Introduction Globally, gay and bisexual men (GBM) are over-represented in HIV, syphilis and gonorrhoea cases. However, surveillance systems rarely provide meaningful measures of inequity, such as population-specific rates, due to a lack of sexual orientation denominators. HIV, gonorrhoea and syphilis are legally notifiable diseases in New Zealand (NZ); we calculate rates by sexual orientation for the first time.
Methods We analysed 2019 national surveillance data on HIV, syphilis and gonorrhoea notifications disaggregated by sexual orientation. Unique health records identified duplicate notifications and reinfections. Missing data were imputed from known cases. We used the NZ Health Survey 2014/2015 to estimate population sizes by sexual orientation, measured in two ways (current sexual identity, sexual contact in the previous 12 months with men, women or both). We calculated notification rates per 100 000 for each sexual orientation subgroup and rate ratios.
Results In 2019, GBM accounted for 76.3%, 65.7% and 39.4% of HIV, syphilis and gonorrhoea notifications, respectively. Population rates per 100 000 for HIV were 158.3 (gay/bisexual men) and 0.5 (heterosexuals); for syphilis, population rates per 100 000 were 1231.1 (gay/bisexual men), 5.0 (lesbian/bisexual women) and 7.6 (heterosexuals); for gonorrhoea (imputed), population rates per 100 000 were 6843.2 (gay/bisexual men), 225.1 (lesbian/bisexual women) and 120.9 (heterosexuals). The rate ratios for GBM compared with heterosexuals were: 348.3 (HIV); 162.7 (syphilis); and 56.6 (gonorrhoea). Inequities remained in sensitivity analysis (substituting sexual identity with sexual behaviour in the previous 12 months).
Conclusion GBM in NZ experience profound inequities in HIV, syphilis and gonorrhoea. Rate ratios by sexual orientation provide useful ‘at-a-glance’ measures of inequity in disease incidence.
- sexual and gender minorities
- public health
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Handling editor Jason J Ong
Contributors PJWS: conceptualisation, methods, writing – original draft and statistical analysis. SMM: methods and writing – review and editing. CET: data extraction, methods, writing – review and editing. AL: conceptualisation, writing – review and editing. JPB: data extraction, writing – review and editing. ATA: data extraction, methods, writing – review and editing. PCP: writing – review and editing. GJBS: writing – review and editing.
Funding The AIDS Epidemiology Group at the University of Otago, and Environmental Science and Research, are funded by the New Zealand Ministry of Health to undertake surveillance of HIV and STIs, respectively. PJWS was supported by the New Zealand AIDS Foundation Fellowship at the University of Auckland. No specific grant supported this analysis.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.