HIV in gay and bisexual men in the United Kingdom: 25 years of public health surveillance

Abstract

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, we examine how national surveillance systems have evolved over the past 25 years in response to the changing epidemiology of HIV/AIDS among gay and bisexual men in the United Kingdom as well as advances in laboratory techniques and medical treatments. We also reflect on how they will need to continue evolving to effectively inform health policy in the future.

What has changed HIV and syphilis infection among men who have sex with men (MSM) in Southwest China: a comparison of prevalence and behavioural characteristics (2013–2017)

“…For example, the 2005–2011 surveillance results showed that the percentage of MSM who had multiple homosexual sexual partners over 6 months increased from 68.0% in 2008 to 85.4% in 2011 [13, 44]. In addition, MSM was not only associated with high-risk behaviours but also with high migration rates, which can increase the number of casual sexual partners [45]. In the present study, multiple sexual partners were negatively associated with years for the floating populations along with downward HIV prevalence.…”

Meta-analysis: prevalence of HIV infection and syphilis among MSM in China

“…MSM are at high risk for HIV infection in worldwide because of their high partner numbers without protection and high migration rates 40 – 42. Among 30 956 AIDS cases reported among men in the USA in 2005, 53% were MSM.…”

Occupation and mortality related to alcohol, drugs and sexual habits

“…A major factor in this is likely to be differences between job groups in the prevalence of homosexuality, rates of HIV infection being higher in male homosexuals. [16] A second influence may be the frequency of intravenous drug abuse, shared use of needles being another important route by which the virus is transmitted. [17] Hepatitis B and C can also be transmitted in this way, and this may explain why many of the job groups with high PMRs for HIV/AIDS also had high mortality from viral hepatitis.…”