Our modelling study aims to assess overall and individually for each population group:
- Will we achieve the elimination transmission target by 2030 if the prevention interventions remain at their current levels? If not, will we reach it in 50 years?
- How many new transmissions will be acquired by 2030, and in the next 50 years, if prevention interventions remain at their current levels?
- How can increasing efforts help us get closer to reaching the elimination target?
We use an adapted version of a previously published HIV transmission model (4). The model considers six interventions, including PrEP uptake, HIV testing, 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 need (7). Transmission ‘elimination’ was defined using the England-specific HIV Commission targets for 2030 (<100 transmissions for the total population)(8).
We predict that the number of new HIV transmissions acquired 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 and Black African heterosexual men and women as a result of a higher uptake of prevention measures in these groups. GBMSM and people of Black African ethnicity have historically had much higher levels of HIV incidence, and this downward trend is slowly closing the gap.
Between 2024 and 2030, transmissions are expected to decrease by 26% for GBMSM, while they are expected to grow by 9-21% for heterosexual men, women and people who inject drugs, due to inequalities in intervention uptakes in these groups. After 2030, we predict a steady upward trend as the growing transmissions in the heterosexual population begin to offset the great progress in the GBMSM population.
For the total population, we predict the new transmissions will increase by 25% over the next 50 years, and without any changes to interventions, transmissions among heterosexual men and women are predicted to make up almost three-quarters of the total new transmissions, with 22% of these among the Black African heterosexual population.
Our results indicate that England will not reach the 2030 elimination target under current intervention levels. However, increasing intervention efforts can significantly alter the upward trajectory and help get us closer to the goal.
With ‘moderate’ increases in the prevention interventions, we predict the annual number of new transmissions will decrease over time, reducing the total number acquired between 2024 and 2030 by 599 transmissions (19,444 transmissions by 2073). Much larger increases in interventions could prevent 1,932 transmissions by 2030 (35,530 by 2073).
While expanding intervention efforts requires significant increases in funding, it could avoid substantial HIV treatment and management costs. The transmissions prevented by 2030 in our two future scenarios could avert £44 – £391 million in lifetime HIV treatment costs, while the transmissions prevented by 2073 could avert £1.4 – £7.1 billion.
While great progress has been made in HIV prevention and treatment, and England has already achieved the UNAIDS elimination target for the overall population, a substantial increase in prevention efforts is needed to meet the HIV Commission population-specific goal. This goal is ambitious, but ambitious commitments are needed to end HIV transmissions in all population groups, and we must leverage the learnings from the success of the response to date. The new HIV Action Plan for England should consider the most effective prevention strategies to reduce transmissions, such as expanding screening programs and equitable access to PrEP. No single intervention will be sufficient to achieve the goal, and increasing investment in a combination of prevention interventions is necessary.
This work was commissioned and funded by Gilead Sciences. The work was carried out independently by Aquarius Population Health.
References
- GOV.UK [Internet]. [cited 2025 Jun 10]. Health Secretary announces goal to end HIV transmissions by 2030. Available from: https://www.gov.uk/government/news/health-secretary-announces-goal-to-end-hiv-transmissions-by-2030
- Labour’s Manifesto: Build an NHS fit for the future [Internet]. The Labour Party. [cited 2025 Jun 23]. Available from: https://labour.org.uk/change/build-an-nhs-fit-for-the-future/
- UK Health Security Agency. GOV.UK. [cited 2024 Nov 29]. HIV Action Plan monitoring and evaluation framework 2024 report. Available from: https://www.gov.uk/government/publications/hiv-monitoring-and-evaluation-framework/hiv-action-plan-monitoring-and-evaluation-framework-2024-report
- Massey K, Vardanega V, Chaponda M, Eddowes LA, Hearmon N. Investigating zero transmission of HIV in the MSM population: a UK modelling case study. Arch Public Health. 2023 Nov 20;81(1):201.
- Cambiano V, Miners A, Lampe FC, McCormack S, Gill ON, Hart G, 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):e713–22.
- Brizzi F, Birrell PJ, Kirwan P, Ogaz D, Brown AE, Delpech VC, et al. Tracking elimination of HIV transmission in men who have sex with men in England: a modelling study. Lancet HIV. 2021 Jul;8(7):e440–8.
- Huntington SE, Bates L, Coukan F, Adams EJ. Estimating the number of people who could benefit from HIV pre-exposure prophylaxis (PrEP) in England and the unmet need. Sex Transm Infect. 2025 Jul 6;sextrans-2024-056456.
- HIV Commission [Internet]. [cited 2024 Nov 25]. Our targets. Available from: https://www.hivcommission.org.uk/final-report-and-recommendations/our-targets/