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A tale of three cities: persisting high HIV prevalence, risk behaviour and undiagnosed infection in community samples of men who have sex with men
  1. Julie P Dodds1,
  2. Anne M Johnson1,
  3. John V Parry2,
  4. Danielle E Mercey1
  1. 1Department of Primary Care and Population Sciences, Centre for Sexual Health & HIV Research, University College London, London, UK
  2. 2Virus Reference Department, Centre for Infections, Health Protection Agency, London, UK
  1. Correspondence to:
 MsJ Dodds
 Department of Primary Care and Population Science, Centre for Sexual Health & HIV Research, University College London, Mortimer Market Centre, Mortimer Market, off Capper Street, London WC1E 6JB, UK; jdodds{at}


Objectives: To examine the geographical variations in HIV prevalence (diagnosed and undiagnosed), use of sexual health services, sexually transmitted infections and sexual behaviour in a community sample of men who have sex with men in three cities in England, specifically London, Brighton and Manchester.

Methods: Cross-sectional surveys of men visiting gay community venues in three large cities in England. Men self-completed a questionnaire and provided an anonymous oral fluid sample for HIV antibody testing.

Results: HIV prevalence ranged from 8.6% to 13.7% in the three cities. Over one-third of HIV infection remained undiagnosed in all sites despite 69% of HIV-positive men reporting attending a genitourinary medicine clinic in the last year. Similar and high levels of risk behaviour were reported in all three cities. 18% of HIV-negative men and 37% of HIV-positive men reported unprotected anal intercourse with more than one partner in the last year. 20% of negative men and 41% of positive men reported an STI in the last year.

Conclusions: Across all cities, despite widespread availability of anti-retroviral treatment and national policy to promote HIV testing, many HIV infections remain undiagnosed. Data from this community sample demonstrate high levels of risk behaviour and STI incidence, especially among those who are HIV positive. Renewed efforts are needed to increase diagnosis and to reduce risk behaviour to stem the continuing transmission of HIV.

  • GUM, genitourinary medicine
  • MSM, men who have sex with men
  • STI, sexually transmitted infection
  • UAI, unprotected anal intercourse

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  • Funding: This work was supported by the Department of Health and Camden & Islington NHS Primary Care Trusts.

  • Competing interests: None.

  • JPD, DEM, JVP and AMJ initiated and designed the study. JPD managed the project. JVP coordinated the HIV testing. JPD analysed the data, wrote the first draft and coordinated subsequent revisions of the paper. All authors contributed to the final version of this paper. JPD and DEM are the guarantors.

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