Largest-ever number of HIV diagnoses in gay men

During 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 diagnosed.

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.

Diagnoses 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

Seven 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.

When 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

Research 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 interventions.

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

A 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.

While 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.

Some products also killed off beneficial vaginal bacteria.

In general, 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?

Further lab 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.

The researchers continue to encourage the use of condoms with lubricant.

Problems with rapid 'combination' test

A 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.

More 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

A 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.

Meanwhile, in Uganda, 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:

  • Yorkshire 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 communities.

In addition, Yorkshire MESMAC will act as the local delivery partner across Yorkshire, especially in Leeds, Bradford, Wakefield and York, where it has strong roots.

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