HIV This Week

Dodds JP, Johnson AM, Parry JV, Mercey DE. A tale of three cities: persisting high HIV prevalence, risk behaviour and undiagnosed infection in community samples of men who have sex with men. Sex Transm Infect 2007 Aug;83(5):392-6.

Dodds and colleagues’ study objectives were to examine geographical variations in HIV prevalence (diagnosed and undiagnosed), sexual health service use, sexually transmitted infections and sexual behaviour in a community sample of men who have sex with men (MSM) in three cities in England, specifically London, Brighton and Manchester. The authors used cross-sectional surveys of men visiting gay community venues in three large cities in England. Men self-completed a questionnaire and provided an anonymous oral fluid sample for HIV antibody testing. The results showed that HIV prevalence ranged from 8.6% to 13.7% in the three cities. Over one third of HIV infections remained undiagnosed in all sites despite 69% of HIV positive men reporting attending a Genito-Urinary Medicine (GUM) clinic in the last year. Similar and high levels of risk behaviour were reported in all three cities. 18% of negative men and 37% of positive men reported unprotected anal intercourse (UAI) with more than one partner in the last year. 20% of negative men and 41% of positive men reported an STI in the last year. The authors concluded that across all cities, despite widespread availability of anti-retroviral treatment (ART) and national policy to promote HIV testing, many HIV infections remain undiagnosed. Data from this community sample demonstrate high levels of risk behaviour and STI incidence, especially among those who are HIV positive. Renewed efforts are needed to increase diagnosis and reduce risk behaviour to stem the continuing transmission of HIV.

Editors’ note: This tale speaks volumes about the need for serious rethinking about effective prevention in the community of men who have sex with men in England. For a start, the fact that so many HIV infections are unrecognised suggests that introduction of provider-initiated offers of HIV testing and counselling in sexually transmitted disease clinics could go a long way to reducing the number of undiagnosed infections.