Sexually active gay and other men who have sex with men
(MSM) should have an HIV test every three to six months, US investigators suggest in
the June 3rd edition of Morbidity
and Mortality Weekly Report.
The investigators make the recommendation after examining
HIV prevalence and risk behaviour in over 7000 gay men who believed themselves
to be HIV-negative.
Overall, 9% of men tested HIV-positive.
Current US guidance recommends annual HIV tests for all
sexually active gay men, and more frequent tests (every three to six months)
for men deemed to be at higher risk of HIV – those with multiple partners,
or engaging in unprotected sex, as well as users of methamphetamine or other drugs
However, HIV prevalence in the current study did not differ between
men who were considered “higher risk” and those deemed to have a lower risk of
This finding lead the investigators to comment:
“self-reported risk behaviors might not determine which MSM should be tested
more frequently…more frequent testing, perhaps as often as every 3 to 6 months,
might be warranted among all sexually active MSM, regardless of their risk
In June 1981 the first clusters of what was to become known
as AIDS were reported in young gay men in New York and San Francisco. Thirty
years later gay men still remain a major focus of the HIV epidemic in the US
and many other countries.
Testing is a central plank of HIV prevention efforts.
“Persons often reduce their risk behaviors when they receive a diagnosis of HIV
infection and persons who do not know they are infected are estimated to
account for more than half of sexually transmitted HIV,” explain the
With this in mind, the researchers wished to gain a clearer
understanding of testing and risk behaviours in gay and other MSM in the US.
The study sample comprised 7271 gay men recruited in 21
cities in 2008 who participated in the National HIV Behavioral Surveillance
All the men reported sex with another man, and completed
questionnaires about HIV testing and sexual risk. Only men who believed
themselves to be HIV-negative were eligible for inclusion in the study.
Overall HIV prevalence was 9%. Just under a fifth of men
testing positive reported never having an HIV test, and 29% reported a previous
test within the past six months.
Analysis was focused on the 4453 individuals (61%) who
reported an HIV test within the past twelve months. In all, 7% of these men
were found to be HIV-positive. Prevalence differed by race, and was higher in
African Americans than other groups (15%, vs 7% Hispanics vs 3% whites).
Of the 3672 men who reported high-risk behaviour in the past
twelve months, 7% were HIV-positive. This compared to a prevalence rate of 8%
in men who did not report higher-risk sex or drug use.
The danger of relying on self-reported behaviour to assess
HIV risk was starkly demonstrated by one of the study’s findings. Participants
were asked to report if they had had unprotected sex in the previous twelve
Analysis restricted to individuals who had had a previous
HIV test within this period revealed that 8% of men reporting no unprotected
sex were HIV-infected compared to 6% of individuals who reported unprotected
“This analysis demonstrates that MSM remain a key population
for expanded HIV testing efforts,” comment the authors, who conclude that
current HIV screening guidelines need to reconsidered, and testing every three
to six months should be recommended for all gay men, regardless of their report