HIV This Week

Dougan S, Evans BG, Macdonald N, Goldberg DJ, Gill ON, Fenton KA, Elford J. HIV in gay and bisexual men in the United Kingdom: 25 years of public health surveillance. Epidemiol Infect 2008 Feb;136(2):145-56.

It is more than 25 years since the first case of AIDS was reported in the United Kingdom. In December 1981 a gay man was referred to a London hospital with opportunistic infections indicative of immunosuppression. National surveillance began the following year, in September 1982, with the notification of deaths and clinical reports of AIDS and Kaposi's sarcoma plus laboratory reports of opportunistic infections. Since then epidemiological surveillance systems have evolved, adapting to, and taking advantage of advances in treatments and laboratory techniques. The introduction of the HIV antibody test in 1984 led to the reporting of HIV-positive tests by laboratories and the establishment of an unlinked anonymous survey in 1990 measuring undiagnosed HIV infection among gay men attending sexual health clinics. The widespread use of highly active antiretroviral therapies (HAART) since 1996 has averted many deaths among HIV-positive gay men and has also resulted in a large reduction in AIDS cases. This led to a need for an enumeration of gay men with HIV accessing NHS treatment and care services (1995 onwards), more clinical information on HIV diagnoses for epidemiological surveillance (2000 onwards) and the routine monitoring of drug resistance (2001 onwards). Twenty-five years after the first case of AIDS was reported, gay and bisexual men remain the group at greatest risk of acquiring HIV in the United Kingdom. Latest estimates suggest that in 2004, 26,500 gay and bisexual men were living with HIV in the United Kingdom, a quarter of whom were undiagnosed. In this review, Dougan and collagues examine how national surveillance systems have evolved over the past 25 years in response to the changing epidemiology of HIV among gay and bisexual men in the United Kingdom as well as advances in laboratory techniques and medical treatments. The authors also reflect on how they will need to continue evolving to effectively inform health policy in the future.

Editors’ note: Over a period of 25 years the United Kingdom has created one of the most advanced surveillance systems in the world to describe the evolution of the HIV epidemic among gay and bisexual men, incorporating technological advances in surveillance, laboratory testing, and treatment and care. Between 1995 and 2004 incidence in this population was stable ranging between 2 and 3.5/100 person-years, however a concerning higher incidence in older men (4.5/100 person years in men aged 35–44 years in 2004) has alerted both authorities and gay communities to the need to take stock. Qualitative research is also needed to help understand why some men continue to present for treatment at very late stages of infection.