Approximately 40% of UK gay men with 30 or more sexual partners in the last twelve months did not visit a sexual health clinic in the last year, according to the results of the 2005 Gay Men’s Sex Survey. The study, Consuming Passions, also found that 85% of HIV-negative or untested men who had attended a sexual health clinic in the last year had been offered an HIV test, indicating that although routine, opt out HIV testing is becoming routine for gay men in the UK, a significant number of men leave a sexual health consultation without being offered the opportunity, or agreeing to, test for HIV.
The survey also asked men who had recently attended a sexual health clinic how satisfied they were with the service they received. The answers will surprise many. Despite reports of a ‘crisis’ in sexual health services in recent years, more men expressed satisfaction with their experiences of such services in 2005 than in 1998, the last time the Gay Men’s Sex Survey enquired about this subject.
Findings from the study regarding unprotected anal sex can be read here, and a summary of the survey’s findings on drug use can be found here.
Use of sexual health services
In all, 38% of the 16,500 gay men who completed the 2005 survey said that they had never visited a sexual health clinic.
When the investigators looked at utilisation of sexual health services according to HIV status, they found that 78% of untested men had never been to a sexual health clinic, compared to 9% of men who said they were HIV-negative and less than 1% of HIV-positive men.
Just over a third (35%) of men had used a sexual health clinic in the last year. When the investigators asked about very recent visits to a clinic, they found that 11% of all men said that they had visited a sexual health clinic in the last month. Men most likely to have had a recent visit to a clinic were those with HIV (61%), followed by 12% of men who said they were HIV-negative, and only 2% of men who had never tested for HIV.
The study also found that 40% of men with 30 or more partners in the last year had not visited a sexual health clinic in this period.
Most men (68%) said that they had visited a sexual health clinic for a general check-up, and 62% said that they had attended specifically for an HIV test. Only 1% of men said that their visit to a clinic was to obtain post-exposure prophylaxis after a possible sexual exposure to HIV.
Offering of an HIV test
It is now recommended that all gay and bisexual men (not already diagnosed with HIV) be offered an HIV test when attending a sexual health clinic. The survey revealed that 79% of men had ever been offered a test at a clinic. However, this rose to 86% when the investigators asked men who had visited a clinic in the last year.
“Receiving an offer of an HIV test…is high but not universal”, write the authors. It should be noted that approximately 40% of men in the survey reported that they had never had an HIV test, and it is estimated that between a quarter and a third of all cases of HIV amongst gay men in the UK are undiagnosed. Many HIV-related deaths in the UK could be prevented if the infection had been diagnosed more promptly, and recent studies have shown that undiagnosed individuals with recent HIV infection are responsible for half of all new HIV infections.
Who attends clinics?
The survey revealed that the men most likely to have accessed sexual health services in the past year lived in London, were in their 30s and 40s, had six or more years of education after the age of 16, had an income of over £40,000 per year, rated themselves as attractive, had more sexual partners, and were more likely to be HIV-positive.
Quality of sexual health services
Information on the quality of services provided by sexual health clinics was obtained from men living in England and Wales. The last time questions were asked about gay men’s experiences of sexual health clinics was in 1998. Since then, pressure on sexual health services has increased with clinics said to be at the point of ‘crisis.’
Given this background, it was perhaps surprising to find that the proportion of gay men expressing satisfaction with their experience of sexual health services actually increased, and well over 80% of men said that they would recommend the clinic they attended to other gay men.
Key conclusion
Although attendance at a sexual health clinic was associated with greater number of sexual partners, the authors write with concern “40% of men with more than thirty male partners in the last year had not been to a clinic in the same time period. Given that these men were most likely to be involved in transmission of both HIV and other STIs, more effort needs to be put into encouraging men with larger numbers of partners to use the GUM services available.”
Hickson F et al. Consuming passions: findings from the United Kingdom gay men’s sex survey 2005. Sigma Research, March 2007.