Does the recent increase in HIV diagnoses among men who have sex with men in the UK reflect a rise in HIV incidence or increased uptake of HIV testing?
- Sarah Dougan1,2,
- Jonathan Elford2,
- Timothy R Chadborn1,
- Alison E Brown1,
- Kirsty Roy3,
- Gary Murphy4,
- O Noel Gill1,
- on behalf of the group investigating rising HIV diagnoses among MSM in the UK*
- 1HIV & Sexually Transmitted Infections Department, Health Protection Agency Centre for Infections, London, UK
- 2City University London, Institute of Health Sciences, St Bartholomew School of Nursing and Midwifery, London, UK
- 3Health Protection Scotland, Glasgow, UK
- 4Virus Reference Department, Health Protection Agency Centre for Infections, London, UK
- Correspondence to: MissS Dougan Health Protection Agency Centre for Infections, 61 Colindale Avenue, London, NW9 5EQ, UK;
- Accepted 18 October 2006
- Published Online First 7 November 2006
Objectives: To determine whether the increase in HIV diagnoses since 1997 among men who have sex with men (MSM) in the UK reflects a rise in HIV incidence or an increase in HIV testing.
Methods: Estimates of HIV incidence were derived using data from UK HIV surveillance systems (HIV diagnoses; CD4 surveillance; unlinked anonymous surveys) for 1997–2004. Data on HIV testing were provided by KC60 statutory returns, voluntary testing and unlinked anonymous surveys in sentinel genitourinary medicine (GUM) clinics.
Results: HIV diagnoses among MSM in the UK rose by 54% between 1997 and 2004 (from 1382 to 2124), with variation by age and geographical location. The number of HIV diagnoses among MSM <35 years of age in London showed no increase, but in all other groups it increased. Throughout the UK, uptake of HIV testing increased significantly among MSM attending GUM clinics between 1997 and 2004, including “at-risk” MSM (p<0.001). Direct incidence estimates (serological testing algorithm for recent HIV seroconversion assay) provided no evidence of a statistically significant increase or decrease in HIV incidence. Indirect estimates suggested that there may have been a rise in HIV incidence, but these estimates were influenced by the increased uptake of HIV testing.
Conclusions: The number of HIV diagnoses increased among MSM in the UK between 1997 and 2004, except among younger MSM in London, in whom there was no change. The increase in HIV diagnoses among MSM in the UK since 1997 seems to reflect an increase in HIV testing rather than a rise in HIV incidence.
- E,W&NI, England, Wales and Northern Ireland
- GUM, genitourinary medicine
- MSM, men who have sex with other men
- STARHS, serological testing algorithm for recent HIV seroconversion
- STI, sexually transmitted infection
- VCT, voluntary confidential testing
↵* Katy Sinka, Barry G Evans, Catherine M Lowndes, Neil Macdonald, Glenn Codere, David Goldberg, John V Parry and Kevin A Fenton.
Published Online First 9 November 2006
Funding: The Department of Health provides funding for the unlinked anonymous genitourinary medicine survey in E,W&NI, and the CD4 Surveillance Scheme in England and Wales. The Scottish Executive provides funding for the unlinked anonymous GUM survey in Scotland. The funding bodies were not involved in the analysis or interpretation of this work.
Competing interests: None.
SD and KF conceived the idea for the paper, with significant input from JE, TRC, AEB and KR; SD provided the UK diagnoses data, AEB the unlinked anonymous GUM survey data from E,W&NI, GM the unlinked anonymous STARHS data, TRC the CD4 surveillance data from England and Wales, and GM and KR the Scottish data. SD undertook the main analysis and writing of the paper, with all authors, particularly JE, involved in interpretation of the results and drafting of the paper. ONG is the guarantor, who oversaw analyses at the Health Protection Agency and also commented on the drafts. SD is currently registered for a PhD at City University, London.