Sexually transmitted infection as a risk factor for homosexual HIV transmission: a systematic review of epidemiological studies

Existing reviews suggest some sexually transmitted infections (STIs) are risk factors in heterosexual HIV transmission. This may not be so in homosexual HIV transmission, about which reviews make no specific conclusions. This paper reviews published studies which report on the relative risk of STIs in HIV seroconversion in homosexually-active men in order to examine this matter. Papers obtained via various searches were judged adequate if they were prospective cohort or cohort-nested case-control studies; used HIV seroconversion as the outcome; assessed STI exposure objectively; and controlled for potential confounding from age and sexual behaviour. Sixteen papers were obtained, of these 3 were judged adequate. Adequate papers reported little association. Inadequate papers were more likely to report association. Evidence from adequate studies does not suggest STIs are risk factors in homosexual HIV transmission. Some caution is needed in interpreting the results because of the paucity of adequate studies

The knowledge, the will and the power : a plan of action to meet the HIV prevention needs of Africans living in England

The Knowledge, The Will and The Power is a statement of what we, the NAHIP Partners, plan to do to prevent HIV transmissions occurring during sexual activity among the diverse population of Africans living in England (Chapter 1). We describe the size and context of Africans living in England (Chapter 2), the size of the HIV epidemic and the number of new infections occurring (Chapter 3), as well as the behaviours and facilitators of new infections (Chapter 4). We then articulate how the NAHIP partners intend to influence future behaviours (Chapter 5). The final three chapters describe what is required in order to meet the HIV prevention needs of individual African people (Chapter 6), of NAHIP partner organisations (Chapter 7) and of those undertaking decisions related to policy, planning and research (Chapter 8)

London counts: HIV prevention needs and interventions among gay men in 16 London Health Authorities

Duration: December 1998 - February 2001 Commissioned by the sixteen London Health Authority Commissioners, the Link Evaluation included work by both Sigma Research, and the Thomas Coram Research Unit at the Institute of Education, University of London. The LINK Evaluation aimed to identify whether and why HIV prevention interventions are successful for Gay men in London. Objectives of the study included: Identification and agreement of health promotion aims with all commissioners and prevention agencies within the partnership. Collation of data and information from related studies of Gay men’s HIV health promotion needs and comparable programme evaluations. Annual health promotion ‘Activity Map' which described all HIV health promotion interventions planned for London for each year. Annual ‘Needs Map' report concerning the needs of Gay men in London. Examination of the collective impact of the activities of collaborating agencies on the population of Gay men in London. Four examinations of the performance and impact of individual interventions or groups of interventions sharing methodological characteristics. The LINK Evaluation was a rolling programme of utilisation-focussed outcome evaluation and needs assessment of HIV health promotion intended to reduce the incidence of HIV through sex between men resident in London. A range of research methods were employed including: self-completion questionnaires, face-to-face interviews and workshops. Sample sizes varied according to the specific programme activity: 1500 men were recruited to a rolling cohort to examine their changing HIV health promotion needs, a further 200 were recruited for more in-depth needs and experiences mapping and over 100 agencies were recruited to examine the health promotion activity being delivered in London. Findings were useful in answering questions such as: i) What needs required addressing - the Needs Map was used to prioritise health promotion aims and population groups, and to guide intervention selection and the development of services within a broad programme planning approach. ii) Which interventions best address identified need - findings regarding the performance and impact of specific interventions were used in order to maximise cost-efficiency. iii) Where interventions were being implemented, and where they were not - the Activity Maps were used to gauge intended impact, identify gaps in provision and to facilitate collaborative planning. iv) Whether the programme of HIV health promotion was working - the programme evaluation findings were used to identify the overall impact of a strategic and collaborative London-wide programme and to inform future developments. v) Why the programme of HIV health promotion was working - the in-depth data from those exposed to interventions was used to identify the key features of a strategic programme which contribute to change. Two reports are available: London counts: HIV prevention needs and interventions among gay and bisexual men in 16 London Health Authorities and HIV health promotion activity map for Greater London 1999-2000

Relative safety: risk and unprotected anal intercourse among gay men diagnosed with HIV

Duration: January 1998 - January 1999 This study investigated the experiences of gay men with diagnosed HIV in order to better understand the range of social, psychological and cultural meanings attached to HIV risk. We examined how men engaged in unprotected anal intercourse (UAI) and how they felt about it. We looked at the meanings they attached to UAI, the risks (if any) they perceived, and how engaging in UAI affected their lives. The study generated data from two sources. First, information on sexual risk behaviour was provided by the second annual Gay Men's Sex Survey in 1998. We compared the demographics and sexual behaviour of men diagnosed with HIV, those who had never tested and those who had tested negative in order to gain a comparative picture of sexual risk behaviour. This data demonstrated that, on a population level, substantial differences in sexual behaviour occurred between men who had never tested for HIV and those that had. Men who had never tested were substantially less likely to engage in sexual activities implicated in HIV exposure (UAI and sero-discordant UAI) compared to those who had tested. Among those who had tested, men with diagnosed HIV were no more likely to engage in UAI than those tested negative. However, among men that engaged in UAI, men who had tested positive did so substantially more often. The study also included 64 in-depth, semi-structured interviews with gay men who had diagnosed HIV. All had engaged in UAI in the previous year: some with partners who they knew were also HIV infected; others with partners whom they knew to be uninfected; and some with partners whose HIV status they did not know. Most interviewees had done UAI with a range of partners from all three categories. We found that UAI was an act that resists easy classification, imbued with multiple meanings, it's perceived safety and desirability dependent upon the circumstances in which it occurs and the partners involved. Moreover, the concepts of safety and risk that health promoters employ in relation to UAI were not necessarily shared by the positive men we interviewed. Important for our purposes was that gay men with diagnosed HIV engaging in UAI, felt they were risking something entirely different to their uninfected partners. For them, risk was experienced in a mediated and diffuse manner on three levels: risks to personal health, risks to psychological well-being and risks to social standing. The final report was called Relative safety: risk and unprotected anal intercourse among gay men diagnosed with HIV

Vital Statistics Ireland: findings from the All-Ireland Gay Men’s Sex Survey 2000

Duration: March 2000 - September 2010 Sigma Research has been working with Ireland's Gay Health Network (GHN) since 2000. GHN is an umbrella organisation working towards gay men's health and HIV prevention. GHN instigated a community-based, self-completion survey to take place across The Republic of Ireland and Northern Ireland during the summer of 2000 and commissioned Sigma Research to work with them. This large-scale community research project was the third such survey among gay men in Ireland, and built on previous findings. After the development and piloting of the survey, recruitment commenced at Dublin Pride in June 2000 and continued throughout the summer at similar events in Belfast, Derry, Galway, Limerick and Waterford. Recruitment in bars and clubs took place in Dublin and Cork, and social groups in more rural area were sent copies of the questionnaire and a request to distribute them to their members. 1,290 questionnaires were returned by gay men (81%), bisexual men (11%) and other homosexually active men living in Ireland. 19% of all respondents lived in Northern Ireland. A full survey report, including implications for HIV prevention planning is available to download. Since 2003 Gay Health Network members - particularly The Gay Men's Health Service (Health Services Executive) and the Rainbow Project, Northern Ireland - have collaborated with our online UK version of the Gay Men’s Sex Survey (Vital Statistics) by promoting it to men in Ireland via community websites and postcards distributed on the gay scene. Real Lives, a summary report covering the main GMSS 2003 and 2004 data for men resident on the island of Ireland, was published in June 2006 and is available to download. It was published with The Gay Men's Health Service, Health Services Executive and the Rainbow Project. Real Lives II, a summary report covering the main GMSS 2005 and 2006 data for men resident on the island of Ireland, was published in June 2009 and is available to download. It was published with The Gay Men's Health Service, Health Services Executive and the Rainbow Rpoject. A summary report for Irish-resident men taking part in GMSS 2007 and 2008 will be published in June 2010

Grevious harm: Use of the Offences Against the Person Act 1861 for sexual transmission of HIV

No abstract available

HIV, sexual risk and ethnicity among gay and bisexual men in England: survey evidence for persisting health inequalities.

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. 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. 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. 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