Gay men remain focus of European HIV epidemic

Gay men continue to be the focus of the HIV epidemic in Europe, a series of articles published in Eurosurveillance Weekly show.

Research from a number of countries demonstrates that there are large numbers of new HIV infections amongst gay men. Moreover, large numbers of gay men are being diagnosed late.

“Over twenty-five years into the epidemic, patterns in Europe have not changed and men who have sex with men remain the group most affected” by HIV, comment the authors of an editorial accompanying the studies.

“High-risk behaviour is increasing across Europe, HIV transmission is ongoing, increased levels of co-infections are observed and outbreaks of sexually transmitted infections continue amongst men who have sex with men,” add the authors of the editorial.

Risk behaviour and its causes

Researchers in Catalonia report that 32% of gay men have had unprotected anal sex with a casual partner. Higher rates of unprotected sex were reported by men with HIV, who used more drugs, had greater numbers of sexual partners, used the internet to look for sex, and had feelings of “internalised” homophobia.

The investigators recommend that HIV prevention initiatives should include activities that build the self-esteem of gay men and take into account internalised homophobia. They also suggest that programmes for men with diagnosed HIV should include information about sexually transmitted infections.

HIV-negative gay men and serosorting

Over a fifth of gay men in France selected a partner for unprotected anal sex on the basis of their reported HIV infection (serosorting).

HIV-negative men were more likely to report serosorting than those who had HIV (26% vs 14%).

The use of the internet to find sexual partners was associated with serosorting amongst HIV-positive men, possibly because of the safety of disclosing online.

Drug use was more common amongst men reporting serosorting (31% vs 24%).

Having fewer sexual partners was the only factor associated with serosorting by HIV-negative men.

“For HIV-seronegative men who have sex with men, the practice of serosorting implies the need for an up-to-date knowledge of their own HIV serostatus obtained through regular screening,” comment the investigators. However, they found “no difference in the frequency of HIV testing in the previous two years between men who have sex with men who practised serosorting and those who did not.”

They suggest that campaigns should be targeted to both HIV-negative and HIV-positive gay men about the potential risks of serosorting.

HSV and HIV in gay men

Over 50% of HIV-positive gay men in England and Wales are co-infected with the genital herpes virus, HSV-2, according to research conducted in 2003 and involving almost 4000 men.

By contrast, only 17% of HIV-negative men were infected with HSV-2.

Prevalence of HSV-1 was also higher in HIV-positive than HIV-negative gay men (88% vs 69%).

In other research, infection with genital herpes has been associated with an increased risk of HIV infection and faster HIV disease progression.

“The high prevalence of HSV-2 amongst HIV-positive men who have sex with men in England and Wales suggest a review of HSV control in the management of HIV in men who have sex with men is warranted,” conclude the investigators.

Continuing new HIV infections

Research conducted in Belgium suggests that there are high levels of new HIV infections amongst gay men.

Of the 1079 new HIV diagnoses in Belgium in 2008, 48% were amongst gay men.

Rates of HIV testing have not increased amongst Belgium men in recent years, and the investigators believe that high rates of new diagnoses amongst gay men in Belgium points towards continued transmission of the virus.

Of the sexually transmitted infections diagnosed amongst people with HIV in Belgium, over 95% were in gay men.