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Assessing the impact of national anti-HIV sexual health campaigns: trends in the transmission of HIV and other sexually transmitted infections in England
  1. Angus Nicoll1,
  2. Gwenda Hughes1,
  3. Mary Donnelly1,
  4. Shona Livingstone2,
  5. Daniela De Angelis2,3,
  6. Kevin Fenton1,4,
  7. Barry Evans1,
  8. O Noël Gill1,
  9. Mike Catchpole1
  1. 1HIV and STI Division, Communicable Disease Surveillance Centre
  2. 2Statistics Unit, Public Health Laboratory Service, 61 Colindale Avenue, London NW9 5EQ, UK
  3. 3MRC Biostatistics Unit, University of Cambridge, Institute of Public Health, University Forvie Site, Robinson Way, Hills Road, Cambridge CB3 9NF, UK
  4. 4Department of STDs, Mortimer Market Centre, Royal Free and University College Medical School, Off Capper Street, London WC1E 6AU, UK
  1. Angus Nicoll anicoll{at}phls.org.uk

Abstract

Objective: To assess the impact of the sexual component of AIDS and HIV campaigns on transmission of HIV and other sexually transmitted infections (STIs).

Design: Comparison of time series data.

Setting: England, 1971–1999.

Outcome measures: HIV transmission and diagnoses among men who have sex with men (MSMs), rates of attendances and specific STI diagnoses (per 100 000 total population) at genitourinary medicine (GUM) clinics.

Results: Awareness of AIDS and campaigns in 1983–4 among homosexual men coincided with substantial declines in transmission of HIV and diagnoses of syphilis among MSMs. During general population campaigns in 1986-7 new GUM clinic attendances requiring treatment fell by 117/105 in men and 42/105 in women. Rates for gonorrhoea fell by 81/105 and 43/105 and genital herpes by 6/105 and 4/105, respectively. Previous rises in genital wart rates were interrupted, while rates of attendances not requiring treatment (the “worried well”) increased by 47/105 and 58/105 for men and women, respectively. Since 1987 diagnoses of HIV among MSMs have not declined, averaging 1300–1400 annually. Following a period of unchanging rates there have been substantial increases in GUM attendances requiring treatment, notably for gonorrhoea, syphilis, and viral STIs since 1995.

Conclusions: Self help initiatives and awareness among homosexual men in 1983–4 contributed significantly to a fall in HIV transmission among MSMs, and the general campaigns of 1986–7 were associated with similar effects on all STI transmission. Both effects seem to have occurred through changing sexual behaviour, and probably contributed to the UK's low national HIV prevalence. Bacterial STI incidence has increased significantly since 1995 and there is no evidence that recent prevention initiatives have reduced HIV transmission among MSMs, hence sexual health initiatives need to be comprehensively reinvigorated in England.

  • HIV
  • gonorrhoea
  • syphilis
  • interventions
  • health promotion
  • homosexual males
  • heterosexuals
  • England
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Supplementary materials

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    Web Figure 1: Annual rates of total new attendances at genitourinary medicine clinics in England, males and females 1971�99.

    Web Figure 2: Annual rates of attendances at genitourinary clinics in England: with new diagnoses of genital herpes; males and females, 1971�99.

    Web Figure 3: Annual rates of attendances at genitourinary clinics in England with new diagnoses of genital warts; males and females, 1971�99.

    Web Table 2: Numbers and rates (per 100 000 total population) of attendances at genitourinary medicine clinics in England.

    Web Table 3: Numbers and rates (per 100 000 total population) of attendances at genitourinary medicine clinics in England.

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