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HIV, sexual risk and ethnicity among gay and bisexual men in England: survey evidence for persisting health inequalities
  1. Ford Hickson1,
  2. G J Melendez-Torres2,
  3. David Reid1,
  4. Peter Weatherburn1
  1. 1 Sigma Research, Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
  2. 2 Warwick Medical School, University of Warwick, Coventry, UK
  1. Correspondence to Dr Ford Hickson, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK; ford.hickson{at}


Objectives To examine ethnic group differences in HIV testing and sexual behaviours among a large sample of gay and bisexual men (GBM), 13 years after similar observations were made, assess national HIV prevention responses and inform planning priorities.

Methods Cross-sectional convenience self-completion online survey in summer 2014, designed and recruited in collaboration with community-based health promoters and gay internet services; comparison with earlier findings reporting on similarly designed survey in 2001.

Results We recruited 15 388 GBM living in England who self-reported as follows: 18.5% from ethnic minorities; 9.0% tested HIV positive (cf. 17.0% and 5.4% in 2001). Compared with the white British, Asian men were no longer less likely to report diagnosed HIV but had an equal probability of doing so (2001 OR=0.32, 95% CI 0.13 to 0.79; 2014 OR=1.04, 95% CI 0.71 to 1.54); black men remained significantly more likely to report diagnosed HIV (2001 OR=2.06, 95% CI 1.56 to 3.29; 2014 OR=1.62, 95% CI 1.10 to 2.36) as did men in the other white group (2001 OR=1.54, 95% CI 1.23 to 1.93; 2014 OR=1.31, 95% CI 1.10 to 1.55). Overall annual incidence of reported HIV diagnoses in 2014 was 1.1%. Black men were significantly more likely to report diagnosis with HIV in the last 12 months than the white British (adjusted odds ratios (AOR) 2.57, 95% CI 1.22 to 5.39). No minority ethnic group was more or less likely to report condom unprotected anal intercourse (CUAI) in the last year but men in the Asian, black and all others groups were more likely than the white British to report CUAI with more than one non-steady partners.

Conclusions Among GBM in England, HIV prevalence continues to be higher among black men and other white men compared with the white British. The protective effect of being from an Asian background appears no longer to pertain. Sexual risk behaviours may account for some of these differences.

  • HIV

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  • Handling editor Jackie A Cassell

  • Contributors FH conceived the paper, designed the analysis and wrote the first draft; FH, PW and DR designed and managed the survey; GMT advised on and ran the analysis; all authors contributed to the manuscript and agreed the final version. FH revised the manuscript.

  • Funding The Gay Men's Sex Survey 2014 was commissioned by Terrence Higgins Trust as part of the HIV Prevention England programme funded by Public Health England.

  • Competing interests None declared.

  • Ethics approval Observational Research Ethics Committee of the London School of Hygiene and Tropical Medicine (LSHTM ethics reference number 7658).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data from the Gay Men's Sex Survey are available at a local authority level to HIV prevention commissioners and planners in England. Contact