Data on trans people and HIV in the UK

Transcription

1 Data on trans people and HIV in the UK Peter Kirwan National Infection Service, Public Health England

2 Who are Public Health England Public Health England was established on 1 April 2013 to bring together public health specialists from more than 70 organisations into a single public health service. Public Health England provides government, local government, the NHS, Parliament, industry and the public with evidence-based professional, scientific expertise and support. 2

3 Responsibility Public Health England exists to protect and improve the nation s health and wellbeing, and reduce health inequalities. 3

4 Historical lack of data on trans people For trans people, most public health evidence is: Qualitative Small sample size Only among those attending gender identity clinics HIV among trans people International studies suggest very high HIV prevalence among trans people. 4

5 Improving the way we ask about gender 5

6 Improving the way we ask about gender In collaboration with CliniQ, the LGBTQ Foundation and a partnership of trans organisations, a new two-stage question was developed: Questions now in use for routine HIV public health monitoring in England, set to be implemented for all GUM clinic attendances in

7 National HIV data HARS HIV & AIDS Reporting System National system for monitoring HIV outpatient care in England Collects clinical data at every attendance Gender identity data may be partially complete, this is being addressed through continued follow-up with clinics and improved guidance 7

8 Trans people accessing HIV care 123 trans people were accessing HIV care in England in 2017 Gender identity Male 8% Gender diverse 4% 56% live in London Age group Aged 50 and over 31% BAME 38% Aged % White 62% Female 88% Residency Aged % Ethnicity Further breakdowns are published online: Trans is an umbrella term that refers to all people whose gender identity is different to the gender given at birth, this includes trans men, trans women, genderqueer, non-binary, and other gender identities. 8

9 Late diagnosis* rate, Whole population 43% Trans people 40% 0% 20% 40% 60% 80% 100% *diagnosed with a CD4 count<350 cells/mm 3 9

10 Cascade of HIV care, UK 2017 Whole population Trans people 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 100% 100% 98% 98% 95% 97% 98% 97% 98% 99% Diagnosed On ART Virally suppressed 10

11 Survey of people living with HIV A representative sample of people living with HIV in England and Wales were invited to complete the survey 4,424 people responded, of whom 39 identified as trans or non-binary Questions about living with HIV, health service use, met and unmet need, relationships etc. 11

12 General UK Population Positive Voices Cis Men Cis Women Trans/Non-binary On ARV Not on ARV Sex between Men Injecting Drugs Heterosexual sex Blood/blood products Mother to child Quality of life scores (EQ-5D-5L) in general population vs HIV populations Gender Treatment Status Exposure group 12

13 Current health 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% How would you rate your health today? 1% 2% 4% 5% 21% 33% Very bad 40% Bad 32% Fair Good Very good 33% 29% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% How would you describe your level of anxiety and depression today? 3% 6% 14% 24% 53% 9% 11% 21% 16% 43% I am extremely anxious or depressed I am severely anxious or depressed I am moderately anxious or depressed I am slightly anxious or depressed I am not anxious or depressed 13

14 Socioeconomic status 70% 60% 65% Current work situation 70% 60% Has your household been keeping up with bills? 64% 55% Cis men/women Trans/Non-binary 50% 46% 50% 40% 38% 40% 30% 23% 30% 28% 24% 20% 10% 16% 12% 20% 10% 12% 8% 4% 4% 0% Employed Unemployed Economically inactive 0% Up to date with bills Behind with some bills Behind with all bills Prefer not to say 14

15 Delayed care 14% 12% 10% Felt you were refused health care or delayed treatment or medical procedure because of your HIV? 12% 11% Cis men/women Trans/Non-binary 8% 6% 4% 2% 7% 6% However, no difference in fear or avoidance of healthcare services due to HIV 0% Yes, in the last year Yes, more than a year ago 15

16 Non-disclosure of HIV status 25% Apart from medical staff, I have told noone about my HIV 21% 20% 15% 14% 10% 5% 0% Cis men/women Trans/Non-binary 16

17 Good HIV care and support DOES make a difference... 17

18 We gratefully acknowledge the continuing collaboration of people living with HIV, as well as clinicians, microbiologists, immunologists, public health practitioners, occupational health doctors, nurses and other colleagues who contribute to the surveillance of HIV and STIs in the UK. Thank you to all Positive Voices survey participants & staff at 73 recruiting HIV clinics. 18