Beyond targets: how inequity is threatening progress towards ending the HIV epidemic in England

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Frances Luff, Senior Director, Government Affairs | Gilead UK & Ireland

This material has been developed and funded by Gilead Sciences

Triumph and the transmission gap
England’s ambitious goal to end new HIV transmissions by 2030 is a milestone that would mark a monumental historic public health achievement. This target builds on the UNAIDS 95-95-95 framework, which in 2024, England provisionally met – meaning at least 95 per cent of people living with HIV are diagnosed, on treatment, and are virally suppressed.¹ This success demonstrates that, even without a cure or a vaccine, we already have the tools to end the epidemic.

So, what threatens our 2030 elimination goal?
The answer is that our progress is undermined by a "transmission gap" driven by unequal access to testing, prevention and care.¹ Much of the progress achieved so far reflects success among people who are already likely to and able to, engage with HIV services. Meanwhile, others – including Black African heterosexual men and women and heterosexual men outside London – continue to face greater barriers to access. Until these inequities are addressed, elimination targets will remain out of reach.

Late diagnosis, inequality and rising mortality
Nationally, 42 per cent of new HIV diagnoses are still made too late, rising to 50 per cent for Black African heterosexual men.¹ This is critical as late diagnosis drives onward transmission and increases the risk of death tenfold.¹ These losses are preventable, highlighting how inequity continues to cost lives.

Geography deepens the divide. While diagnoses have fallen in London, they have increased by 9 per cent among heterosexual men outside London, where access to testing and specialist care can be limited.¹ Alarmingly, deaths among Black African heterosexual women in England rose by 14 per cent between 2023 and 20242 – the only key population to see an increase.

Prevention gaps and the economic case
If this trend continues, England will not meet its 2030 elimination target.³ Research published by Aquarius Population Health warns that current interventions are not enough.

Prevention efforts are failing due to inequity in pre-exposure prophylaxis (PrEP) access, which remains far lower among Black African heterosexual men and women than in other communities.¹ If this inequity continues, by 2073, heterosexual men and women are projected to account for nearly three-quarters (73 per cent) of new transmissions.³

Ensuring equal access to PrEP is imperative. The 'optimal' investment scenario, which would expand testing and PrEP use in underrepresented groups, could reduce transmissions by 30 per cent by 2030 based on modelling assumptions,³ saving the NHS up to £391m in lifetime treatment costs (actual outcomes may vary).³ Simply put, equitable intervention pays off.

The policy mandate: sustained will and innovation
The new HIV Action Plan offers an opportunity to realign efforts. Achieving the 2030 goal will require sustained political will, clear accountability and targeted investment. Proven initiatives such as Opt-Out testing in Emergency Departments must be scaled up and adapted for other settings, alongside dedicated funding to improve PrEP access for Black African and heterosexual communities.

Campaigns such as Gilead’s Women and HIV, developed with the Sophia Forum,⁴ have already drawn attention to the gendered inequalities that persist in testing, treatment and prevention – insights that should inform this next phase of action.

To end HIV transmission for good, the government must commit to funding innovation, sustaining local specialist services and ensuring equitable access to testing, care and prevention.

For more information on this topic, contact [email protected]

References

1. UK Health Security Agency (UKHSA); HIV testing, PrEP, new HIV diagnoses and care outcomes for people accessing HIV services: 2025 report
2. UK Health Security Agency (UKHSA); HIV diagnoses, AIDS, deaths and people in care: England tables, 2015 to 2024
3. Aquarius Population Health; Modelling the impact of HIV prevention efforts on progress towards the 2030 elimination goal (2025)
4. Gilead Sciences; Systematically Excluded and Ignored: Addressing Inequalities for Women in the HIV Response. (2025)

 Job Number: UKI-UNB-2082. DOP: November 2025

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