinic for STI testing and the percentage of the population aged 15-24 years screened as part of the National Chlamydia Screening Programme (NCSP) has been decreasing in Hull and has been relatively low overall compared to England suggesting a more targeted approach to STI testing in Hull. However, rates have increased in Hull in the last year or two.
• The number of syphilis diagnoses among people accessing sexual health services per 100,000 residents was considerably lower in Hull compared to England and the Yorkshire and Humber region for 2023. Only East Riding of Yorkshire out of the 14 local authorities with data in the Yorkshire and Humber region has a rate that is lower than Hull.
• In 2023 the number of new cases of gonorrhoea diagnosed in Hull was lower than in England, but on a par with the region. There were 108 cases per 100,000 population in Hull compared to 149 cases diagnosed per 100,000 population for England and 107 cases diagnosed per 100,000 population across the region. Gonorrhoea is often used as a marker for rates of unsafe sexual activity, because not all STIs result in symptoms and the majority of cases of gonorrhoea are diagnosed in sexual health clinics, and consequently the number of gonorrhoea cases may be a measure of access to STI treatment. Therefore it may be of concern if this reflects an increase for unsafe sexual activity although it could also reflect improved access to services and treatment.
• In 2023, the rate of new cases genital warts diagnosed in Hull was higher than England (49.1 versus 45.8 new cases diagnosed per 100,000 population) and higher than the region (41.0 cases per 100,000 population). The number of new cases of genital warts diagnosed per 100,000 population was the third highest across the region in Hull for 2023 (Leeds was highest with 53.9, followed by North East Lincolnshire at 55.8).
• The number of new diagnoses for genital herpes was higher in Hull compared to England for 2023 (50.2 versus 47.6 cases diagnosed per 100,000 population) and higher in Hull compared to the Yorkshire and Humber region (where it was 42.2 cases diagnosed per 100,000 population).
• Overall during 2023, there were a total of 1,857 new STI diagnoses among Hull residents giving a rate of 691 per 100,000 population. There had been a decrease in the rate between 2019 and 2020 due to the pandemic, but between 2018 and 2020, the rate of new STIs diagnosed was similar to England. However, between 2020 and 2023, the rate of new STIs diagnosed has increased for both England and the Yorkshire and Humber region. However, as a national screening programme exists for young people for chlamydia, the way in which the local NCSPs are run across the county impact on the overall rate of new STIs. In Hull during 2022, 909 (38%) of these new STIs detected were chlamydia cases among those aged 15-24 years. Excluding chlamydia cases diagnosed as part of the NCMP, there were 1,458 new diagnoses of STIs among Hull residents giving a rate of 547 per 100,000 population. The rate of new STIs diagnosed excluding chlamydia cases among those aged 15-24 years has generally been statistically significantly higher in Hull compared to England, although was more comparable to England just prior to the pandemic (2018 and 2019) and during and after the pandemic (2020 and 2021). The rate in 2023 is lower in Hull compared to England (489 in Hull and in England 520 per 100,000 population).
• The test positivity for chlamydia among those aged 15-24 years for 2022 is the fourth among the 148 upper-tier local authorities in England with 16.2% of all tests returning a positive chlamydia result (903 out of 5,570 tests) compared to 11.1% for England. Between 2017 and 2020, the rate of positive tests was around twice that of England, and it has been around 50% higher than England for the last couple years. This could suggest that a more targeted approach to chlamydia testing within the NCSP has been undertaken in Hull with only higher risk groups asked to take chlamydia tests.
• In 2023, there were 5,619 HIV tests undertaken in Hull equating to 2,090 tests per 100,000 population. Whilst this was much lower than England (2,770 per 100,000 population) where the rate is skewed by the very high testing rates in London, the testing rate in Hull was considerably higher than the regional average (1,657 per 100,00 population). In 2023, there were 24 new cases of human immunodeficiency virus (HIV) diagnosed in Hull, and the rate of new diagnoses slightly lower than England. The rate of new cases of HIV has historically been lower than England, but the incidence rate in Hull has increased since 2020 and was higher than England for the first time for both 2021 and 2022. The incidence rate had been consistently decreasing in England between 2011 and 2020, but the incidence rate has also increased nationally since 2020. Due to small numbers, there is year-on-year variability in the percentage of people diagnosed with HIV at a late stage of the disease, but for 2021-23, the rate of late diagnosis of HIV was higher in Hull compared to England (62% versus 44%). The percentage diagnosed at a late stage has been reasonably similar to England but has increased in Hull in the last 2-3 years. For 2021-23, a similar percentage of newly diagnosed patients had prompt antiretroviral therapy in Hull (84%) compared to England (84%) with a high rate of virological success in Hull (96%) in that their viral load was undetectable meaning that they could not pass the disease to others although the rate was among the lowest in the region and lower than England (98%).
• In 2023, it was estimate that there were 239 people living in Hull with diagnosed HIV which was considerably lower than England (1.46 versus 2.40 residents per 100,000 population). The rate in Hull has increased by 47% from 0.99 to 1.46 per 100,000 population between 2011 and 2023 compared to an increase of 22% for England over the same time period (from 1.97 to 2.40 per 100,000 population).
• In 2018 and 2019, there were 1,521 and 1,410 new cases of STIs diagnosed excluding cases of chlamydia picked up through the NCSP. However, this fell substantially to 973 in 2020, and remained relatively low in 2021 at 1,130 new STIs diagnosed. The increase to 1,458 in 2022 represents an increase back to pre-pandemic levels. Access to services were significantly disrupted in March 2020 due to the COVID-19 pandemic across the country, and the decrease in the rate of STIs detected in Hull was not unique with relatively similar decreases both regionally and nationally. Whilst local Sexual and Reproductive Health Services adapted by introducing telephone triage, virtual appointments and a postal service for STI testing kits, it is likely that access to services was reduced or became problematic for some individuals particularly young people living at home. It is also possible that the prevalence of STIs and the need for STI testing was reduced with the pandemic and subsequent lockdowns as people socialised less and were more restricted in where they could go and visit. It is possible that the impact of the pandemic on the incidence and testing undertaken goes beyond the duration of the pandemic due to changes in behaviour and services during 2020 as well as changes that were made to service due to different and improved ways of working such as more online testing.

The Population Affected – Why Is It Important?

Information from the NHS states that many people with sexually transmitted infections (STIs) do not get symptoms, so it’s worth getting tested even if you feel fine. If you think you have an STI, the earlier you’re tested, the sooner treatment can be given if it’s needed. An STI can be passed from one person to another through sexual contact. Many STIs can be cured with antibiotics.

The NHS stated that most common STIs are chlamydia, gonorrhoea, trichomoniasis, genital warts, genital herpes, pubic lice, scabies and syphilis. Another STI is human immunodeficiency virus (HIV) which can lead to acquired immunodeficiency syndrome (AIDS). There is further information on the NHS website relating these STIs.

The severity and consequences of different STIs vary, but most can be treated relatively easily if treated early. Some of the symptoms of some STIs also can disappear by themselves, but can also result in recurrences in the infection. However, some STIs can cause long-term problems if left untreated, and can cause pelvic inflammatory disease, infertility, and even death in the case of syphilis and HIV.

Some of the STIs can be passed from mother to baby whilst pregnant, at birth or even through breastfeeding in the case of HIV. Gonorrhoea can cause permanent blindness in a newborn, trichomoniasis in rare cases can cause premature birth and low birth weight for newborns, and genital herpes can also cause problems for newborns. Syphilis can be very serious in pregnant women resulting in miscarriage, stillbirth or a serious infection in the baby (congenital syphilis) as can HIV which can be passed to the newborn.

HIV attacks and weakens the immune symptoms making it less able to fight infections and disease. Emergency anti-HIV medication called post-exposure prophylaxisis (PEP) may stop someone becoming infected if started within 72 hours of possible exposure to the virus. Early diagnosis is important to avoid life-threatening consequences of the disease and avoid passing it to others. Antiretroviral medicines are used to treat HIV which prevent the virus from replicating in the body, allowing the immune system to repair itself and prevent further damage. The goal of HIV treatment is to have an undetectable viral load in that the level of the HIV virus in the body is low enough to be not detected by a test. If the viral load has been undetectable for six months or more, then it means the person cannot pass the virus on through sex. AIDS is the final stage of an HIV infection when the body can no longer fight life-threatening infections. Men who have sex with men, Black African heterosexuals and people who share needles, syringes and other injecting equipment have an increased risk of HIV. It can also be transmitted from mother to baby during pregnancy, birth or breastfeeding. There is also pre-exposure prophylaxis (PrEP) available for those high risk groups at risk of HIV from sex or injection drug use. This prescription drug is taken before on a regular basis and is highly affective for preventing HIV.

HIV testing is integral to the treatment and management of HIV. Knowledge of HIV status increases survival rates, improves quality of life and reduces the risk of HIV transmission.

It should be noted that when examining rates of STIs across different populations, it could be assumed that a high rate is bad as it means that the prevalence is high in that population. However, as many STIs are asymptomatic, a high rate of STIs or a high detection rate can also be considered to be good as it assumed that a higher percentage of people with STIs in that population are being detected and therefore treated in that population. This is the case for chlamydia where a high rate is classified as ‘better’ by The Office for Health Improvement & Disparities (formerly Public Health England). However, because of this, the rate of STIs detected in different populations should be treated cautiously as it depends on the numerous factors, such as the willingness of the population to come forward to be tested, access to Sexual Health and Reproductive Services (SHRS), the way in which local SHRS are administered and advertised, as well as the overall prevalence in the population.

The Hull Picture

The Office for Health Improvement & Disparities’ Fingertips present some information on the number of diagnoses of STIs. The rates are presented as the numbers diagnosed within the time period per 100,000 population unless otherwise stated.

The diagnostic or detection rate is given below for the main STIs and is given as the number of positive tests or cases of the STI out of the total resident population presented as the rate of new cases per 100,000 population.

Syphilis

The number of syphilis diagnoses among people accessing sexual health services per 100,000 residents was considerably lower in Hull compared to England and the Yorkshire and Humber region for 2023. Only East Riding of Yorkshire out of the 14 local authorities with data in the Yorkshire and Humber region has a rate that is lower than Hull.

However, the rate in Hull has been quite variable due to small numbers with 7 new diagnoses of syphilis in 2023. Since 2014 the diagnosis rate for syphilis in Hull has been consistently lower than the rate for England.

Gonorrhoea

Gonorrhoea is used as a marker for rates of unsafe sexual activity. This is because the majority of cases are diagnosed in sexual health clinics, and consequently the number of cases may be a measure of access to STI treatment. Infections with gonorrhoea are also more likely than chlamydia to result in symptoms. Despite this it is likely that there will be people with gonorrhoea with or without symptoms who do not present at a sexual health clinic.

In 2023 the number of new cases of gonorrhoea diagnosed in Hull was lower than in England, but on a par with the region. There were 108 cases per 100,000 population in Hull compared to 149 cases diagnosed per 100,000 population for England and 107 cases diagnosed per 100,000 population across the region.

However, the rate had been increasing in Hull between 2014 and 2019 with a fall in 2020 and a further fall in 2021. It is possible that the decrease in 2020 and 2021 is a real decrease because of the pandemic with less social mixing or because Sexual and Reproductive Health Services were disrupted (although there were only brief reductions to services, the way services were delivered changed). There were similar decreases for both England and the region for 2020 and 2021.

However, for Hull, the region and England, there was an increase in the number of gonorrhoea cases diagnosed in 2022 and 2023. Furthermore, the increasing trend between 2014 and 2019 appears to have continued with the rate in 2022 similar to what might have been expected given the pattern of increase between 2014 and 2019.

In Hull, there were around 100 new cases of gonorrhoea diagnosed each year between 2012 and 2016, but this increased to 200 or more (241 in 2019) since then. The number of cases of gonorrhoea diagnosed in Hull in 2023 is the highest number since at least 2012 with 291 new cases of diagnosed during 2022.

Genital Warts

In 2023, the rate of new cases genital warts diagnosed in Hull was higher than England (49.1 versus 45.8 new cases diagnosed per 100,000 population) and higher than the region (41.0 cases per 100,000 population). The number of new cases of genital warts diagnosed per 100,000 population was the third highest across the region in Hull for 2023 (Leeds was highest with 53.9, followed by North East Lincolnshire at 55.8).

In contrast to syphilis and gonorrhoea, the diagnosis rate for genital warts in Hull had been consistently higher than the rate for England since 2014. The rate was 170 per 100,000 population in 2014 with 437 new diagnoses of genital warts in Hull but has fallen significantly over time with a rate of 49.1 per 100,000 population in 2023 with a total of 132 new diagnoses.

Genital Herpes

The number of new diagnoses for genital herpes was higher in Hull compared to England for 2023 (50.2 versus 47.6 cases diagnosed per 100,000 population) and higher in Hull compared to the Yorkshire and Humber region (where it was 42.2 cases diagnosed per 100,000 population).

The diagnosis rate for genital herpes has been consistently high in Hull compared to England since 2015, and statistically significantly so between 2015 and 2020. Between 2020 and 2021, the rate fell in Hull with a marginal increase between 2021 and 2022 resulting in a diagnosis rate that was lower in 2022 than for 2020 for Hull. In contrast, between 2020 and 2023, the rate increased across England and the region. So whilst the rate in Hull is higher than both England and the region for 2023, it is only marginally higher and the difference is not statistically significant.

Whilst the rate has decreased significantly since 2019 from 191 individuals diagnosed in 2019 to 135 diagnosed in 2023, it is possible that some of this decrease could be due to disruption to Sexual and Reproductive Health Services and reduced prevalence following reduced social interactions throughout the pandemic. However, unlike gonorrhoea, the diagnosis rate for genital herpes rate has not bounced back to levels seen in 2019.

All Sexually Transmitted Infections

The diagnosis rate for all new STIs in Hull is slightly lower than England for 2023 with 691 new STIs diagnosed per 100,000 population compared to 704 for England. The rate in Hull is also higher than the rate across the Yorkshire and Humber region of 584 with Hull having the second highest rate across the region (after North East Lincolnshire where levels were 751 new STIs diagnosed per 100,000 population).

A sizable percentage of all new diagnoses of STIs are due to cases of chlamydia among under 25s because of the National Chlamydia Screening Programme (NCSP). In 2021, 38.4% of all new STIs in Hull were cases of chlamydia among under 25s in Hull.

As the way the NCSP is implemented locally differs across different geographical areas, the incidence of all new STIs can be influenced by the way in which the local NCSP is run. Therefore, it is also useful to examine the rate of new STIs excluding diagnoses of chlamydia among those aged 15-24 years (the target age group for the NCSP). Furthermore, there could be changes to the way the NCSP is implemented locally over time. Between 2012 and 2022 in Hull, between 25% and 52% of new cases of STIs diagnosed were cases of chlamydia among under 25s.

In Hull, the rate of new STIs excluding chlamydia diagnoses among under 25s in 2022 was 547 new STI diagnoses per 100,000 population which was statistically significantly higher than the rate for England of 496. It was also the highest across the Yorkshire and Humber.

The rate of new STIs was relatively constant between 2013 and 2016 with just over 1,000 new diagnoses per 100,000 population (and around 2,700 diagnoses), but the rate decreased in Hull between 2016 and 2019, and decreased more sharply in 2020 likely associated with the pandemic. Whilst the rate increased between 2020 and 2021, the rate in 2021 was still lower than 2019, so the rate in 2021 might have also been affected by the pandemic. However, between 2021 and 2022, the rate has increased considerably, and the rate in 2022 is higher than it was in 2019. In 2023 the rate decreased again and is on a par with tat seen in the whole of England.

There are differences in trends over time for England and the region compared to Hull, but the pattern of change over time is broadly similar except that the decreases between 2016 and 2019 were greater in Hull and that the increases between 2020 and 2022 have also been greater in Hull. However, as mentioned above, the rate of new STIs diagnosed is influenced by the way the NCSP is administered locally.

During 2023, there were 1,314 new STIs detected in Hull.

A more comparable measure in relation to STI diagnoses rates is the new STIs diagnosed excluding new chlamydia diagnoses among those aged under 25 years, as this is not impacted by the considerably different way the NCSP programmes are run across the country. When examining this rate, it can be seen that the rate has been statistically significantly higher in Hull compared to England between 2013 and 2017, but with slight decreases in the rate between 2016 and 2018 in Hull, the rate in Hull was comparable or lower than England for 2018 and 2019. The rate decreased considerably in 2020 due to the pandemic, and increased slightly between 2020 and 2021 with the pattern in Hull following a similar pattern of change as England and the region. However, the increase in the rate of new STIs diagnosed in Hull between 2020 and 2022 has been greater than England resulting in a statistically significantly higher rate in 2022 in Hull. In 2023 rates in Hull decreased and are below the rates for England.

There were around 1,600 new STIs diagnosed excluding chlamydia diagnoses among under 25s in Hull each year between 2013 and 2017 so the current number of 1,314 new STI cases detected represents a decrease.

Fingertips also presents the testing rate and the test positivity rate.

The testing rate is the number of people of all ages who are tested for syphilis, HIV and gonorrhoea and the number of people aged 25 to 64 years tested for chlamydia out of the total number of people tested for one or more infections for syphilis, HIV, gonorrhoea and chlamydia at a new attendance (chlamydia tests only included for people aged 25-64 years). Each episode is counted once regardless of the number of tests that were provided, and an individual may appear more than once in the denominator if they attend for more than one episode of infection during the year.

The test positivity rate is the sum of all positive diagnoses of syphilis, HIV and gonorrhoea among all ages and chlamydia diagnoses among those aged 25-64 years out of the number of people tested for syphilis, HIV, gonorrhoea and chlamydia at a new attendance. Each episode is counted once regardless of the number of tests that were provided, and an individual may appear more than once in the denominator if they attend for more than one episode of infection during the year.

For 2023, whilst the numbers tested for STIs is considerably lower than England it is higher than most other local authorities in the regio and the rate of positive tests is higher. Thus it would appear that there is a more targeted approach to STI testing in Hull.

The rate of STI testing in Hull has been consistently lower than England and more recently consistently lower than the Yorkshire and Humber regional average. However, the pattern of change over time is relatively similar to England and the region except that the rate in Hull decreased between 2020 and 2021 in contrast to an increase for both England and the region. The STI testing rate in Hull in 2023 surpasses that of the region and is just below levels recorded nationally.

In contrast, the test positivity rate in Hull has steadily increased in Hull at a faster rate than increases observed across England and the region. Thus, it is possible that the approach to STI testing in Hull may be slightly different to other geographical areas.

Chlamydia

For 2023, the number of chlamydia diagnoses among 15-24s per 100,000 population aged 15-24 years was higher in Hull compared to England but slightly lower than the rate in the region.

Between 2012 and 2016, the chlamydia detection rate among 15-24s in Hull was consistently higher than England, and at its highest more than 50% higher than England. However, the rate fell in Hull between 2016 and 2017 by a quarter, and the overall rate in Hull between 2017 and 2019 was similar to the rate in England. However, during the period 2017 to 2022, the percentage of tests sent out that result in a positive result for chlamydia has increased and has been consistently high in relation to other local authorities. In 2023 levels decreased in Hull and levels in Hull, the region and nationally are on a par.

The detection rate in Hull fell sharply between 2019 and 2020 which is perhaps not surprising as the pandemic could have had an influence on the rate. However, whilst the reduction between 2019 and 2020 in Hull was greater than England and the region, the increase in Hull between 2020 and 2022 has been much greater than both England and the region resulting in Hull having a considerably higher detection rate during 2022 compared to both England and the region.

There was a reasonably similar trend over time among both men and women, but more marked for women.

The percentage of young people screened for chlamydia has fallen significantly over time between 2013 and 2020 in Hull. During 2012 and 2013, it was estimated that over 35% of people aged 15-24 years were screened for chlamydia, but this fell to 9% in 2019 prior to the pandemic. Whilst the rate further decreased in 2020 likely associated with the pandemic, the rate in Hull increased sharply between 2020 and 2021, and whilst the rate was significantly lower than England for 2021, a further smaller increase in the percentage in Hull between 2021 and 2022. Rates fell again in 2023.

However, the percentage of chlamydia tests that are sent out and come back positive for chlamydia is much higher in Hull. In fact, the percentage for Hull (at 16.2%) is the fourth highest out of the 148 upper-tier local authorities (excluding Isles of Scilly as the numbers are too small) in England for 2022 (range 5.9% to 17.9%).

From previously available trend tables on The Office for Health Improvement & Disparities’ Fingertips for the detection rate and the percentage screened, the number of positive tests and tests completed respectively are given. From this information, it is possible to calculate the percentage of positive tests. However, this should be used as a guide though as there are caveats associated with the data, for example, for both measures, ‘records are re-duplicated in order to prevent over-estimation’ and the table below might not take this into account.

From this information, it appears that the NCSP in Hull has used a much more targeted approach in recent years compared to other local authorities in England.

The information is no longer available for persons after 2022 as the information on Fingertips has changed, although it is available for females. In 2023, there were 347 positive tests out of 2,374 tests among Hull women (14.6%) compared to 64,670 positive tests out of 672,576 tests among women in England (9.6%) so it appears that there is still a higher percentage of tests that are positive in Hull compared to England.

Year	Hull tests	Hull positive tests	Hull positive tests (%)	England positive tests (%)
2012	14,319	1,068	7.5	7.8
2013	14,768	1,122	7.6	8.2
2014	11,935	1,029	8.6	8.3
2015	8,446	1,108	13.1	8.4
2016	7,463	1,050	14.1	9.1
2017	4,380	771	17.6	9.7
2018	3,663	674	18.4	10.1
2019	3,080	680	22.1	10.0
2020	1,918	346	18.0	9.8
2021	4,847	647	13.3	9.0
2022	5,570	903	16.2	11.1

In 2022 the diagnostic rate for chlamydia is around 50% higher in Hull compared to England and the Yorkshire and Humber region for both all ages and people aged over 25 years. In 2023 rates in Hull decreased sharply and although higher than the region figure, are on a similar levels to those recorded for England.

As the majority of chlamydia diagnoses are among those aged 15-24 years (55-76% between 2012 and 2022), the trend over time in the chlamydia detection rate among all ages follows a similar pattern to the pattern observed for those aged 15-24 years.

However, the percentage of chlamydia diagnoses that were among those aged 15-24 years has fallen over time in Hull as it was around 75% between 2012 and 2015, but has been around 60% between 2020 to 2022. This could have been changes to the NCSP or it could be that there are more cases among those aged 25+ years.

The number of new cases of chlamydia among those aged 25+ years at 301 per 100,000 population for 2022 is the highest it has been (68% higher than the average rate between 2012 and 2020), but levels decreased in 2023 to 220 per 100,000 population.

HIV (Human Immunodeficiency Virus)

The Office for Health Improvement & Disparities’ Fingertips also presents information relating to human immunodeficiency virus (HIV).

Testing For HIV

The HIV testing covering percentage is presented. It represents the total number of HIV tests taken per year, across all sexual health services which report into Genitourinary Medicine Clinic Activity Database (GUMCAD). This includes publicly funded sexual health services providing specialist level 3 and non-specialist level 2 sexually transmitted infection related care (including online services). If individuals attending the same clinic have more than one HIV test during a six-week period, only one test is counted. So this indicator does count the total number of tests rather than the number of people tested. The figures are given as the number of tests in year per 100,000 population.

For 2023, the testing rate in Hull is considerably higher than the Yorkshire and Humber region average, but considerably lower than England. The testing rate in Hull is third highest across the region. A high testing rate is consider to be good so all local authorities in the region have a rate that is statistically significantly lower than England. The rate in England tends to be skewed by the particularly high testing rates in London which range between 3,000 and 15,500 per 100,00 population across the 33 upper tier local authorities in the London region.

The number of HIV tests undertaken per 100,000 population ranged from 1,263 to 1,763 per 100,000 population between 2015 and 2019, before falling to 1,139 for 2020 and 846 for 2021 which could partly be associated with the pandemic. However, since the low of 2021, the testing rate has increased to a new high of 2,090 tests per 100,000 population for 2023.

There were 5,619 HIV tests undertaken among Hull residents during 2023.

New Cases of HIV

The new HIV diagnosis (incidence) rate per 100,000 population in Hull was similar to England for 2023 was lower than England but not statistically significantly so (8.8 versus 10.4 new cases of HIV diagnosed per 100,000 population).

The new HIV diagnosis rate has been consistently lower in Hull compared to England with the rate quite variable in Hull, although the rate has been increasing in Hull since a low of 2.7 per 100,000 population in 2016. The rate nationally has shown a consistent decrease until 2020.

In 2021, the rate in Hull was higher than England for the first time since 2011 (6.4 in Hull versus 5.6 in England per 100,000 population), and was also higher than England for 2021 (7.4 in Hull versus 7.0 in England per 100,000 population). However, for 2023, the rate of new diagnoses of HIV is lower than England (8.8 in Hull versus 10.4 in England per 100,000 population).

As there are a relatively small number of new cases of HIV diagnosed each year, there will be year-on-year variability and the confidence intervals are relatively wide for Hull (95% confidence interval 5.7 to 13.1 per 100,000 population in 2023).

There were 24 new cases of HIV diagnosed in Hull during 2023.

Prevalence of HIV

The estimated prevalence of HIV is over 40% lower in Hull compared to England, and it is estimated that there are around 1.5 people diagnosed with HIV per 1,000 population aged 15-59 years in 2023.

As the incidence of HIV is much lower in Hull compared to England, the estimate prevalence of HIV is considerably lower than England. However, the incidence in Hull has been increasing gradually over time compared to a decrease for England (until 2020). This has resulted in the prevalence increasing at a slightly faster rate in Hull compared to England.

The prevalence of HIV has been increasing in Hull from 1.0 per 1,000 population aged 15-59 years in 2011 to 1.5 per 1,000 population aged 15-59 years in 2023 with the overall numbers increasing from 159 people in 2011 to 239 people in 2023.

Late Diagnosis of HIV

Early diagnosis of HIV is very important as late diagnosis is the most important predictor of morbidity and mortality, with a 10-fold risk of death among those who were diagnosed late compared to those diagnosed at an early stage of HIV.

Late diagnosis is defined as those with a CD4 count less than 350 cells per cubic millimetres. The people included in the measure need to have had their CD count available within 91 days of their diagnosis, be aged 15+ years and resident in England. It also includes all reports of HIV diagnoses made in the UK regardless of country of the first HIV positive test (i.e. including people who were previously diagnosed with HIV abroad).

The percentage diagnosed with HIV at a late state during the three year period 2021-23 was higher in Hull than England (62% versus 44%).

For the three year period 2021-23, there were 26 individuals diagnosed with HIV who had their CD4 count available within 91 days of their diagnosis, and 16 (62%) of them were diagnosed at a late stage of HIV.

However, due to the small number of new diagnoses of HIV each year, the percentage diagnosed at a late stage can be quite variable. The percentage diagnosed at a late stage in Hull has generally been reasonably comparable to England, and has only increased in the last two years.

The information on late diagnosis is also available for MSM, heterosexual men and heterosexual women, although due to small numbers the percentages are not given for all local authorities for all three groups.

Interpretation of the differences and trends becomes difficult when the numbers are so small (see Small Numbers for more information).

The percentage of late diagnoses of HIV among MSM has been increasing in Hull, although it is difficult to interpret the data fully as the numbers of new cases will be small. To maintain confidentiality in relation to the numbers of men involved, the numbers of men diagnosed late and the 95% confidence intervals are not given.

The numbers of heterosexual men who were diagnosed with HIV (and had a CD4 count available within 91 days of diagnosis) during the three year period 2021-23 is also very small with only four men diagnosed during the three year period, of whom one was diagnosed late.

As the numbers are so small, it becomes very difficult to interpret the data fully, although it does appear that fewer heterosexual men in Hull diagnosed with HIV are diagnosed late compared to England.

Numbers are also small for heterosexual women have been diagnosed with HIV (and had a CD4 count available within 91 days of diagnosis) although were much higher for the latest period 2021-23 with six of the eight women diagnosed late (75%).

Treatment Success Among People with HIV

Fingertips also presents information on the percentage of patients diagnosed with HIV who start antiretroviral therapy (ART) within 91 days of their diagnosis as well as the percentage who have an undetectable viral load (<200 copies per millilitre).

The indicator measures the prompt treatment which reduces the risk of onward HIV infection among partners. Successful ART decreases a person’s viral load and HIV transmission does not occur when the viral load is undetectable, and the percentage of people who are virally suppressed (also known as an undetectable viral load) has implications in the potential for onward transmission of HIV.

For 2021-23, there is prompt initiation of ART in Hull with 84% commencing ART within 91 days of diagnosis which is similar to England (84%). The success rate in relation to HIV viral load in Hull for 2023 is comparable to England (96% versus 98%).

Information on the trends over time is not available for prompt ART initiation although the number of individuals is given for Hull. ART was given promptly (within 91 days) to 47 of the 56 people newly diagnosed with HIV during the period 2021-23.

The viral load was successfully reduced to an undetectable level for 264 people with HIV during 2023 (out 274 people with HIV where information on viral load was available).

Strategic Need and Service Provision

People need to be aware that symptoms are not always present, and that if they think they might have been exposed or have an STI should be encouraged to seek medical help.

Locally, there are programmes in place to educate and change behaviour, not just to treat sexually transmitted infections, but to empower and allow people to make positive, informed, proactive choices about contraception. There are also specific services available for high risk groups such as sex workers and men who have sex with men (MSM).

Hull Clinical Commissioning Group (and its successor Hull’s Health & Care Partnership) and Hull City Council offer an integrated community-based range of free to access services. Over the last decade Hull has significantly changed the way it delivers sexual health services, with an increasing emphasis on prevention and health promotion to challenge perceived social norms and deliver behaviour change. Services are available throughout the area and in easy to access community settings.

Whilst it might be considered to be positive that the number of STIs has fallen, it is also possible that there has been little change to the prevalence and that the detection rate is lower and as a consequence fewer people with STIs are being treated. It is often not known which is the case. However, for chlamydia screening among young people aged 15-24 years, it is evident that the number of tests and the percentage screened has decreased significantly over time, but as the percentage of tests sent out that are positive for chlamydia is the highest in the county, this denotes a much more targeted approach in Hull compared to perhaps other geographical areas across the country. There has been a greater focus on prevention locally which could also be having an impact.

During the COVID-19 pandemic, whilst the number of STIs detected as well as access to other services such as contraception (see Sexual and Reproductive Health under Health Factors under Adults) reduced, it is difficult to ascertain whether this was due to a reduced detection rate or because the prevalence of STIs decreased or the need for the service decreased. There was clear and significant disruption to Sexual Health and Reproductive Services as the normal face-to-face service could not operate particularly at the start of the first lockdown in March 2020 when people and services were learning and working out the best way to deal with the pandemic and its lockdowns. This clearly was not unique to Hull, but it is likely that different services adapted slightly differently throughout the country. The local Sexual Health and Reproductive Health Service was disrupted initially, but quickly introduced telephone triage and virtual appointments with a postal service for testing kits. This adaptation could have made access to the service more problematic for young people who were living at home during lockdown as it might have been more difficult to have privacy for telephone calls or virtual appointments during lockdown, more problematic receiving testing kits through the post, and no access to a walk-in service for testing. However, it is also likely that the need for Sexual Health Services were reduced as people were not socialising and going out as much.

It is possible that the knock-on effects of this disruption might be felt for some time, even after services were ‘back to normal’ or almost ‘back to normal’. However, some of forced changes to the service have had benefits and some of the changes were retained after the service could ‘return to normal’, and therefore the service model currently operating will differ from the service in 2019. People’s behaviours and the way in which they accessed the service could have also changed, which may be still having an impact on the number of tests undertaken and test positivity. There has been a greater uptake of online testing since the pandemic.

In recent years, it does appear that there is a more targeted approach to STI testing and specifically for chlamydia in Hull compared to some other local authorities.

Resources

NHS. Sexually transmitted infections: https://www.nhs.uk/

The Office for Health Improvement & Disparities’ Fingertips: https://fingertips.phe.org.uk/

HIV/STI Data Exchange (restricted access)

Updates

This page was last updated / checked on 22 October 2024.

This page is due to be updated / checked in January 2025.