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 during sex.
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 infection.
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 behaviors.”
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 investigators.
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 System.
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 months.
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 sex.
“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 risk behaviour.
Oster AM et al. HIV testing among men who have sex with men – 21 cities, United States, 2008. Morbidity and Mortality Weekly Report, 60: 694-99, 2011 (click here for the full text).