United Kingdom: A Tale of Three Cities: Persisting High HIV Prevalence, Risk Behavior and Undiagnosed Infection in Community Samples of Men Who Have Sex With Men

The authors set out to study geographical variations in diagnosed and undiagnosed HIV prevalence, use of sexual health services, STDs, and sexual behavior in a community sample of men who have sex with men (MSM) in the English cities of Brighton, Manchester, and London.

Men visiting gay community venues in the three cities were evaluated via cross-sectional surveys. The subjects completed a self-administered questionnaire; they also provided oral fluid samples to be tested anonymously for HIV antibodies.

Among participants in the three cities, HIV prevalence ranged from 8.6 percent to 13.7 percent. More than one-third of HIV infections were previously diagnosed, despite the fact that 69 percent of HIV-positive MSM said they had presented to a genitourinary medicine clinic in the past year.

The researchers found similar high levels of risk activity in all three cities. Unprotected anal intercourse with more than one partner was reported by 18 percent of HIV-negative men and 37 percent of HIV-positive men. An STD in the past year was reported by 20 percent of HIV-negative men and 41 percent of HIV-positive men.

"Across all cities, despite widespread availability of antiretroviral treatment and national policy to promote HIV testing, many HIV infections remain undiagnosed," the authors concluded. The study, they said, found evidence of high levels of both risk behaviors and STD infection "especially among those who are HIV-positive. Renewed efforts are needed to increase diagnosis and to reduce risk behavior to stem continuing transmission of HIV."

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