In 2019, the previous UK government set the ambitious target of eliminating HIV transmission within the UK by 2030. While great progress has been made in HIV prevention and treatment in the UK, with England reaching the UNAIDS 95-95-95 target in 20231, past evidence suggested that the goal of ‘elimination’ by 2030 is unlikely to be met for Gay, Bisexual, and other Men who have Sex with Men (GBMSM) if prevention interventions remain at current levels2,3. No research has been done to evaluate this question for other groups, such as women.
We expand on previous modelling work by analysing transmissions for other groups (GBMSM, heterosexual men, women, and people who inject drugs) and using more recent data to capture the UK’s increased prevention intervention efforts, including expanding the use of PrEP and introducing ED opt-out HIV screening in high-prevalence areas.
Our modelling study aims to assess:
- Will we achieve the zero-transmission target by 2030 if the prevention interventions remain at their current levels? If not, will we reach it in 50 years?
- Will we achieve the current zero-transmission target by 2030 with a ‘moderate’ increase in prevention interventions?
We use an adapted version of a previously published HIV transmission model2. The model considers six interventions, including PrEP uptake, HIV screening, HIV diagnosis within three months of infection, timely treatment initiation and viral load suppression. The PrEP uptake numbers are informed by our recent work that calculated PrEP need in England and estimated the unmet need4. ‘Zero transmissions’ was defined using the England-specific HIV Commission targets for 2030 (<100 transmissions for the total population)5.
We predict that the number of new HIV transmissions in England is expected to increase over the next 50 years for heterosexual men, women and people who inject drugs if prevention efforts remain at 2023 levels. In contrast, we expect decreases over time for GBMSM as a result of a higher uptake of prevention measures in this group. Without any changes to interventions, we predict that between 2024 and 2073, women and heterosexual men will make up nearly three-quarters of the total new transmissions (73%; 38,315 out of 52,727).
Our results indicate that England will not reach the 2030 zero-transmission target under current intervention levels or ‘moderate’ increases in intervention levels. However, ‘moderate’ increases in the prevention interventions can help get us closer to the target, preventing 19,444 new transmissions between 2024 and 2073 (from 52,727 to 33,282). Preventing these transmissions could avoid substantial HIV treatment costs. In England, the lifetime cost of managing HIV ranges from £73,000 to £404,300 per person6.
While great progress has been made in HIV prevention and treatment, particularly among the GBMSM population, a substantial increase in prevention efforts is needed to meet the zero-transmission goal. No single intervention will be sufficient to achieve the goal, and increasing investment in a combination of prevention interventions is necessary.
The poster was presented at the BHIVA conference in Brighton, April 2025 and can be downloaded here.
Acknowledgements: This work was commissioned and funded by Gilead Sciences. The work was carried out independently by Aquarius Population Health
To learn more about our work at Aquarius, please visit our website or email us at info@aquariusph.com
References
- UKHSA. HIV Action Plan monitoring and evaluation framework 2024 report.
- Massey et al. Investigating zero transmission of HIV in the MSM population: a UK modelling case study. Arch Public Health. 2023 Nov 20;81(1):201. doi: 10.1186/s13690-023-01178-0
- Cambiano et al. The effect of combination prevention strategies on HIV incidence among gay and bisexual men who have sex with men in the UK: a model-based analysis. Lancet HIV. 2023 Nov;10(11):e713-e722. doi: 10.1016/S2352-3018(23)00204-7
- Huntington et al. Estimating the number of people who could benefit from HIV pre-exposure prophylaxis (PrEP) in England and the unmet need. BMJ [In press]
- HIV Commission. Our targets.
- Ong et al. HIV care cost in England: a cross-sectional analysis of antiretroviral treatment and the impact of generic introduction. HIV Med. 2019 Jul;20(6):377-391. doi: 10.1111/hiv.12725
Article by Alice McGreevy May 2025