Behavioural predictors of subsequent hepatitis C diagnosis in a UK clinic sample of HIV positive men who have sex with men.

OBJECTIVE: To explore the associations between self reported high risk sexual behaviours and subsequent diagnosis with hepatitis C virus (HCV) infection. METHODS: The Sex, Health and Anti-Retrovirals Project (SHARP) was a cross sectional study of sexual behaviour in HIV positive, men who have sex with men (MSM) attending a London outpatient clinic. From July 1999 to August 2000 participants completed a computer assisted self interview questionnaire (CASI) on recent sexual behaviour, recreational drug use, and detailed reporting of the last two sexual episodes involving different partners. Results were combined with routine clinic data and subsequent testing for HCV up to 21 April 2005. A new HCV diagnosis was defined as anti-HCV antibody seroconversion or positive HCV RNA following a previous negative. Incident rate ratios (IRR) were calculated using Poisson regression in Stata (version 9). Men contributed time at risk from interview until either their diagnosis or their last negative test result. RESULTS: Of the 422 men who completed questionnaires, 308 (73%) had sufficient clinical and HCV testing data available for analysis. Incident HCV infection was identified in 11 men. Unprotected anal intercourse, more than 30 sex partners in the past year, higher numbers of new anal sex partners, rimming (oro-anal sex), fisting, use of sex toys, and intranasal recreational drug use were associated with HCV. In multivariate analysis only fisting remained associated with HCV (adjusted IRR 6.27, p = 0.005). CONCLUSIONS: In this study of HIV positive MSM, fisting is strongly associated with HCV infection. Where individuals report high risk sexual behaviours, clinicians should offer appropriate testing for HCV infection.

Men who have sex with men: a comparison of a probability sample survey and a community based study.

We compared characteristics of men who have sex with men (MSM) in a probability sample survey with a community based study in London. The majority of men in both surveys reported male sex partner(s) in the last year but MSM recruited through the population based survey had lower levels of HIV risk behaviour, reported fewer sexually transmitted infections and HIV testing than those recruited from gay venues. Community samples are likely to overestimate levels of risk behaviour among all MSM.

Increasing risk behaviour and high levels of undiagnosed HIV infection in a community sample of homosexual men.

OBJECTIVES: To estimate changes in sexual behaviour over time. To examine the proportion of undiagnosed HIV infection in a community sample of homosexual men. To explore the relation between HIV status, diagnosis, and sexual behaviour. METHODS: Five cross sectional surveys of men attending selected gay community venues in London between 1996 and 2000 (n = 8052). Men were recruited in 45 to 58 social venues (including bars, clubs, and saunas) across London. Participants self completed an anonymous behavioural questionnaire. In 2000, participants in community venues provided anonymous saliva samples for testing for anti-HIV antibody. RESULTS: The proportion of men having unprotected anal intercourse (UAI) increased significantly each year from 30% in 1996 to 42% in 2000 (p<<0.001). In 2000, 132 of 1206 (10.9%) saliva samples were HIV antibody positive. Of the HIV saliva antibody positive samples, 43/132 (32.5%) were undiagnosed. Around half of both diagnosed and undiagnosed HIV saliva positive men reported UAI in the past year. Of the 83% of men who reported their current perceived HIV status, 4.1% reported an incorrect status. HIV antibody positivity was associated with increasing numbers of UAI partners, and having a sexually transmitted infection (STI) in the past year (OR 2.15). CONCLUSIONS: Homosexual men continue to report increasing levels of UAI. HIV prevalence is high in this group, with many infections remaining undiagnosed. The high level of risky behaviour in HIV positive men, regardless of whether they are diagnosed, is of public health concern, in an era when HIV prevalence, antiretroviral resistance, and STI incidence are increasing.

A comparison of high-risk sexual behaviour and HIV testing amongst a bar-going sample of homosexual men in London and Edinburgh.

BACKGROUND: This study compared high-risk sexual and HIV testing behaviour amongst homosexual men recruited from gay bars in London and Edinburgh. METHODS: A cross-sectional survey monitoring high-risk sexual and HIV testing behaviour using a self-completed questionnaire was conducted in November and December 1996. RESULTS: Two thousand, three hundred and ninety-seven questionnaires were returned (1,366 recruited in London and 1,031 in Edinburgh), with a response rate of 77%. A larger proportion of men surveyed in London had had unprotected anal intercourse (UAI) with one or more male partners in the previous year (35%) than in Edinburgh (30%). Men recruited in Edinburgh were less likely to have had an HIV test (54%) than men in London (63%). In both surveys, 25% of men who reported UAI with partners of the same HIV status as themselves also reported never having had an HIV test. CONCLUSIONS: The observed dissimilarities in the HIV epidemic in the two cities may be accounted for by the differences in self-reported high-risk sexual and HIV testing behaviours between the two populations. A large proportion of men in both cities continue to engage in high-risk sexual behaviour suggesting continued transmission of HIV in these populations. Thus, there is a continued need for innovative and relevant health promotion amongst homosexual men in the UK.

Active surveillance of sexual behaviour among homosexual men in London.

The objective of this study was to establish a surveillance programme to monitor high risk sexual behaviour among homosexual and bisexual men socializing and/or using health care services in London. Between November 1996 and January 1997 a brief, self-completed questionnaire was distributed in various commercial venues (bars, clubs, and saunas) and genitourinary medicine (GUM) clinics in inner London. A total of 2482 questionnaires were returned (response rate 75%). A third of men (32%) reported having had unprotected anal intercourse in the previous year and 18% had done so with one or more partners of unknown or different HIV status. High risk sexual behaviour was associated with younger age, having casual partners, and recruitment from GUM clinics. The combination of high levels of both sexual risk behaviour and HIV prevalence demonstrates the need for sustained and innovative health promotion campaigns among homosexual men in London.