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Largest-ever number of HIV diagnoses in gay men
2011, 3010 men who have sex with men (MSM) were diagnosed with HIV in the UK.
This is the largest number ever recorded – whereas new diagnoses were stable at
around 1400 men each year in the 1990s, the figure went above 2000 in the year
2003 and has risen steadily since then. But 2011 is the first year that the
Health Protection Agency (HPA) has reported that more than 3000 MSM have been
What’s more, men who have sex with men are being diagnosed
younger. A decade ago, just a quarter of new diagnoses were in men in their
twenties, whereas almost half were in men in their thirties (despite the common
perception that HIV is primarily a young person’s problem). Now, equal numbers
of men in their twenties and thirties are diagnosed.
It’s unclear whether these figures reflect higher uptake of
HIV testing (therefore diagnosis at a younger age) or a real increase in
infections in that age group.
among people born in sub-Saharan Africa continue to decline, especially among
people born in East Africa. Whereas there were
3291 diagnoses in 2003, in 2011 there were 1527 diagnoses made in the UK in African people.
Sexual problems of gay men with HIV
in ten HIV-positive gay men in the UK report having at least one problem with
sex in the last year, a study shows. Large numbers of men complained of
loss of libido; poor self-image or self-confidence; too little sex; concern
about transmitting HIV; fear of rejection by partners; fear of disclosing to
partners; physical sexual problems; and fear of prosecution for transmission.
Younger men and men who had been diagnosed for less time
were especially concerned by the connected problems of disclosure, rejection by
partners and criminal prosecutions. Men who reported problems with self-confidence
or self-image tended to be older.
asked what could be of help to improve their problems, over a third said that some
kind of one-to-one or group therapeutic support might help them address low
self-esteem. One said: “Feeling better about myself and not seeing myself as a
dirty, infected bastard would help things.” A quarter said that better public
awareness about HIV would help them with disclosure.
Gender inequalities and HIV infection
from South Africa has shown links between imbalanced power relationships
between men and women and HIV infection.
While the findings cannot be directly transferred to African
communities in England,
they shed light on cultural issues that may be relevant in some cases and on
the importance of paying attention to gender in designing HIV prevention
In a poor, rural area where HIV infection is very common,
researchers recruited a group of women in their late teens and early twenties.
The following groups of women were found to have increased risks of becoming infected with HIV
two years later:
- Women who said that sexual partners had been
physically or sexually violent.
- Women who reported having relatively little
power in sexual relationships.
- Women who had casual relationships where the
male partner was expected to provide cash, goods or services.
How can the last finding be explained? The researchers say: “When
there is an absence of explicit negotiation and a bolstered sense of male
entitlement, men perceive that gifts of cash result in a woman accepting sex on
his terms, which are often without condoms and without space to assert
preferences for monogamy and so forth.”
Some sexual lubricants damage cells
number of commercially available lubricants used for sex can dry out and
irritate the mucous membranes that line the vagina and rectum, test-tube studies have found.
Researchers evaluated products that are sold in the United States (nine water-based
lubes, two silicone-based lubes and two oil-based lubes) with a variety of
laboratory tests – no tests were conducted in living people.
several water and oil-based products damage mucous membranes, the
silicone-based lubes and some of the water-based lubes did not cause damage. In
general, the lubes that caused irritation drew water out of human tissues,
while the other lubes did not.
products also killed off beneficial vaginal bacteria.
damage to a mucous membrane can increase the risk of acquiring HIV when
exposure occurs (this is how ulcerative STIs increase the risk of HIV
infection). So do these lubes actually raise the risk of infection?
tests were conducted to look at the lubes’ ability
to stop or slow down HIV infection of cells. These results were more
encouraging - none of the products appeared to increase the likelihood of HIV
infection or replication.
But test-tube studies cannot mimic whether lubes have
protective or harmful effects when actually used in sex. The study could not
examine whether lubes protect against HIV infection by protecting against the
soreness and injuries that can occur without them.
researchers continue to encourage the use of condoms with lubricant.
Problems with rapid 'combination' test
rapid, point-of-care test, which aims to reduce the ‘window period’, is in fact
unable to detect very recent infection, a new study says.
The Determine HIV-1/2 Ag/Ab Combo is the only rapid test
which combines detection of HIV antibodies and p24 antigen. Since p24 antigen
is usually detectable a few days before HIV antibodies, it was hoped that the
test would improve identification of recent infection.
Confirming previous reports, UK clinicians have found that, while
the test reliably identified people with established HIV infection, it gave
false negative results to people who were infected in the last few weeks.
encouragingly, another study has found that people are able to accurately ‘self-test’ with
the Determine Combo test, although it was not designed for this purpose.
Volunteers were given written instructions and 92% were able to get a valid
result with the test, which needs a fingerprick blood sample.
African men who have sex with men
report from Kenya provides a reminder of the extremely high rates of infection
among men who have sex with men (MSM) in many African countries.
Researchers followed 449 men over time, tracking the number
of new infections. Most of the men reported sex with both men and women, and
every year in this group, 6 in 100 men were newly infected with HIV (incidence
5.8%). Among the smaller group of men who only reported sex with men, 35 in 100
were newly infected each year (incidence 35.2%).
Several other recent studies have shown that HIV prevalence
among men who have sex with men equals or exceeds that seen in the general
population in most sub-Saharan countries. While the situation in the UK is likely to
be somewhat different, the studies demonstrate that men who have sex with men
exist in African communities and have particular HIV prevention needs.
Stigma around same-sex behaviour in UK African communities
is likely to contribute to risk-taking and to make it harder for MSM to be open
with community organisations.
politicians are renewing efforts to implement an “anti-homosexuality” bill
that, it is feared, will make it even harder to provide health services to men
who have sex with men.
Yorkshire MESMAC’s role in HIV Prevention England
Yorkshire MESMAC is one
of six partners making up HIV
Prevention England, the new national HIV prevention programme that is
targeted towards gay men and African communities.
Set up in 1993, Yorkshire MESMAC’s historical focus has been
sexual health promotion with men who have sex with men, although it now also
works on wider issues affecting lesbian, gay, bisexual and transgender (LGBT)
people and also on HIV work with African communities.
Within HIV Prevention England, Yorkshire MESMAC is one of
three organisations working to ensure there is community engagement with the
national HIV prevention campaigns. The three organisations are:
MESMAC (work with gay communities in central and northern England)
- MBARC (work
with gay communities in London and southern England)
- BHA (work
with African communities across England).
The three organisations will co-ordinate a network of
organisations (known as local delivery partners), which will deliver activities
in support of the campaigns. This will include working with NHS clinics,
commissioners and businesses, as well as delivering interventions within
addition, Yorkshire MESMAC will act as the local delivery partner across
Yorkshire, especially in Leeds, Bradford, Wakefield
and York, where
it has strong roots.
Other recent news headlines
Individuals whose HIV infection is diagnosed late are making only a minimal contribution to the HIV epidemic, Danish investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. Using phylogenetic anaylsis, researchers were able to trace transmission clusters. Only 20% of people diagnosed late were located within such a cluster. Read more >>
Only a third of gay men and one in six heterosexual people who came forward for a rapid HIV community testing programme were aware of post-exposure prophylaxis (PEP), a Spanish study has found. Read more >>
Starting antiretroviral therapy is associated with reductions in sexual risk-taking and injecting among HIV-positive drug users, according to US research published in the online edition of AIDS. There was a 75% reduction in the risk of unprotected sex, whereas the risk of injecting drugs fell by over a third. However, among the small sub-set of patients who continued to inject, the risk of sharing injecting equipment almost doubled. Read more >>
Editors' picks from other sources
from Positive Lite
In a wide-ranging interview that poses difficult
questions, Bob Leahy asks clinician/scientist Dr Rupert Kaul about how can we
interpret risk of HIV transmission in the age of undetectable viral load,
especially in the context of a recent decision by the Supreme Court of Canada.
from BMJ Group blogs
How is it that the nations of the Middle East
and North Africa appear to have relatively low
rates of HIV? A recent paper seeks to demonstrate that the predominance of the
Muslim religion in a country may have a macro-level, cultural impact on the
sexual behaviour of its residents, including those who aren’t themselves
from New York Times
handful of younger gays and lesbians, many educated in the West, are
seeking to foster more acceptance of their sexuality and to carve out an
identity, even in a climate of religious conservatism. Activists are
not focusing on tackling legal discrimination, but on influencing
parents’ deciding whether or not to shun their gay child. They see this
approach as ultimately more productive.
from ACON press release
A new HIV prevention campaign is aiming to increase gay men's knowledge about the degrees of risk involved in not using condoms when they're having sex.
from Drug & Alcohol Findings
A summary of several recent studies which remind Britain of the
value of needle exchange and methadone maintenance services. Harm reduction
services have curbed hepatitis C and will eventually save the health service