Transmission of HIV remains high among homosexual and bisexual men

November 23, 2000

Serosurveillance of prevalence of undiagnosed HIV-1 infection in homosexual men with acute sexually transmitted infection

The level of undiagnosed HIV-1 infection among homosexual and bisexual men did not fall between 1993 and 1998, indicating a high level of continuing transmission, finds a study in this week's BMJ.

Samples from over 32,000 homosexual and bisexual men, attending 15 genitourinary clinics in England and Wales with sexually transmitted infections, were tested for HIV-1 infection. In London, the level of HIV-1 declined among men attending with an acute sexually transmitted infection, such as gonorrhoea and chlamydia, from 16.5% in 1993 to 9% in 1998: an average decrease of 9% a year. However, when samples from men known to be HIV-1 positive were excluded, there was no such trend. In contrast, the level decline in prevalence of HIV-1 among men attending with a non-acute sexually transmitted infection was significant: 17% a year overall and 11% a year when men known to be HIV-1 positive were excluded. Outside London, the level of HIV-1 infection was lower and, similarly, a significant decline (11% a year) was seen only in men with a non-acute sexually transmitted infection.

The findings suggest that men with acute sexually transmitted infections represent a significant risk for HIV-1 transmission. These men probably have more partners and engage in riskier sex than those without such infections, say the authors. Health promotion directed at this group of men should be intensified, they conclude.

Michael Catchpole, Consultant Epidemiologist, Public Health Laboratory Service, Communicable Disease Surveillance Centre, London, UK


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