Data from 23 European countries show that the annual number of HIV diagnoses in men who have sex with men (MSM) has increased by 86% between 2000 and 2006, report epidemiologists in the November 2008 issue of Sexually Transmitted Infections. The United Kingdom is the country with the highest number of new diagnoses in Europe, but dramatic increases were also seen in low prevalence countries in Central and Eastern Europe.
Giedrius Likatavicius and colleagues from the EuroHIV programme analysed data on new HIV diagnoses in men who have sex with men from 30 European countries (the member states of the European Union, plus Switzerland, Iceland and Norway).
For the year 2006, a total of 7,693 new diagnoses in MSM were reported in the 27 European countries which had data available (excluding Spain, Italy and Estonia). That equates to 57 cases per million adult men in the population (57/million).
However the 2,597 diagnoses in the United Kingdom that year made it the country with the largest number of new cases in Europe and also the country with the highest rate of new diagnoses among MSM per million male adults (130/million). The rate was also above 100 cases per million men in the Netherlands and Luxembourg, and above 75 cases per million men in Switzerland and Portugal.
By contrast, the rate was much lower in countries such as Lithuania (7/million), Hungary (11/million) and Slovenia (35/million).
In four countries, over half of new diagnoses were in men who have sex with men: Slovenia, Czech Republic, the Netherlands and Germany.
For the comparison of 2000 and 2006, data were available for 23 countries. The other countries could not provide data for each year, or had changed their surveillance system during the period. The Netherlands, France and Spain are among the countries excluded from the analysis for these reasons.
There was an overall increase of 86% in the number of new diagnoses between 2000 and 2006. Only four countries reported a decrease (Cyprus, Iceland, Lithuania and Luxembourg).
Cases increased by 91% in the UK, and the number of annual diagnoses more than doubled in several countries, including Finland, Germany and Norway.
Despite having a comparatively low prevalence, rates also doubled in Hungary (118% increase) and tripled in Slovenia (257% increase). The authors draw attention to sexual mobility and high levels of reported risk behaviour in such countries, which they say leaves open the potential for the rapid spread of HIV there.
More encouragingly, in all but one of the 18 countries which had data on late diagnosis, the proportion of cases diagnosed late had decreased. In 2000, 25% of men were diagnosed late, but by 2006 this was down to 10%.
The authors note that this latter finding indicates an increase in rates of HIV testing, which may have contributed to the number of new diagnoses, but is unlikely to account for all of the increase. They also cite increased life expectancy of HIV positive people (and therefore a larger pool of infection) as an influence on these figures.
Furthermore, the authors point to studies demonstrating continued risk behaviour. Indeed, this week also saw the release of new data which identifies increases in risky sexual behaviour among MSM in Denmark.
The annual Sex Life Survey has been run in 2000, 2001, 2002 and 2006, with over 3,000 men participating in the most recent survey. The researchers report several increases in risk behaviour, each of which is statistically significant:
- In the three previous surveys, between 26% and 28% of men reported unprotected anal sex that was not known to be with a man of the same HIV status. In 2006, 33% of men reported this behaviour.
- Previously, between 84% and 86% of men reported any anal sex. In 2006, this rose to 92%.
- The average number of anal sex partners increased from 8 to 9.4.
- The proportion of men with one steady partner dropped from 26% to 20%, while the numbers who only had casual partners rose from 28% to 34%. The proportion of men with both steady and casual partners rose from 29% to 35%.
Returning to the European surveillance report, its authors conclude: “We have reported a recent increase in the number of HIV diagnoses among MSM in nearly all EU and EFTA countries, and in some countries this probably represents a true increase in incidence. This, combined with the high prevalence of HIV reported in many gay community settings, the high prevalence of HIV among MSM diagnosed with STI and the high sexual mobility of this population, highlight the need for a Europe-wide HIV prevention strategy.”
Likatavicius G et al. An increase in newly diagnosed HIV cases reported among men who have sex with men in Europe, 2000–6: implications for a European public health strategy. Sexually Transmitted Infections 84: 499-505, 2008.