Population rates of HIV, gonorrhoea and syphilis diagnoses by sexual orientation in New Zealand

Abstract

IntroductionGlobally, gay and bisexual men (GBM) are over-represented in HIV, syphilis and gonorrhoea cases. However, surveillance systems rarely provide meaningful measures of inequity, such as population-specific rates, due to a lack of sexual orientation denominators. HIV, gonorrhoea and syphilis are legally notifiable diseases in New Zealand (NZ); we calculate rates by sexual orientation for the first time.MethodsWe analysed 2019 national surveillance data on HIV, syphilis and gonorrhoea notifications disaggregated by sexual orientation. Unique health records identified duplicate notifications and reinfections. Missing data were imputed from known cases. We used the NZ Health Survey 2014/2015 to estimate population sizes by sexual orientation, measured in two ways (current sexual identity, sexual contact in the previous 12 months with men, women or both). We calculated notification rates per 100 000 for each sexual orientation subgroup and rate ratios.ResultsIn 2019, GBM accounted for 76.3%, 65.7% and 39.4% of HIV, syphilis and gonorrhoea notifications, respectively. Population rates per 100 000 for HIV were 158.3 (gay/bisexual men) and 0.5 (heterosexuals); for syphilis, population rates per 100 000 were 1231.1 (gay/bisexual men), 5.0 (lesbian/bisexual women) and 7.6 (heterosexuals); for gonorrhoea (imputed), population rates per 100 000 were 6843.2 (gay/bisexual men), 225.1 (lesbian/bisexual women) and 120.9 (heterosexuals). The rate ratios for GBM compared with heterosexuals were: 348.3 (HIV); 162.7 (syphilis); and 56.6 (gonorrhoea). Inequities remained in sensitivity analysis (substituting sexual identity with sexual behaviour in the previous 12 months).ConclusionGBM in NZ experience profound inequities in HIV, syphilis and gonorrhoea. Rate ratios by sexual orientation provide useful ‘at-a-glance’ measures of inequity in disease incidence.

PrEP awareness and protective barrier negotiation among transgender people attracted to men in Aotearoa New Zealand

“…Using the question from Trans PULSE Ontario [ 18 , 19 ], participants were asked “Who are you sexually attracted to? Mark all that apply.” Response options included “trans men,” “cis men,” “trans women,” “cis women,” “genderqueer or non‐binary people,” “none of the above” and “others.” As HIV prevalence in Aoteaora is concentrated among MSM [ 7 ], we created a nominal variable “gender and sexual attraction” that differentiated between participants who are sexually attracted to men—either trans or cis men—and those who are not (Table 1 ). We chose trans women who are sexually attracted to men as the reference group given previous literature has identified this group as vulnerable to HIV risk [ 2 , 7 ].…”

“…As HIV prevalence in Aoteaora is concentrated among MSM [7], we created a nominal variable "gender and sexual attraction" that differentiated between participants who are sexually attracted to men-either trans or cis men-and those who are not (Table 1). We chose trans women who are sexually attracted to men as the reference group given previous literature has identified this group as vulnerable to HIV risk [2,7].…”

“…Aotearoa has had a successful record controlling HIV, being one of the first countries to record a decline in AIDS diagnoses in the 1990s [ 5 ]. Annual per‐capita HIV diagnosis rates have remained low [ 6 ] and in 2019 were 2.4/100,000 adults [ 7 ]. The epidemic is concentrated in men who have sex with men (MSM) who comprised over three‐quarters of all locally acquired HIV diagnoses in 2019 [ 7 ].…”

“…Annual per‐capita HIV diagnosis rates have remained low [ 6 ] and in 2019 were 2.4/100,000 adults [ 7 ]. The epidemic is concentrated in men who have sex with men (MSM) who comprised over three‐quarters of all locally acquired HIV diagnoses in 2019 [ 7 ]. HIV transmission among other key populations has been effectively contained, including sex workers [ 8 ] and people who inject drugs [ 9 ].…”

Sexualverhalten und Prävention sexuell übertragbarer Infektionen unter Berücksichtigung der SARS-CoV-2-Pandemie. Daten aus einem Versorgungszentrum für sexuelle Gesundheit und Medizin – WIR

“…Menschen aus Lebenswelten mit sehr hohen Risikokonstellationen (MSM, FSF) scheinen sich dieser mehr bewusst zu sein und mehr Kenntnisse dazu zu haben [19,46,47 [53]).…”