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HIV on the rise again in high-income countries

In the late 1970s and early 1980s, gay and bisexual men – who are sometimes referred to as men who have sex with men (MSM) – were the main risk group affected by AIDS when it first appeared. Today, in Australia, Canada and the United States, these men continue to be the risk group most commonly diagnosed with HIV infection.

In the early years of the AIDS epidemic, gay community groups organized and conducted educational efforts resulting in safer-sex programs. These activities highlighted the danger of the riskiest activity—unprotected anal intercourse. As a result, HIV infection rates slowed in the 1990s, at least among some gay and bisexual men in the United States and perhaps other high-income countries.

In 1998, researchers in these countries noticed a troubling trend: Rates of syphilis began to increase among gay and bisexual men. Sexually transmitted infections (STIs) such as syphilis can cause sores, lesions and inflammation in the genitals, which can make a person more susceptible to HIV infection.

Trends

An international research team recently finished its analysis of HIV and syphilis testing data among MSM collected between 1995 and 2005 from the following high-income countries:

Australia;
Canada;
France;
Germany;
Netherlands;
Spain;
United Kingdom;
United States.

They found that HIV infection rates decreased by about 5% per year between 1996 and 2000. However, after 2000, infection rates rose by about 3% per year. They also found that, on average, the age at which MSM were diagnosed with HIV infection was increasing, from 34 years in 1996 to 36 years in 2005. These trends held for all countries except Spain, where the data made available for this study was limited.

The study also found that syphilis rates increased sharply after 2000. This disease may have played a role in the subsequent increase in HIV transmission.

Noteworthy

The increase in HIV infection rates after 2000 does not appear to be linked to increased rates of HIV testing. Moreover, the trends found in this study occurred in several countries on different continents all around the same time. Overall, the research team suggests that HIV infection rates have indeed increased among gay and bisexual men. The psychosocial reasons underpinning this increase in HIV transmission rates is unclear.

What is to be done?

The findings from the international study suggest that gay and bisexual men continue to be at high risk for HIV infection and syphilis. The research team stated: “New HIV prevention interventions at multiple levels—individual, couple, group, community and structural—should be considered high priorities for prevention scientists and program experts.”

They added that their results “call for urgent attention to further our understanding of the reasons for this resurgence, to develop new HIV prevention interventions for the highest-risk MSM, and to deploy available interventions aggressively in these at-risk populations.”

—Sean R. Hosein

REFERENCES:

Garry RF, Witte MH, Gottlieb AA, et al. Documentation of an AIDS virus infection in the United States in 1968. Journal of the American Medical Association. 1988 Oct 14;260(14):2085-7.
Sterry W, Marmor M, Konrads A, et al. Kaposi’s sarcoma, aplastic pancytopenia, and multiple infections in a homosexual (Cologne, 1976). Lancet. 1983 Apr 23;1(8330):924-5.
Huminer D, Rosenfeld JB and Pitlik SD. AIDS in the pre-AIDS era. Reviews of Infectious Diseases. 1987 Nov-Dec;9(6):1102-8.
Gerstoft J, Malchow-Møller A, Bygbjerg I, et al. Severe acquired immunodeficiency in European homosexual men. British Medical Journal. 1982 Jul 3;285(6334):17-9.
Scheer S, Kellogg T, Klausner JD, et al. HIV is hyperendemic among men who have sex with men in San Francisco: 10-year trends in HIV incidence, HIV prevalence, sexually transmitted infections and sexual risk behaviour. Sexually Transmitted Infections. 2008 Nov;84(6):493-8
Likatavicius G, Klavs I, Devaux I, et al. An increase in newly diagnosed HIV cases reported among men who have sex with men in Europe, 2000-6: implications for a European public health strategy. Sexually Transmitted Infections. 2008 Nov;84(6):499-505.
Sullivan PS, Hamouda O, Delpech V, et al. Reemergence of the HIV epidemic among men who have sex with men in North America, Western Europe and Australia, 1996-2005. Annals of Epidemiology. 2009 Jun;19(6):423-31.

Created on: 08/19/2009

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