High HIV rates in UK black gay men

A new analysis has found that black gay men in the UK have almost twice the risk of having HIV as white gay men, and nine times the risk of having HIV as other black people living in the UK.

Researchers identified 13 different previous studies and pooled the results – this makes the findings more reliable.

While black gay men had high rates of both HIV and other sexually transmitted infections, this was not because they were taking more sexual risks. Compared to white gay men, there were no statistically significant differences in terms of unprotected anal intercourse, unprotected sex with men of a different HIV status, number of partners, drug use and protective behaviours.

Similar results have been seen in the United States, where social and economic inequalities are key factors in understanding the HIV epidemic.

New infections driven by people with undiagnosed HIV

Researchers analysing the HIV epidemics in several different European countries have recently come to similar conclusions – that the impact of ‘treatment as prevention’ on the epidemic will be blunted because of the large number of transmissions which can be attributed to individuals with recent HIV infection. Many of these people will be unaware that they have HIV and few will be taking anti-HIV drugs.

Analysis of thirty years of data from the Dutch HIV epidemic suggested that new infections have continued, despite the widespread availability of effective treatment, because of increased rates of unprotected sex, especially among gay men who have undiagnosed HIV.

In north-eastern France, the average viral load of people with diagnosed HIV has been going down and this seems to be linked to small reductions in the number of new diagnoses. But researchers said that more people with HIV would need to be diagnosed and put on treatment to make a large difference to the infection rate. 

In Switzerland, researchers said that phylogenetic analysis (comparing the genetic structure of HIV in different people’s blood samples) showed that very few people who had been diagnosed in recent years were likely to have been infected by someone who had been diagnosed several years before. New infections were coming from recently infected, untreated individuals, they said.

The situation is similar in the United Kingdom. In June it was reported that over 70% of new infections in gay and bisexual men are acquired from men with undiagnosed HIV. In order to bring the number of infections down, it will be necessary for gay and bisexual men to test far more frequently than at present. In addition, those diagnosed with HIV should begin HIV treatment promptly and condom use must be maintained.

Undiagnosed infection in African people – new campaign

The first HIV Prevention England campaign will appear in October, with advertising appearing in newspapers, magazines, websites and social media used by Africans in the UK.

The primary aim of the THIVK campaign is to reduce the average time between HIV infection and diagnosis in Africans who become infected. Adapting concepts and materials that have previously been developed for an audience of men who have sex with men (MSM), the campaign questions assumptions that readers may have about whether they need to take an HIV test.

The adverts explain that thousands of Africans in the UK have undiagnosed HIV infection for years without knowing it.

The campaign will be launched after October 1st, the date from which HIV treatment will be free to all, regardless of immigration status. The adverts emphasise this point.

Undiagnosed HIV infection is a significant problem affecting African communities in the UK. Amongst those born in Africa, one-in-four men with HIV and one-in-five women with HIV are unaware of their infection. This contributes to individuals being diagnosed late and to onward transmission.

Religious beliefs, health and HIV

Although it is often feared that religious beliefs deter some black African people from accessing HIV testing or taking HIV treatment, a newly published study suggests that this is not the case.

Researchers asked 246 black African people who had recently been diagnosed with HIV in London to complete a questionnaire, including a series of questions on religion. As expected, religious beliefs were very important to the majority of participants.

But the researchers did not find that those who attended religious services very regularly or who had strong beliefs had different health behaviour from other participants. They were no statistically significant differences in terms of late HIV diagnosis, taking HIV treatment or the success of HIV treatment.

While more religious people were more likely to say that faith alone can cure HIV, they were able to reconcile their beliefs with the knowledge that they themselves still needed anti-HIV drugs to stay well.

But small numbers of people did express beliefs that health workers will find challenging – for example, 7% were deterred from HIV testing because they believed God would protect them.

And the research highlights an underutilized resource in HIV prevention – fewer than one in ten participants had received HIV information from a faith leader or organization before their diagnosis.

Changing the way HIV prevention is delivered

In July, the International AIDS Conference highlighted three essential steps to implementing effective HIV prevention strategies.

Firstly, commissioners and service providers must use data on new infections and prevalence in order to identify the populations which are at greatest risk of HIV infection. Interventions must focus on these groups and their risk factors.

Secondly, we must prioritise resources and efforts on interventions that are proven to be effective. Cost is relevant, speakers said: “If you have minimum resources, maximising prevention means achieving the lowest cost per infection averted.”

Thirdly, effective interventions need to be packaged together, provided in combination and delivered at a sufficient scale, so that a large proportion of the population are reached. Biomedical interventions need to be delivered together with behavioural support, the conference heard.

Different responses to PrEP

The International AIDS Conference also heard findings from several studies about attitudes to pre-exposure prophylaxis (PrEP) in different communities. (PrEP involves HIV-negative people taking antiretroviral drugs to reduce their risk of infection).

Taken together, the studies indicate the potential for a great deal of variation in how people respond to opportunities to use PrEP. For example, men and women sometimes expressed different attitudes, and the responses of gay and other men who have sex with men (MSM) were not uniform. Further research will be needed in specific locations and subpopulations.

In more than one study, there was a minority of people who thought they would use condoms less frequently if they were taking PrEP. Individuals who currently do not always use condoms were more likely to anticipate this occurring, as were those who had a relatively high self-perceived risk of acquiring HIV.

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