Service needs of people living with HIV in the UK (Positive Voices 2022): a cross-sectional survey

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BACKGROUND: Despite accessible and effective HIV treatment, the health and wellbeing of people with HIV can be negatively affected by social and economic disadvantage and stigma. We assessed needs and unmet needs for health and welfare services among people with HIV in the UK. METHODS: Positive Voices 2022 is a questionnaire study of 4622 adults, conducted between April 11, 2022, and March 31, 2023, at 101 clinics in the UK. Participants self-completed a confidential questionnaire, including questions on sociodemographics, HIV-related factors, lifestyle factors, mental and physical health, and health and social care service needs; we included participants who provided sociodemographic data, year of HIV diagnosis, and at least one response about health care and other needs (4326 [93·6%] of 4622). 27 health and welfare services were grouped into five categories: HIV-related services; mental health services; welfare services; lifestyle services; and drug services. We assessed the association of sociodemographic factors with those who reported a service need, and those with an unmet need among those with a service need, using logistic regression, adjusted for age group, sociodemographic group, and year of HIV diagnosis. FINDINGS: For the 4326 participants, the median age was 53 years (IQR 44-60) and 996 (22·3%) were diagnosed with HIV between 2014 and 2023. The study population was predominantly gay, bisexual, and other men who have sex with men ([GBMSM] 2564 [59·3%]) and men of any sexual orientation (3237 [74·8%]). 260 (6·0%) were Black African heterosexual men and 360 (8·3%) were heterosexual men of other ethnicity. Of the 1031 women, 574 (13·3%) were Black African women, 457 (10·6%) were women of other ethnicities; and 2·6% (111) people were from other or undisclosed gender identities or sexualities. The most common reported needs were HIV-related (2779 [64·2%]), followed by mental health services (1877 [43·4%]), lifestyle (1492 [34·4%]), and welfare services (1492 [34·4%]). Need for drug services was lower (305 [7·1%]). For each area, service need was greater for younger people, those facing financial hardship, and those not in employment (compared with those who were employed or retired). GBMSM had lower need for HIV-related, welfare, and lifestyle services than most other sociodemographic groups but higher need for drug services. Heterosexual men had the lowest need for mental health services. Among those with a service need, unmet need was lower for HIV-related services (1153 [41·5%] of 2779) than other service categories (from 66·2% to 70·3%), and was associated with younger age, financial hardship, and demographic group. INTERPRETATION: A substantial proportion of people with HIV who have mental health, welfare, and lifestyle needs in the UK are not receiving these services. Regular assessment of such needs, with referral and service signposting to appropriate services, should be implemented to benefit the wellbeing of this population. FUNDING: UK National Institute for Health Research.

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