Objective: To examine, by ethnicity, gender and sexual orientation, uptake of antiretroviral treatment among people living with HIV in London.
Methods: Between June 2004 and June 2005, 1687 people living with HIV (73% response) receiving treatment and care in North East London National Health Service outpatient clinics completed a confidential, self administered, questionnaire. Respondents were asked whether they were currently taking HIV treatments (antiretroviral or combination therapy)
Results: Overall, 73.7% (1057/1435) of respondents said they were currently taking HIV treatments: white men who have sex with men (MSM) 70.7%; ethnic minority MSM 70.9%; black African heterosexual women 75.0%; black African heterosexual men 80.8% (p<0.05). In all groups, taking HIV treatments was strongly associated with having a low CD4 cell count at diagnosis (p<0.001); 30.1% of white and ethnic minority MSM had a CD4 cell count less than 200 cells/mm3 at diagnosis compared with 53.1% of the black African heterosexual women and 66.3% of the black African heterosexual men (p<0.001). After adjusting for CD4 cell count at diagnosis, no significant differences in uptake of HIV treatments remained between the groups: MSM AOR 1.00 (reference group); black African heterosexual women AOR 1.15, 95% CI 0.71 to 1.88, p = 0.6; black African heterosexual men AOR 0.88, 95% CI 0.43 to 1.80, p = 0.7.
Conclusion: Our analysis suggests that in London, once HIV infection is diagnosed, people from the two main risk groups—MSM (mostly white men) and black African heterosexual men and women—receive HIV treatment according to clinical need regardless of their ethnicity, gender or sexual orientation.
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Contributors: JE and JA conceived the study; JE, JA and CB designed the survey questions with input from the advisory panel; CB was responsible for questionnaire distribution, data collection and data entry; FI for data management and analysis; JE and FI planned the statistical analysis; JE drafted the manuscript; and all authors contributed to the interpretation of data and read, revised and approved the final manuscript. JE is the guarantor.
Funding:The study was funded by St Bartholomew’s and The Royal London Charitable Foundation, Research Advisory Board (Grant JRB XMNS), with additional support from City University London, Institute of Health Sciences.
Competing interests: None.
Ethics approval: Ethics approval was obtained.