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New HIV cases in England and Wales increase by 20% in past year
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     The number of new cases of HIV diagnosed in England and Wales rose by 20% between 2002 and 2003, triggering anxiety among public health authorities.

    "The year on year increase we are observing in the number of newly diagnosed HIV infections is a cause for considerable concern," said Dr Barry Evans from the Health Protection Agency, which released the figures last week. "HIV is an infection that is here to stay."

    So far, 5047 new HIV diagnoses have been recorded for 2003, compared with 4204 at the same time last year. This follows the 26% increase that took place from 2001 to 2002.

    When all reports have been counted, the 2003 total for new diagnoses is expected to exceed 7000—the highest ever level—and unsafe sex was "undoubtedly the driving force," said the agency.

    "We抳e got no vaccine, we抳e got no cure, but people have got accustomed to HIV in many respects," Dr Evans told the BMJ. "The chances of having an HIV infected partner have never been greater in the UK."

    The rising trend was seen in both homosexuals and heterosexuals.

    Among gay men, reports received so far show there were 1414 new diagnoses during 2003 compared with 1195 at this time last year for 2002, although some of this is due to more prompt reporting from some centres. When the counting is over, 2000 new cases are expected—the highest number since testing began.

    A 27% hike has also been seen among heterosexuals. So far, 2785 new heterosexual cases have been identified for 2003, compared with 2199 at this point last year for 2002. Heterosexual infections contracted in England and Wales increased to 254, but some 80% in this group were contracted in Africa and elsewhere.

    Dr Evans said the rise in other sexually transmitted infections could be behind the increase in HIV reporting.

    It could also be partly due to people coming forward for HIV testing who may have been infected for some time, he said. "This is good news because the earlier people are aware of their HIV status, the more their health can be monitored and they can begin on antiretroviral treatment when they need to, which can prolong their life."

    Nevertheless, almost a third of the estimated 49 500 people who are HIV positive in Britain are thought be unaware of their infection. Figures like this mean that the rising trend is liable to get worse before it gets better, Dr Evans said.

    They also mean that more needs to be done to stem the tide, says the agency. This could include promoting more "safer sex" messages to the general population and those at high risk, reducing waiting times at sexual health clinics, and further encouraging gay men to have HIV testing.

    "In the third decade of HIV, we抮e in it for the long haul," Dr Evans said. "Somehow we抳e got to reinvigorate health promotion, and we抳e got to get people practising safe sex . . . and the scare tactics of the 1980s aren抰 going to work."(London Stephen Pincock)