In 2019, the previous government committed to eliminating HIV transmission by 2030 [1]. An action plan was developed [2] and a funding commitment made for opt-out HIV testing in hospital A&Es. However, despite the recent progress made in HIV prevention and treatment, England is not predicted to achieve the 2030 zero-transmission target under the current intervention levels [3].
PrEP (pre-exposure prophylaxis) refers to the use of antiretroviral drugs by HIV-negative people to prevent transmission. In 2016, the PROUD study, an extensive PrEP trial in GBMSM (gay, bisexual, and other men who have sex with men), found that PrEP was effective at reducing HIV transmission rates [5]. Since then, PrEP has become available from NHS-run sexual health services (SHSs) to anyone of any gender at risk of HIV, and the recent UCL model [4] found that PrEP has played a crucial role in reducing HIV transmission.
Until now, it was not clear how many additional people not currently using PrEP might benefit from its use. The UK Health Security Agency (UKHSA) publishes data on the number of people using PrEP and on those with PrEP need among people attending SHSs [6], but these data cannot tell us the number of people with PrEP need who are not accessing these services.
In a recent study, we aimed to estimate the total number of people in England who need PrEP and to identify the unmet need by population group and ethnicity. We used behavioural data from a survey of GBMSM and national surveillance data on new HIV diagnoses. By comparing these estimates with data on current PrEP use among individuals attending SHSs, we determined the unmet need for PrEP. This type of analysis has not been published before for England.
Our analysis reveals a significant unmet need for PrEP that disproportionately affects certain population groups and ethnicities. We estimated that in 2023, approximately 485,335 people in England could benefit from PrEP, with 388,773 (80.1%) not obtaining it. Among those with unmet need, 94.5% did not visit an SHS. Three ethnic groups had over 85% of individuals who needed PrEP not accessing it: Black African (98.6%), Black Other (96.3%), and Black Caribbean (85.4%).
This study highlights the need for new strategies to reach people who could benefit from PrEP, such as increasing awareness, improving availability, and reducing barriers to its use. Other countries where PrEP is available could also adopt a similar approach to quantify the number of people who could benefit from PrEP and identify unmet needs in their setting.
The findings of this research were presented at the HIV Prevention Conference in London in September 2024, and the complete results have been published in BMJ STI in July 2025.
We hope this study can support future efforts to reduce the gap between PrEP need and PrEP use.
Acknowledgements: This work was commissioned and funded by Gilead Sciences. The work was carried out independently by Aquarius Population Health.
References
- Department of Health and Social Care. Let’s pledge to do our part to end HIV. Jan 2019. Accessed August 2024 www.gov.uk/government/speeches
- Department of Health and Social Care. Towards Zero: the HIV Action Plan for England – 2022 to 2025. December 2021 www.gov.uk/government/publications
- Aquarius PH. When will the UK achieve HIV transmission elimination? Modelling the impact of current HIV prevention efforts on progress towards the 2030 elimination goal. May 2025 https://aquariusph.com/portfolio/when-will-the-uk-achieve-hiv-transmission-elimination-modelling-the-impact-of-current-hiv-prevention-efforts-on-progress-towards-the-2030-elimination-goal/
- Cambiano et al, Lancet HIV 2023; 10: e713–22. https://pubmed.ncbi.nlm.nih.gov/37923485/
- McCormack et al, Lancet 2016; 387: 53–60 Online paper
- UKHSA. HIV testing, PrEP, new HIV diagnoses and care outcomes for people accessing HIV services: 2023 report. Updated 6 October 2023. https://www.gov.uk/government/statistics
To learn more about our work at Aquarius, please visit our website or email us at info@aquariusph.com
Article by Maria Delgado – July 2025