HIV/AIDS Notifications in Korea, 2022

Abstract

In this report, we described the major results of the HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) cases reported in 2022, based on the ‘2022 HIV/AIDS Annual Report’ published in June 2023. The report stated that in 2022, 1,066 people in the Republic of Korea, were classed with newly detected cases of HIV infection. Among them, 825 cases (77.4%) were Koreans and 241 cases (22.6%) were foreigners. Approximately 92.3% of all cases (984 cases) were men. The proportion of newly detected HIV cases from 20 years old to 39 years old was 66.4%. Among all cases: 30–39 years old age group was 34.9% (372 cases), 20–29 years old group was 31.5% (336 cases), and 40–49 years old group was 16.4% (175 cases) of all cases. There were 761 cases (71.4%) detected in hospitals and 206 cases (19.3%) detected in public health centers. The most common reason for undergoing an HIV test was to confirm the cause of a voluntary physical examination (221 cases, 28.3%). Almost all cases (99.1%, 577 cases) answered their route of transmission was a sexual contact. New HIV infection cases in 2022 increased by 9.3% compared to the cases in 2021. During coronavirus disease 2019(COVID-19), most of the public health centers had to stop their HIV testing, reassigning their manpower to cope with COVID-19 epidemic in the community. HIV detection increased due to the effects of resumption from the second half of 2022.

Key messages

① What is known previously?

More than 1,000 new HIV infections in Republic of Korea were reported every year. However, in 2021, fewer than 1,000 were reported due to the influence of COVID-19.

② What new information is presented?

In 2022, 1,066 new HIV cases were reported, reflecting a 9.3% increase (91 cases) compared to 2021 and a 4.9% increase (50 cases) from 2020.

③ What are implications?

As the growing population of newly infected individuals in the 20–39 age group and among foreigners, it is necessary to prepare a more detailed set of preventive management measures.

Introduction

Human immunodeficiency virus (HIV) is the causative agent of acquired immune deficiency syndrome (AIDS). On infection, HIV primarily targets CD4-positive T lymphocytes, which are crucial for the body’s cellular immune response, and affected individuals become vulnerable to serious illnesses such as tuberculosis, meningitis, and lymphoma [1]. However, consistent treatment with antiretroviral therapy (ART) suppresses the activity of the virus in the body and maintains an adequate level of immunity, enabling people living with HIV (PLHIV) to continue with a healthy life.

According to a report by the Joint United Nations Programme on HIV and AIDS (UNAIDS), the specialized agency of the United Nations focused on AIDS, there were 1.3 million new HIV infections worldwide in 2022, a 59% drop from the peak in 1995 (3.2 million new cases). In 2022, there were 630,000 AIDS-related deaths and approximately 39 million PLHIV. Furthermore, 86% of PLHIV were aware of their HIV status (86% awareness rate), and 89% of these individuals underwent ART (89% treatment rate). Among those who underwent treatment, 93% had their viral load suppressed to undetectable levels (93% viral suppression rate) [2]. UNAIDS has set ambitious targets for 2025, known as the “95-95-95 targets for all”; more specifically, 95% of PLHIV to know their status, 95% of those diagnosed to be on treatment, and 95% of those on treatment to achieve viral suppression. UNAIDS has called for shared efforts from the global community to achieve these targets.

Every June, the Korean Disease Control and Prevention Agency (KDCA) publishes and disseminates an annual report entitled “Annual Report on the Notified HIV/AIDS in Korea” [3]. In this report, we present an analysis of the major characteristics of HIV/AIDS cases, including reporting status, infection route, and motive for testing based on the 2022 HIV/AIDS Notification Status Report published in 2023.

Methods

1. Data Analyzed

Analysis of HIV/AIDS notification statistics is based on HIV-positive cases reported and notified through the Disease and Health Integrated Management System, from January 1, 2022, to February 28, 2023, by testing facilities in 2022 (KDCA, Public Health and Environment Research Institute).

2. Content of Analysis

Data were collected from the Disease and Health Integrated Management System, including reports addressing HIV/AIDS incidence, deaths, and epidemiological investigations to analyze demographic characteristics (e.g., sex, age), reporting facility, infection route, and motive for testing.

Results

1. New HIV Infections Reported

In 2022, there were a total of 1,066 newly reported cases of HIV infection (2.08 per 100,000 population), a 9.3% (91 individuals) increase from that in the previous year. Among these cases, 825 (77.4%) were Korean nationals, a 6.7% (52 individuals) increase from the previous year, while 241 (22.6%) were foreigners, reflecting a 19.3% (39 individuals) increase from the previous year (Table 1). The proportion of foreigners among all cases has been steadily increasing over the years: 18.0% in 2018; 17.7% in 2019; 19.5% in 2020; 20.7% in 2021; and 22.6% in 2022.

Table 1. Demographic characteristics of notified HIV/AIDS cases, 2020–2022.

	2020				2021				2022
	Total	Korean	Foreigner		Total	Korean	Foreigner		Total	Korean	Foreigner
Total	1,016	818	198		975	773	202		1,066	825	241
Incidence rate per 100,000 peoplea)	1.96	1.58	0.38		1.88	1.49	0.39		2.08	1.61	0.47
Sex
Male	935	790	145		897	742	155		984	790	194
Female	81	28	53		78	31	47		82	35	47
Age (yr)
0–9	0	0	0		0	0	0		0	0	0
10–19	17	17	0		17	16	1		13	12	1
20–29	343	295	48		352	286	66		336	257	79
30–39	303	219	84		293	216	77		372	275	97
40–49	152	111	41		148	106	42		175	126	49
50–59	122	104	18		112	98	14		96	88	8
60–69	62	55	7		41	39	2		55	49	6
≥70	17	17	0		12	12	0		19	18	1
Screening site
Clinic or hospital	731	569	162		712	555	157		761	567	194
Public health center	166	144	22		157	129	28		206	179	27
Others	119	105	14		106	89	17		99	79	20

Unit: person. Source: Annual report on the notified HIV/AIDS in Korea, 2022. KDCA; 2023 [3]. HIV=human immunodeficiency virus; AIDS=acquired immune deficiency syndrome; KDCA=The Korea Disease Control and Prevention Agency. ^a)Mid-year population (resident registration), Statistics Korea.

Regarding sex distribution, the majority of new HIV cases were male (n=984 [92.3%]), with females accounting for 82 (7.7%) cases. However, when Korean and foreign nationals were analyzed separately, there was a slight difference in the percentage of males, with 95.8% (n=790) among Korean nationals and 80.5% (n=194) among foreigners.

In terms of age, the most common age group was 30–39 years (n=372 [34.9%]), followed by 20–29 (n=336 [31.5%]), 40–49 (n=175 [16.4%]), 50–59 (n=96 [9.0%]), 60–69 (n=55 [5.2%]), ≥70 (n=19 [1.8%]), and 10–19 (n=13 [1.2%]) years of age, demonstrating that the more sexually active, younger age groups (i.e., 20–39 years) accounted for 66.4% (n=708) of all cases. This is a slight increase from the 66.2% reported for the same age group in the previous year.

By reporting facility, hospitals and clinics accounted for the majority (71.4% [761 cases]), public health centers accounted for 19.3% (206 cases), and other institutions (e.g., blood centers, military health agencies, private organizations) accounted for 9.3% (99 cases). The proportion of reports from public health centers increased by 3.2% (49 cases) compared with 16.1% (157 cases) in the previous year. Among other facilities, blood centers reported the highest number of cases (n=55 [5.2%]).

2. Reports of Death among HIV Infected Persons

In 2022, there were 142 reported deaths among Korean national HIV infected persons in Republic of Korea (ROK), an increase of 30 deaths compared with the previous year (112 deaths). However, reporting of 22 of these deaths was delayed because they had occurred in previous years (2014–2021), thus necessitating caution when interpreting the results.

In terms of sex, 132 (93.0%) deaths were male, and 10 (7.0%) were female, demonstrating a similar sex distribution from that of HIV incidence rates. According to age, 39 (27.5%) deaths occurred in those ≥70 years, followed by 50–59 (n=34 [23.9%]), 60–69 (n=28 [19.7%]), and ≤40 (n=41 [28.9%]) years of age. Among deaths of PLHIV, 52.8% were ≤50 years of age, which is a high percentage compared to the percentage of Korean national deaths ≤50 years of age reported by Statistics Korea in 2021 (14.4%).

3. People Living with HIV

As of the end of 2022, there was a cumulative total of 19,001 reported cases of HIV infection among Korean nationals, with 17,782 (93.6%) male and 1,219 (6.4%) female. Among these individuals, 15,880 were alive at the end of 2022, with 14,882 (93.7%) male and 998 (6.3%) female. The number of surviving PLHIV increased in proportion to the incidence of new infections.

In terms of age, those ≥60 years of age accounted for 2,927 (18.4%), while those <60 years were 12,953 (81.6%). Although the majority of surviving PLHIV are <60 years, the proportion of the older adult population ≥60 years of age has been steadily increasing annually: 14.8% in 2018; 16.4% in 2020; and 17.3% in 2021.

4. Route of Infection and Motive for Testing among New HIV Cases

Analysis of epidemiological data regarding new HIV infections among Korean nationals revealed that 70.5% (582 individuals) responded to the estimated transmission route question, a 1.5% increase in response rate compared to the previous year (69.0%). Most of the responses (n=577 [99.1%]) indicated infection via sexual contact, and 5 individuals (0.9%) reported infection from sharing a needle(s) for narcotics use. Notably, no one before 2017 reported infection from sharing needles for narcotics, but at least 1–2 individuals continue to report this response since 2017, with 5 specifying this as the route of infection in 2022. Among males reporting transmission through sexual contact (560 individuals), 62.1% (348 individuals) reported same-sex sexual contact, while all female individuals (17 individuals) reported transmission via heterosexual contact. The percentage of respondents reporting same-sex sexual contact has been increasing: 56.9% in 2019; 58.3% in 2020; and 66% in 2021. However, considering that the male-to-female ratio of newly reported cases is 95.8% to 4.2%, it appears that same-sex sexual contact continues to be underreported.

Among Korean nationals newly infected with HIV, 94.8% (728 individuals) responded to the testing motive category, a 0.6% increase in response rate compared to the previous year. The most common testing motive was voluntary testing (n=221 [28.3%]), in which individuals willingly submitted to HIV testing at public health centers or clinics. Other motives included diagnosis as part of disease work-up (n=204 [26.1%]), detection during routine testing for surgery or hospitalization (n=182 [23.3%]), and identification during routine health check-ups (n=99 [12.7%]). The proportion of respondents opting for voluntary testing had decreased to 21.4% in 2020 but increased to 24.9% in 2021, and further to 28.3% in 2022.

Discussion

In 2022, there were 1,066 new HIV infections reported in ROK, marking a 9.3% increase compared to 2021 and a 4.9% increase compared to 2020. The decrease in new infections in 2020 and 2021 are speculated to be attributable to reduced social interactions due to coronavirus disease 2019(COVID-19) isolation measures and reduced testing capacity at public health centers. The slight increase in the number of newly reported cases in 2022 may, in part, be due to the resumption of normal life and activities in the latter half of 2022. The Global Fund to Fight AIDS, Tuberculosis and Malaria (simply the “Global Fund”) contributes 28% of total international funding for HIV eradication programs, and countries receiving support from the Global Fund reported a 72% reduction in AIDS-related deaths between 2002 and 2022. Furthermore, HIV programs have largely recovered from the impact of COVID-19, and the number of people reached with HIV prevention services increased significantly [4].

Foreign nationals accounted for 22.6% of all new cases in 2022, indicating a consistent upward trend from 15.3% in 2017 and 17.7% in 2019, to 20.7% in 2021. This increase in the number of foreign nationals with HIV infection could be influenced by the growth in the number of foreign residents in ROK, which has increased from 2.04 million in 2020 and 1.96 million in 2021, to 2.25 million in 2022. Therefore, more refined HIV prevention measures targeting foreign nationals are required.

The ratio of deaths to the number of PLHIV was 1.4% in 2016, 0.9% in 2019, and 0.9% in 2022, demonstrating that the absolute number of HIV-related deaths increased in 2022; however, this appears to be proportional to the growth in the total number of PLHIV.

In terms of facilities reporting new HIV cases, there was also an increase in the number of cases reported by hospitals and clinics (n=49 [6.9% increase]) and public health centers (n=49 [31.2% increase]) from the previous year. This increase is attributed to public health centers resuming HIV testing services to pre-COVID-19 levels in the latter half of 2022 as COVID-19 isolation measures were relaxed and the public slowly resumed their use of healthcare facilities.

Regarding transmission route(s) for new HIV infections among Korean nationals, 99.1% reported transmission through sexual contact, with 60.3% reporting same-sex sexual contact. Given that the male-to-female ratio of new infections is 95.8% to 4.2%, same-sex sexual contact may still be underreported.

UNAIDS has set a goal to achieve a 95% HIV infection awareness rate, 95% treatment rate, and 95% virus suppression rate by 2025. Additionally, the World Health Organization (WHO) announced Global Health Sector Strategies for HIV, viral hepatitis, and sexually transmitted infections (STIs) from 2022 to 2030 during its 75th World Health Assembly in June 2022. The WHO report emphasizes that countries should adopt strategic and integrated approaches to work toward the elimination of HIV, hepatitis B and C, and STIs (Table 2) [5].

Table 2. Impact indicators and targets for HIV, viral hepatitis and sexually transmitted infections among the global health sector strategies announced by the WHO.

Disease area	Impact indicator	Baseline 2020	2025 target	2030 target
Shared	Reduced incidence
	- Number of new HIV and viral hepatitis cases per year	4,500,000	<1,500,000	<500,000
	Healthy lives—reduced mortality and cancers
	- Number of people dying from HIV, viral hepatitis and sexually transmitted infections per year	2,300,000	<1,700,000	<1,000,000
	- From HIV, viral hepatitis and sexually transmitted infections per year	1,200,000	<900,000	<700,000
HIV	Number of people newly infected with HIV per year	1,500,000	370,000	335,000
	Number of people newly infected with HIV per 1,000 uninfected population per year	0.19	0.05	0.025
	Number of children 0–14 years old newly infected with HIV per year	150,000	20,000	15,000
	Number of people dying from HIV-related causes per year	680,000	250,000	<240,000
	Number of people living with HIV dying from TB, hepatitis B and hepatitis C	210,000	110,000	55,000

Unit: person. Source: Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022–2030. WHO; 2022 [5]. HIV=human immunodeficiency virus; WHO=World Health Organization; TB=tuberculosis.

In 2022, there was a continued increase in the proportion of new HIV infections among young adults in their 20s and 30s and among foreign nationals, highlighting the need for prevention policies targeting these groups. To prepare for the increasing number of PLHIV and aging of PLHIV, the country will continue to explore chronic health management measures and establish and implement the second AIDS prevention and management plan (2024–2028) to achieve global goals and targets in the battle against HIV/AIDS.