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New diagnoses in gay men
Health England’s annual report on HIV diagnoses shows that 3250 men who have sex with men (MSM) were
diagnosed in 2012 – the largest number of cases ever recorded in this group.
(In most other recent years, between 2800 and 3000 MSM were diagnosed.)
several indications that efforts to improve the uptake of HIV testing are
beginning to pay off. The proportion of gay men living with HIV who were
unaware of their infection went down to 18%, the proportion of new diagnoses
that were made late (with a CD4 cell count below 350 cells/mm3) went
down to 34%, and the number of HIV tests in sexual health clinics went up – by 13% in England and Wales as a whole and by
19% in London. This
all means that the rise in diagnoses is partly explained by improved testing,
not more newly acquired infections.
But Public Health England also believes that HIV transmission
continues at high levels – its estimations of HIV incidence suggest that
around 2400 MSM newly acquired HIV during the year, a figure that has not
changed in the past decade. The large majority of transmissions originate in
men unaware of their own infection.
PHE also estimates that approximately one-in-five newly diagnosed MSM acquired HIV within the past six months, and that this
figure is even higher among younger gay men and men in London.
Rise in HIV testing
mentioned above, the Public Health England data for 2012 suggest an improvement
in rates of HIV testing, at least among men who have sex with men (MSM) – a 13% rise in the number of sexual health
clinic attendees who took an HIV test.
this in perspective, it is worth looking at the results of three very large studies,
carried out in 1990, 2000 and 2010, which looked at a representative cross-section
of the population, not just sexual health clinic attendees. The
National Survey of Sexual Attitudes and Lifestyles (Natsal) has interviewed a
total of 45,199 people over the past two decades and is more likely than most
other studies to give an accurate picture of HIV testing behaviours across the
In the 1990
survey, 7% of men had taken an HIV test in the previous five years, rising to 17%
in 2010. More women tested – rising from 11 to 28%.
increase in testing was especially marked in people with more than ten
sexual partners in the previous five years. In 2010, 56% of men and 66% of
women with multiple partners had tested.
there was a strong rise in testing levels among men who have sex with men, this still fell far
short of recommendations for all MSM to test at least once a year. Having taken
a test in the previous five years was reported by 34% of MSM in 1990, 40% in 2000 and
52% in 2010. Only a quarter (27%) of men had tested within the previous year.
increased in black African people, reaching 44% of men and 47% of women in the
The results show how much
further the UK needs to go in order to reduce rates of undiagnosed HIV – half
of gay men and African people had not tested at all in the past five years.
Changing sexual behaviour
National Survey of Sexual Attitudes and Lifestyles (Natsal) also contains a
wealth of fascinating data on British people’s sexual behaviour and attitudes,
including comparisons between the surveys in 1990, 2000 and 2010. It
contains some of the most reliable data we have on the topic.
- The differences between women
and men’s sexual behaviour are narrowing, for example in terms of partner
- Sex has become increasingly
detached from reproduction – more people are reporting oral sex, anal sex, sex
at an older age, and other behaviours that have nothing to do with having
- One-in-forty men and
one-in-thirty women report having a partner of the same sex in the previous
- Public attitudes to homosexuality
have become much more accepting, while there is less tolerance of adultery.
- Across the population, HIV risk
behaviours did not increase between the 2000 and 2010 surveys.
- There are links between experiencing
problems with sex (such as lack of libido or relationship problems) and having
a sexually transmitted infection.
- Non-consensual sex was reported
by one-in-ten women and one-in-seventy men, but rates for MSM were as high as
Partner notification is highly effective
contacting the sexual partners of people newly diagnosed with HIV is a very
efficient way of identifying people with undiagnosed HIV, according to an audit
conducted by the British Association for Sexual Health and HIV (BASHH) and the
British HIV Association (BHIVA).
across the UK were asked to check the case notes of just under 3000 people who
had been newly diagnosed with HIV. In the majority of cases, the process of partner
notification was started – the newly diagnosed person was asked about their past
and present sexual partners and, where possible, partners were asked to come to
the clinic for advice and HIV testing.
looked in detail at 1399 partners (contacts) who were tested as a result of
partner notification. There was an extremely high prevalence of undiagnosed HIV
– 293 people (21%) were newly diagnosed as a result. Amongst regular partners,
the rate was even higher (27%).
ten newly diagnosed individuals, an additional person was diagnosed following
audit shows that it needs to be carried out more systematically at some
clinics. For one-in-eight newly diagnosed people, no partner notification at
all took place. And a significant number of ex-partners and casual partners
were missed out, even when contact details were provided – only two thirds were
contacted, and only half actually took an HIV test.
Harm reduction works
of new HIV infections among people who inject drugs in Australia is extremely
low, a new study shows. Australia introduced needle and syringe exchanges
early in the epidemic, has a higher rate of syringe distribution than most
other countries, and has introduced other forms of harm reduction, such as
opioid substitution therapy.
examined new HIV infections (incidence) among people who inject drugs who had
repeat HIV tests between 1995 and 2012. The annual rate was very low throughout
the study period at just 0.11 per 100 person-years – in other words, for every
1000 people, one person acquired HIV each year.
possible that some of the infections were actually acquired through sex – most
of those becoming HIV positive were gay men who injected drugs.
Australia, the UK has good provision of harm-reduction services and low rates
of HIV infection in people who inject drugs – 111 diagnoses in 2012 and a
prevalence of 1.3% in people attending drug services. Continued support for
harm reduction is vital.
At the same
time, there is evidence that there are new groups of drug users, such as people
injecting mephedrone and crystal meth, and evidence of anabolic steroid injectors acquiring
HIV. At present,
not all drugs services have the skills and experience to meet the needs of
Other recent news headlines
There is an increasing and potentially catastrophic HIV and
sexual health epidemic in gay men and men who have sex with men (MSM) in every
part of the world, Professor Kevin Fenton, the National Director of Health and
Wellbeing at Public Health England, told the BHIVA autumn conference last
Prevalence of anal HPV (human papillomavirus) infection is significantly higher among men with
HIV than HIV-negative men who have sex with men (MSM), investigators from the
United States report in PLOS ONE.
Overall, men with HIV had higher rates of infections with the HPV types
strongly and weakly associated with anal cancer, and also lower risk HPV types.
For men with HIV, high levels of adherence to antiretroviral therapy and an undetectable
viral load were protective against high-risk HPV types.
Church attendance is associated with late HIV diagnosis
among men who have sex with men (MSM), according to US research published in
the online edition of Clinical Infectious
Diseases. The study was conducted in Alabama and showed that
church-attending MSM were more than twice as likely to have a CD4 cell count
below 200 cells/mm3 at the time of HIV diagnosis than MSM who did
not attend church. There was also some evidence that church attendance was
associated with less frequent HIV testing among MSM.
HIV-positive gay men living with HIV in France need better
information about the sexual transmission of hepatitis C, according to a
researcher who interviewed 31 men about their experience of living with
Editors' picks from other sources
is clear to me and my team at the Center for Health, Identity, Behavior
and Prevention Studies is this: The notion that young men do not fear
HIV nor are worried about HIV is a myth that needs to be dispelled. It
undermines the lives and struggles of a new generation of gay men trying
to make their places in the world and coming of age in this, the fourth
decade of AIDS.
from BBC Newsbeat
professionals and a sexual health charity say some doctors in parts of
the UK are failing to follow testing guidelines for HIV. Staff from
Britain's largest NHS trust, Barts Health, say clinicians in areas where
infection rates are higher than average are not offering tests
routinely, as recommended.
from Huffington Post
Jonas Gardell's Don't Ever Wipe Tears Without Gloves is a moving tale of life, love and loss among Stockholm's 1980s gay community. Coming to British TV at the same time as the cinema screenings of How to Survive a Plague,
now may be a moment in our culture when sufficient time has elapsed for
reflection and reconciliation, and also, I think, a renewal of anger.
from New York Times
the war on HIV, we have seen successes in some African nations and
stubborn patterns of new infection in developed nations like the US.
Around the world, there are obstacles to prevention and treatment. How
will they be overcome?
The New York Times invited seven respondents including the Executive Director
of UNAIDS and Sir Elton John to contribute to the debate.
from Pink News
In a significant move, the Joint Committee on Vaccination and Immunisation has agreed to set up a working group on possibly offering HPV vaccinations to adolescent boys and gay and bisexual men.
combat the spread of HIV, health officials plan to circumcise 20
million men in Africa, but some scientists worry that the benefits reported for circumcision in clinical trials will not bear out to the same degree when scaled up to tackle a messy epidemic that is spread as much through behaviour as biology.