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HIV rise in gay men linked to fall in condom use

One in twenty men who have sex with men have HIV

Mark Gould

Monday, 18 February 2013

The continued rise of new HIV infections in men who have sex with men (MSM) over the last two decades has been driven by a 26 per cent increase in the proportion having condomless sex says new research.

The findings come from a joint study by the Health Protection Agency (HPA) and University College London (UCL) published in PLOS ONE. However, they also suggest the increase in new infections would have been 68 per cent greater without the introduction of antiretrovirals (ART) in the same period, and 400 per cent greater if MSM condom use had ceased entirely from 2000 onwards.

The report said the figures showed it was vital to promote safe sex. Rates of HIV have been rising in recent years with latest figures showing cases among men who have sex with men (MSM) in the UK reaching an all-time high. A recent report from the HPA found that nearly half of the 6,280 people diagnosed in the UK in 2011 were MSM.

Professor Andrew Phillips, lead investigator at UCL, said: “We created a model reconstructing the HIV epidemic in men who have sex with men in the UK. In doing so, we were able to explore the interplay between HIV testing rates, antiretroviral treatment and sexual behaviour on HIV transmission and incidence. By better understanding the driving forces behind the trends we’ve seen in the past, it will allow us to make informed choices to reduce new HIV infections in the future.”

Dr Valerie Delpech, head of HIV surveillance at the HPA, said: “Our research provides important evidence to support current UK public health recommendations on expanded HIV testing and higher levels of ART coverage, to reduce new infections among men who have sex with men. However, we see it is also vital condom use education continues as not only does this have a strong limiting effect on the HIV epidemic, but only a modest increase in unprotected sex is enough to erode the benefits of other interventions”.

Estimated HIV incidence rose from 0.30 per 100 person years (1990-1997) to 0.53 (2006-2010), associated with increased condomless sex following the introduction of effective ART. However, exploring other scenarios, the research found incidence would have reduced during this period if HIV testing levels had been higher (25 per cent lower incidence), if ART had been prescribed at diagnosis (32 per cent lower incidence) or these interventions had been combined (62 per cent lower incidence). Effective ART therapy reduces the infectivity of HIV positive individuals, lowering transmission risk.

Dr Delpech, HPA, continued: “Everyone should use a condom when having sex with new or casual partners, until all partners have had a sexual health screen. We also encourage men who have sex with men to get an HIV and STI screen at least annually, and every three months if having condomless sex with new or casual partners – and clinicians to take every opportunity to recommend HIV testing to this group. Through combining earlier and more frequent HIV testing, programmes that reduce unsafe sexual behaviour and higher levels of ART coverage for those requiring it, we could substantially reduce HIV transmission in this group.”

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