Prevalence of antibodies to human immunodeficiency virus, gonorrhoea rates, and changed sexual behaviour in homosexual men in London

Is there an ethnic variation in the epidemiology of gonorrhoea? A retrospective population-based study from northern Israel over 15 years between 2001 and 2015

OBJECTIVE

To investigate the trends in the incidence of gonorrhoea through an extended period of time and to compare the epidemiology of gonorrhoea infection between 2 distinct ethnic groups (Jews and Arabs).

DESIGN

A retrospective population-based cohort study was conducted on all consecutive patients diagnosed with gonorrhoea through the years 2001-2015.

SETTING

National Department of Epidemiology of the Ministry of Health, Haifa District, Israel.

PARTICIPANTS

A total of 837 reports on gonorrhoea were received, derived from 779 (93.1%) male and 58 (6.9%) female patients. Approximately 1 million people reside in the Haifa region.

PRIMARY AND SECONDARY OUTCOME MEASURES

We examined the incidence rate of gonorrhoea among residents of Haifa District, northern Israel from 2001 to 2015, by reviewing archives of the Department of Epidemiology, Israeli Ministry of Health. Notified cases were stratified by age, gender and ethnicity.

RESULTS

The overall gonorrhoea incidence was 6.4 cases per 100 000 population per year. The annual incidence rate dropped from 20.5 per 100 000 population in 2001 to a period of 2.2 cases per 100 000 population in 2005, showing a >9-fold decline. This was followed by a relatively steady increase of incidence of 2.5-4.5 per 100 000 population from 2006 to 2015. Men were predominantly more affected than women, with a 13.4-fold higher incidence rate. The most affected age group was residents between 25 and 34 years old. The estimated rate among Jews was 2.5-fold higher relative to Arabs. Only 1.3% recurrent episodes of gonorrhoea were reported. The prevalence of HIV positivity among patients with gonorrhoea is significantly higher than that of the general population (500.0 vs 88.1 cases per 100 000 population, respectively, p<0.001).

CONCLUSIONS

Gonorrhoea incidence rate decreased dramatically until 2005, with no substantial subsequent fluctuations. The infection is much more prevalent among patients of Jewish ethnicity, possibly due to riskier sex practices.

Prevalence and trends in homosexual behaviour in Norway

The three main objectives of this study were to estimate the proportion of the Norwegian population with experience of homosexual behaviour, to study the degree of change in sexual practices among homosexual men during a 5-year period and to study the degree of change in sexual practices reported by HIV positive homosexual men from before to after awareness of HIV-positivity. The data comes from two questionnaire surveys (in 1987 and 1992) of sexual behaviour in the general population of Norway and a questionnaire study of sexual behaviour before and after awareness of HIV-positivity among HIV-positive homosexual men taking part in a cohort study starting in 1988 (the Oslo HIV cohort study). Estimation of the proportion of subjects with homosexual experience was made as well as a trend analysis of the number of male sexual partners per year, number of intercourses per month, condom use and anal sex.

Among men aged 18 to 60 from the general population, 3.8% reported homosexual practice during lifetime and 1.2% during the past 3 years. Among women, the same percentages were 3.1 and 1.0. In the surveys, the number of male partners per year decreased significantly for men with current homosexual experience from a yearly median of 1.0 in 1987 to 0.3 in 1992 ( p = 0.02). Among HIV-positives, the number of male partners decreased from a yearly median of 4.3 before to 1.6 after awareness of HIV-seropositivity ( p<0.01). Among HIV-positives, a significant increase in the use of condoms, a decrease in the number of intercourses and a decrease in the frequency of anal sex was found. The results show that some changes in sexual practice may have occurred among homosexual men in general in the period from 1987 to 1992, and that more significant changes may have occurred for HIV-positive men. The present data do not support other findings of a relapse to more unsafe sex, but suggest that there is still a need to keep modifying behaviour in order to stop the spread of HIV among men who have sex with other men.

Factors influencing perception of risk of HIV acquisition among male heterosexual STD clinic attenders

A variety of demographic, psychosocial, intrapersonal and behavioural factors have been shown to influence behavioural change in response to AIDS education. The study investigated perceived risk of HIV acquisition amongst 50 male heterosexual STD clinic attenders and its relationship to knowledge regarding the nature and prevention of transmission of HIV, current sexual practices, relationship difficulties, sexual dysfunction, alcohol abuse and psychiatric morbidity.

The sample demonstrated a good general knowledge about AIDS but there was little evidence of the practice of ‘safer sex’. The overall incidence of psychiatric morbidity was 38%, of problem drinking 52%, of sexual dysfunction 32% and marital/relationship dysfunction 42%. Only 22% felt that their life-style put them at risk of HIV acquisition. It was felt that a narrow emphasis on information in AIDS prevention programmes ignores the powerful effect other factors may have on an individual's motivation to change his behaviour. Evaluation of the cognitions of this at risk group with particular reference to the role of cognitive distortions in perception of risk could provide a means of enhancing the efficacy of future health education campaigns.

Increased HIV incidence in men who have sex with men despite high levels of ART-induced viral suppression: analysis of an extensively documented epidemic

BACKGROUND

There is interest in expanding ART to prevent HIV transmission, but in the group with the highest levels of ART use, men-who-have-sex-with-men (MSM), numbers of new infections diagnosed each year have not decreased as ARTcoverage has increased for reasons which remain unclear.

METHODS

We analysed data on the HIV-epidemic in MSM in the UK from a range of sources using an individual-based simulation model. Model runs using parameter sets found to result in good model fit were used to infer changes in HIV-incidence and risk behaviour.

RESULTS

HIV-incidence has increased (estimated mean incidence 0.30/100 person-years 1990-1997, 0.45/100 py 1998-2010), associated with a modest (26%) rise in condomless sex. We also explored counter-factual scenarios: had ART not been introduced, but the rise in condomless sex had still occurred, then incidence 2006-2010 was 68% higher; a policy of ART initiation in all diagnosed with HIV from 2001 resulted in 32% lower incidence; had levels of HIV testing been higher (68% tested/year instead of 25%) incidence was 25% lower; a combination of higher testing and ART at diagnosis resulted in 62% lower incidence; cessation of all condom use in 2000 resulted in a 424% increase in incidence. In 2010, we estimate that undiagnosed men, the majority in primary infection, accounted for 82% of new infections.

CONCLUSION

A rise in HIV-incidence has occurred in MSM in the UK despite an only modest increase in levels of condomless sex and high coverage of ART. ART has almost certainly exerted a limiting effect on incidence. Much higher rates of HIV testing combined with initiation of ART at diagnosis would be likely to lead to substantial reductions in HIV incidence. Increased condom use should be promoted to avoid the erosion of the benefits of ART and to prevent other serious sexually transmitted infections.

Re-appraising HIV Testing among Scottish Gay Men: The Impact of New HIV Treatments

This paper explores Scottish gay men's understandings of HIV testing within the context of changes stemming from the availability of new treatments for HIV. Transcripts of one-toone interviews with 18 gay men were analysed together with those from four focus groups (n= 19) concerning HIV testing, HIV status and HIV risk management. Interpretative Phenomenological Analysis was employed to identify recurrent themes. We focus upon a rise of HIV-optimism, risk-complacency and HIV fatigue and chart the apparent transformation of HIV diagnosis from 'death sentence' to 'life sentence'. In turn, we explore how these changes have impacted upon HIV testing. As HIV management becomes increasingly medicalized, we highlight the ongoing need to attend to psychological and social issues.

Secular trends of gonorrhea in young adults in Israel: three decades of follow-up

Recent reports of increased rates of gonorrhea initiated an analysis of secular trends of gonorrhea in a young adult population. Gonorrhea is a notifiable disease in the Israel Defense Forces. The diagnosis is based on the typical clinical presentation, relevant epidemiologic data, and positive bacteriological culture. For the present study, the archives of the Epidemiology Department were reviewed for all documented cases of gonorrhea from January 1, 1978 to December 31, 2008, and the annual and seasonal incidence rates were calculated. Annual gonorrhea rates decreased from 2.3 cases per 1,000 soldiers in 1978 to an all-time low of 0.07 cases per 1,000 soldiers in 2008, representing a 97% decline. Multi-year average monthly rates varied from a low of 5.83 cases per 100,000 population in February to a high of 8.97 cases per 100,000 in August. The difference in the person-time incidence (PTI) rates for winter (5.9 cases per 100,000 person-years) and summer (6.8 cases per 100,000 person-years) was statistically significant (p < 0.01). Analyzing the long-term epidemiology of gonorrhea has shown that the infection rate is continuously decreasing and that it appears to be more prevalent in the warmer months.

HIV in gay and bisexual men in the United Kingdom: 25 years of public health surveillance

It is more than 25 years since the first case of AIDS was reported in the United Kingdom. In December 1981 a gay man was referred to a London hospital with opportunistic infections indicative of immunosuppression. National surveillance began the following year, in September 1982, with the notification of deaths and clinical reports of AIDS and Kaposi's sarcoma plus laboratory reports of opportunistic infections. Since then epidemiological surveillance systems have evolved, adapting to, and taking advantage of advances in treatments and laboratory techniques. The introduction of the HIV antibody test in 1984 led to the reporting of HIV-positive tests by laboratories and the establishment of an unlinked anonymous survey in 1990 measuring undiagnosed HIV infection among gay men attending sexual health clinics. The widespread use of highly active antiretroviral therapies (HAART) since 1996 has averted many deaths among HIV-positive gay men and has also resulted in a large reduction in AIDS cases. This led to a need for an enumeration of gay men with HIV accessing NHS treatment and care services (1995 onwards), more clinical information on HIV diagnoses for epidemiological surveillance (2000 onwards) and the routine monitoring of drug resistance (2001 onwards). Twenty-five years after the first case of AIDS was reported, gay and bisexual men remain the group at greatest risk of acquiring HIV in the United Kingdom. Latest estimates suggest that in 2004, 26 500 gay and bisexual men were living with HIV in the United Kingdom, a quarter of whom were undiagnosed. In this review, we examine how national surveillance systems have evolved over the past 25 years in response to the changing epidemiology of HIV/AIDS among gay and bisexual men in the United Kingdom as well as advances in laboratory techniques and medical treatments. We also reflect on how they will need to continue evolving to effectively inform health policy in the future.

Assessing the impact of national anti-HIV sexual health campaigns: trends in the transmission of HIV and other sexually transmitted infections in England

OBJECTIVE

To assess the impact of the sexual component of AIDS and HIV campaigns on transmission of HIV and other sexually transmitted infections (STIs).

DESIGN

Comparison of time series data.

SETTING

England, 1971-1999.

OUTCOME MEASURES

HIV transmission and diagnoses among men who have sex with men (MSMs), rates of attendances and specific STI diagnoses (per 100 000 total population) at genitourinary medicine (GUM) clinics.

RESULTS

Awareness of AIDS and campaigns in 1983-4 among homosexual men coincided with substantial declines in transmission of HIV and diagnoses of syphilis among MSMs. During general population campaigns in 1986-7 new GUM clinic attendances requiring treatment fell by 117/10(5) in men and 42/10(5) in women. Rates for gonorrhoea fell by 81/10(5) and 43/10(5) and genital herpes by 6/10(5) and 4/10(5), respectively. Previous rises in genital wart rates were interrupted, while rates of attendances not requiring treatment (the "worried well") increased by 47/10(5) and 58/10(5) for men and women, respectively. Since 1987 diagnoses of HIV among MSMs have not declined, averaging 1300-1400 annually. Following a period of unchanging rates there have been substantial increases in GUM attendances requiring treatment, notably for gonorrhoea, syphilis, and viral STIs since 1995.

CONCLUSIONS

Self help initiatives and awareness among homosexual men in 1983-4 contributed significantly to a fall in HIV transmission among MSMs, and the general campaigns of 1986-7 were associated with similar effects on all STI transmission. Both effects seem to have occurred through changing sexual behaviour, and probably contributed to the UK's low national HIV prevalence. Bacterial STI incidence has increased significantly since 1995 and there is no evidence that recent prevention initiatives have reduced HIV transmission among MSMs, hence sexual health initiatives need to be comprehensively reinvigorated in England.

Investigation of the increased incidence of gonorrhoea diagnosed in genitourinary medicine clinics in England, 1994-6

OBJECTIVES

To determine important risk factors associated with cases of gonorrhoea in England, and whether any particular risk groups were associated with the substantial rise in numbers of cases seen between 1994 and 1996.

DESIGN

Two retrospective cross sectional surveys.

SETTING

70 randomly selected genitourinary medicine (GUM) clinics in England.

SUBJECTS

10% of all gonorrhoea patients attending GUM clinics in England in 1994 (847 patients) and 1996 (1146 patients).

MAIN OUTCOME MEASURES

For risk factors in 1996 (study 1), unadjusted rates per 100,000 population aged 14-70 and relative rates (RR) with 95% confidence intervals (CIs). For the change in risk factors between 1994 and 1996 (study 2), adjusted odds ratios (ORs) with 95% CIs, derived from logistic regression analyses of data on patients in 1996, with patients in 1994 as the comparison group.

RESULTS

The incidence of gonorrhoea in 1996 was higher in homosexual males (812 per 100,000; RR = 30.2, CI = 25.2 to 36.0) compared with heterosexual males (27 per 100,000); in black Caribbeans (467 per 100,000; 21.4, 17.9 to 25.5) and black Africans (235 per 100,000; 10.8, 7.5 to 15.5) compared with white people (22 per 100,000); and in previous GUM clinic attenders (433 per 100,000; 37.93, 35.46 to 40.56) compared with those who had not attended previously (11 per 100,000). However, most patients were either white or heterosexual. Heterosexual patients in 1996 were significantly more likely to have reduced sensitivity to penicillin (2.55, 1.20 to 5.41) than those in 1994. Male homo/bisexual patients in 1996 were significantly more likely to be from the north west (3.77, 1.45 to 9.80) and to have either reduced sensitivity (2.63, 1.03 to 6.73) or complete resistance (1.98, 1.03 to 3.78) to penicillin, compared with those in 1994.

CONCLUSIONS

Homo/bisexual men and the black Caribbean population in England experience a disproportionate burden of gonococcal infections, however, the bulk of diagnoses are in white heterosexuals. No single risk group was associated with the rise in numbers of cases between 1994 and 1996. Resistance to penicillin is widespread and has increased in homo/bisexual men, and it is possible that a rise in treatment failures has, to some extent, enhanced transmission of gonorrhoea and contributed to the rise in numbers of diagnoses in this group.

Clinical features of Chlamydia trachomatis rectal infection by serovar among homosexually active men

BACKGROUND AND OBJECTIVES

Because C. trachomatis serovars correlate with the clinical manifestations of cervical infection, we undertook this study to determine whether clinical, behavioral, and laboratory findings correlate with C. trachomatis serovars isolated from rectal infections.

GOAL OF THIS STUDY

To correlate C. trachomatis serovar with signs and symptoms of rectal infection.

STUDY DESIGN

A cross-sectional study of 454 men with rectal C. trachomatis infection attending an urban sexually transmitted disease (STD) clinic was undertaken. Isolates were thawed, passaged to high titer, and typed using a panel of monoclonal antibodies. Compared to men infected with B complex isolates (164), men with C complex isolates (55) were less likely to report symptoms (OR: 0.4; 95% CI: 0.1-0.8), or to have erythema, bleeding, or mucopus (OR: 0.3; 95% CI: 0.1-0.8). Among men with inclusion counts of more than 100, those infected with FG group versus B complex isolates were more likely to present with mucopus (OR: 10.5; 95% CI: 1.2-95.5), more than 15 polymorphonuclear leukocytes (OR: 19.2; 95% CI: 1.7-219.8), and proctitis (OR: 4.2; 95% CI: 1.1-16.7).

CONCLUSION

Signs and symptoms of rectal infection correlate with the serovar of C. trachomatis isolates.

Gender differences in HIV risk behaviors in an adult emergency department in New York City

BACKGROUND

The human immunodeficiency virus (HIV) epidemic in the US increasingly involves urban heterosexual adults, particularly women, belonging to ethnic minority groups. An understanding of gender-based differences in HIV risk behaviors within these groups would be of value in the ongoing struggle to limit HIV transmission in metropolitan centers.

METHODS

This was a prospective study of demographic and historical characteristics and HIV risk behaviors. The study utilized a structured interview format, which was administered to all patients treated by participating emergency department physicians.

RESULTS

On univariate analysis of data obtained from 1,460 patients who had neither a known HIV infection nor a chief complaint or final emergency department diagnosis associated with HIV risk behaviors, men were more likely to be older, homeless, to have ever injected drugs, used crack, engaged in same-gender sex, paid for sex, been incarcerated, or had syphilis or gonorrhea. Women were more likely to report prior chlamydia infection or to report that their sole sex partners had other partners within the past year. On multivariate analysis, variables independently associated with male gender included homelessness, injection drug use, crack use, any prior sexually transmitted disease (in subjects 35 years of age or older), and sex with prostitutes. In a separate analysis of patients admitting to drug use, the male predominance of other risk behaviors was not observed; the only significant differences between genders were a higher rate of prostitution among women and a higher rate of sexual contact with a prostitute among men.

CONCLUSIONS

In patients visiting an inner-city emergency department in the Bronx, HIV risk behaviors are generally more common in men, but rates of risk behaviors among male and female drug users are comparable.

Success and failure in gonorrhea control

This article has shown that all the necessary components for successful control of gonorrhea are available. In developed countries, general improvements in economic conditions and advances in treatment and diagnosis have resulted in the lowest incidence rates of gonorrhea ever. Within these countries, however, control is failing, and gonorrhea is becoming hyperendemic among specific populations who tend to be disadvantaged and marginalized and who may have limited access to health care. Managing gonorrhea in individual patients and ensuring that their sexual partners receive appropriate treatment will contribute to reducing the transmission of infection in the community. Innovative school- and community-based interventions targeted to vulnerable populations will further help to reduce the incidence and contribute to improvements in the sexual health of the population.

Surveillance of sexual behaviour among homosexual men in a central London health authority

OBJECTIVE

To establish a surveillance mechanism of high risk sexual behaviour among homosexual and bisexual men living, socialising and using services in a central London health authority.

DESIGN

Baseline survey for a system of repeatable behavioural surveillance using a self-completed questionnaire delivered by healthcare providers.

SETTING

Genitourinary medicine clinics, gay bars, clubs, community groups and a cruising ground in the defined geographical area of a central London health authority.

PARTICIPANTS

Five hundred and fifty three homosexual and bisexual men.

MAIN OUTCOME MEASURES

Self-reported behaviours including unprotected anal intercourse (UAI), HIV status of unprotected anal intercourse partners, uptake of HIV testing and use of condoms at first time of anal intercourse.

RESULTS

Five hundred and sixty questionnaires were returned (response rate 76%) from 553 men. A third (35%) of men surveyed had had UAI in the previous year. Nearly a fifth (19%) of the sample had had UAI with one or more partners of a discordant or unknown HIV status. A total of 343 (63%) men had had an HIV test. The proportion of men using condoms on the occasion of first anal intercourse has risen from 6% before 1980 to 88% after 1993.

CONCLUSIONS

We have demonstrated that a surveillance programme to monitor high risk sexual behaviour among homosexual men can be easily established. The results can be employed to assess progress towards risk reduction targets and also inform future policy development. Our baseline data demonstrate that a large proportion of homosexual men are continuing to engage in high risk sexual behaviour, although there is some evidence of improvement in condom use at first anal intercourse over time. There is a need for continuing health promotion with evaluation among homosexual men.

Declining rates of gonorrhoea and syphilis in Strasbourg, France: a 20-year study

OBJECTIVE

To report the epidemiology of gonorrhoea and syphilis during the years 1973-1992 in the Strasbourg STD clinic and to discuss the data in the light of changes in STD rates in western countries.

DESIGN

Retrospective analysis of gonorrhoea and syphilis cases recorded annually, total number of consultations, HIV serology, STD among prostitutes.

SETTING

Strasbourg, Bas-Rhin, FRANCE.

SUBJECTS

Patients attending the public STD clinic in Strasbourg.

RESULTS

From 1973 to 1992 79,786 consultations were recorded. Since 1984, a regular fall has been noted, from more than 4500 consultations a year in the 1970s, to 1519 consultations in 1992. A major decline in gonorrhoea was observed, especially since 1984. There were 457 new cases in 1973 (15.3% of all patients) whereas only seven new cases in 1992 (0.8% of all patients). Syphilis has been declining regularly since 1979, with a reinforcement in this decline since 1984: 168 cases were recorded in 1972 (6.4% of all patients), and only two cases in 1992 (0.2% of all patients). Positive HIV tests were found in 14% and 12% of patients in 1985-86, and the positivity rate has regularly decreased to reach 0.6% in 1992. Prostitutes represented 9.2% of all patients in 1980, and only 0.8% of patients in 1992. Since 1987, syphilis and gonorrhoea have been rarely recorded among prostitutes.

CONCLUSIONS

A dramatic decline in both gonorrhoea and syphilis has been observed in Strasbourg, especially since 1984, with a parallel diminution in the STD clinic frequentation. A comparable trend in gonorrhoea rates was noted in many western countries, but syphilis rates are more heterogeneous among geographic areas. Changes in sexual behaviour due to the AIDS epidemic are probably responsible in part for this decline, but nevertheless the rarity of gonorrhoea and syphilis in Strasbourg in 1992 is not clearly explained.

An outbreak of a penicillin-sensitive strain of gonorrhoea in Sydney men

OBJECTIVE

To describe an outbreak of gonorrhoea caused by penicillin sensitive Wild type 1B2-Wt/1B2(FS), in homosexual men in Sydney.

DESIGN AND SETTING

The study sample comprised all gonococcal isolates referred to the Gonococcal Reference Laboratory (GRL), New South Wales, Australia between 1 January 1990 and 30 June 1992. Demographic data on Wt/1B2(FS) were sought by review of all request forms accompanying specimens to the GRL. Detailed review was undertaken of the clinical records of all men with gonorrhoea which had been differentiated by auxotype and serotype (A/S) from two large STD clinics in Sydney.

MEASUREMENTS AND MAIN RESULTS

The first isolation of Wt/1B2(FS) was made in April 1990 and by the end of July 1992, 140 such isolates were identified in 131 patients. The male:female ratio was 130:1 suggesting male homosexual transmission, which was confirmed in 55 of 57 evaluable cases. There was a higher proportion of pharyngeal and anal infections among Wt/1B2(FS) isolates compared with all other male gonorrhoea. Demographic information showed that 60% of men with Wt/1B2(FS) were under the age of 30, and 80% lived in Central or Eastern Sydney.

CONCLUSIONS

An outbreak of a penicillin sensitive strain of gonorrhoea has occurred in Sydney, primarily among gay men living in the inner city. The extent to which the outbreak represents an increase in the risk of HIV transmission is unclear.

Resistance of a human serum-selected human immunodeficiency virus type 1 escape mutant to neutralization by CD4 binding site monoclonal antibodies is conferred by a single amino acid change in gp120

We have selected an HXB2 variant which can replicate in the presence of a neutralizing human serum. Sequencing of the gp120 region of the env gene from the variant and parental viruses identified a single amino acid substitution in the third conserved region of gp120 at residue 375 (AGT-->AAT, Ser-->Asn; designated 375 S/N). The escape mutant was found to be resistant to neutralization by soluble CD4 (sCD4) and four monoclonal antibodies (MAbs), 39.13g, 1.5e, G13, and 448, binding to epitopes overlapping that of the CD4 binding site (CD4 b.s.). Introduction of the 375 S/N mutation into HXB2 by site-directed mutagenesis confirmed that this mutation is responsible for the neutralization-resistant phenotype. Both sCD4 and three of the CD4 b.s. MAbs (39.13g, 1.5e, and G13) demonstrated reduced binding to the native 375 S/N mutant gp120. The ability to select for an escape variant resistant to multiple independent CD4 b.s. MAbs by a human serum confirms the reports that antibodies to the discontinuous CD4 b.s. are a major component of the group-specific neutralizing activity in human sera.

Characterization of neutralizing monoclonal antibodies to linear and conformation-dependent epitopes within the first and second variable domains of human immunodeficiency virus type 1 gp120

A number of linear and conformation-dependent neutralizing monoclonal antibodies (MAbs) have been mapped to the first and second variable (V1 and V2) domains of human immunodeficiency virus type 1 (HIV-1) gp120. The majority of these MAbs are as effective at neutralizing HIV-1 infectivity as MAbs to the V3 domain and the CD4 binding site. The linear MAbs bind to amino acid residues 162 to 171, and changes at residues 183/184 (PI/SG) and 191/192/193 (YSL/GSS) within the V2 domain abrogate the binding of the two conformation-dependent MAbs, 11/68b and CRA-4, respectively. Surprisingly, a change at residue 435 (Y/H or Y/S), in a region of gp120 near the CD4 binding site (M. Kowalski, J. Potz, L. Basiripour, T. Dorfman, W. C. Goh, E. Terwilliger, A. Dayton, C. Rosen, W. Haseltine, and J. Sodroski, Science 237:1351-1355, 1987; L. A. Lasky, G. M. Nakamura, D. H. Smith, C. Fennie, C. Shimasaki, E. Patzer, P. Berman, T. Gregory, and D. Capon, Cell 50:975-985, 1987; and U. Olshevsky, E. Helseth, C. Furman, J. Li, W. Haseltine, and J. Sodroski, J. Virol. 64:5701-5707, 1990), abrogated gp120 recognition by both of the conformation-dependent MAbs. However, both MAbs 11/68b and CRA-4 were able to bind to HIV-1 V1V2 chimeric fusion proteins expressing the V1V2 domains in the absence of C4, suggesting that residues in C4 are not components of the epitopes but that amino acid changes in C4 may affect the structure of the V1V2 domains. This is consistent with the ability of soluble CD4 to block 11/68b and CRA-4 binding to both native cell surface-expressed gp120 and recombinant gp120 and suggests that the binding of the neutralizing MAbs to the virus occurs prior to receptor interaction. Since the reciprocal inhibition, i.e., antibody inhibition of CD4-gp120 binding, was not observed, the mechanism of neutralization is probably not a blockade of virus-receptor interaction. Finally, we demonstrate that linear sequences from the V2 region are immunogenic in HIV-1-infected individuals, suggesting that the primary neutralizing response may be directed to both V2 and V3 epitopes.

Homosexually acquired gonorrhoea in Victoria, 1983-1991

OBJECTIVE

To identify trends in the rate of gonorrhoea, particularly homosexually acquired infection.

DESIGN

A retrospective descriptive study of records stored in a relational database. Records contain epidemiological, demographic and microbiological data of laboratory confirmed cases of gonorrhoea.

SUBJECTS

Individuals with gonorrhoea diagnosed microbiologically in Victoria and from whom isolates were subsequently forwarded to the Microbiological Diagnostic Unit, University of Melbourne, for further bacteriological work for the years 1983-1991.

RESULTS

Overall, gonorrhoea is declining in Victoria in the general population but has risen sharply in recent years in homosexually active men. An increased number of cases of rectal gonorrhoea in men has also been noted. An age cohort effect in homosexually active men is only evident for the final year of the study. These men do not tend to acquire gonorrhoea abroad and beta-lactamase producing gonococci are rarely found in this group.

CONCLUSIONS

Gonorrhoea in homosexually active men has increased disproportionately to the rate of infection in heterosexual men in recent years, despite intensive education and counselling aimed at the gay community. Implications for risk of acquisition of other sexually transmitted diseases, including the human immunodeficiency virus, are evident.

Sexual behaviour and use of the condom by men attending gay bars and clubs in Glasgow and Edinburgh

How widespread are the safer forms of sexual behaviour reportedly adopted by male homosexuals in recent years? A questionnaire was completed by 173 and 83 gay men attending gay bars and clubs in Edinburgh and Glasgow respectively. Comparisons were made between those who reported using the condom (n = 137, [54%]) and those who did not (n = 119, [46%]). Sixty percent of respondents reported more than 5 partners during the previous year. Condom use was much less common among men with less than 5 years' experience as a practising homosexual. Less than one-fifth of respondents reported always using a condom during anal intercourse. Orogenital contact without a condom was reported by 84% of all respondents, and unprotected anal intercourse by 40%, (over 30% for those who used condoms). About one-third of condom users but only 14% of non-users thought they were at risk of catching HIV because of their sexual behaviour, although 80% of users and 70% of non-users said their lifestyles had been affected by the HIV epidemic. While there were some encouraging signs of behaviour change, unprotected anal sex is still widely practised. Gay bars and clubs represent important venues for conveying the safer sex message.

The prevalence of human retroviral infections in female patients attending a central London sexually transmitted disease clinic: 1985-1990

OBJECTIVES

To determine the prevalence of infection with HIV-1, HIV2, HTLV-1 and HTLV-2 in female attenders at a central London sexually transmitted disease clinic in an 8 week period in 1989-1990, and compare it with similar samples studied between 1985 and 1987.

DESIGN

Anonymous testing of serum samples from consecutive female patients having routine serological investigation for syphilis. Testing was for clinically important retroviruses, Hepatitis B core antibodies (anti-HBc), and p24 and reverse transcriptase (RT) antigens. Age (in 5 year bands), nationality (in broad geographical zones), diagnosis on the day of presentation, and history of intravenous drug usage were recorded for each patient. Annual gonorrhoea rates were analysed from 1981 to 1990.

SETTING

Outpatients of the department of genitourinary medicine.

PATIENTS

A total of 850 females attending consecutively and having routine syphilis serology.

MAIN RESULTS

The prevalence of anti-HIV-1 in female attenders in 1989-1990 was 0.35% (3/850). Prevalence in the same clinic has remained statistically unchanged since the first female cases were identified in 1986. No cases of HIV-2, HTLV-1 or HTLV-2 were identified, and no early HIV-1 infection evidenced by the presence of p24 or RT antigenaemia was found. Female gonorrhoea rates continued to decline but other STD monthly/annual rates have remained unchanged.

CONCLUSIONS

Over the last 5 years prevalence of HIV-1 infection in females in our clinic has remained unchanged and other retroviral infections have remained absent. However, the unaltered rates of other genital infections, their potential role in the heterosexual spread of HIV-1 infection, and the lack of evidence for any major changes in female sexual behaviour suggests there is a need to remain vigilant. This work complements the MRC multicentre, unlinked, genitourinary medicine clinic, anonymous testing programme, and our group will continue to apply this simple methodology to specimens from female attenders to contribute to the surveillance of the evolving HIV-1 epidemic.

Sexual behaviour of women attending an inner-city STD clinic before and after a general campaign for safer sex in Denmark

OBJECTIVES

To examine the sexual behaviour and the prevalence of sexually transmitted diseases (STD) among females attending an inner-city STD clinic before and after safer sex campaigns.

SUBJECTS

In 1984 981 women and in 1988 684 women were interviewed immediately after the venerological examination.

SETTING

Department of Dermato-Venereology, Bispebjerg Hospital, Copenhagen, Denmark.

METHODS

In a face to face interview, details of symptoms, age at coitarche, number of sexual partners (lifetime and during the last year), obstetric history, and contraceptive methods were recorded.

RESULTS

A substantially higher proportion of women used condoms in 1988 than in 1984. A dramatic decrease in the prevalence of gonorrhoea occurred (from 22% in 1984 to 6% in 1988, p < 0.01), whereas an increase in the number of patients with genital warts was observed (from 4% in 1984 to 10% in 1988, p < 0.05). The prevalence of chlamydia, genital herpes, and cervical dysplasia remained unchanged. No significant changes in the number of sexual partners, or the frequency of sexual intercourse or unplanned pregnancy could be detected from 1984 to 1988.

CONCLUSIONS

The safer sex campaigns have only been partly successful, as a general reduction in all sexually transmitted diseases should be expected as a result of the increased use of condoms. Future campaigns should focus on the correct use of condoms, and encourage a lifestyle with stable sexual relationship.

HIV disease and levels of prevention

It appears that several cofactors are involved in determining the pathogenesis of HIV disease. Exposure cofactors affect acquisition of HIV infection. Trigger cofactors determine a person's likelihood of being infected after exposure to HIV, or contribute to HIV disease progression in those who have been infected. Identification of the most common exposure and trigger cofactors should become a major focus of community health nursing practice at all levels of prevention. Changes in behaviors, early intervention activities, and rehabilitative measures related to known cofactors may improve the health of persons at all stages of HIV disease.

Transmission of HIV-1 infection by oroanal intercourse

We report the cases of two homosexual men, one of whom is believed to have been infected with HIV-1 during oroanal intercourse with the other, his only current sexual partner. Both patients had sero-conversion illnesses with similar symptoms and signs, and of similar duration. The practise of oroanal intercourse is known to be associated with the transmission of enteric infections and has been implicated in the epidemiology of Kaposi's sarcoma. These well-documented cases indicate that HIV-1 may also be transmitted by this route and supports a cautious approach to recommendations regarding "safer" sex.

Trends in sexual behaviour in a cohort of homosexual men: a 7 year prospective study

A cohort of homosexual men at risk for human immunodeficiency virus (HIV) infection were studied prospectively over a 7-year period (1982/88) to assess trends in sexual behaviour and amyl nitrite intake. During the period, there were dramatic declines in the proportion of HIV seropositive and seronegative subjects reporting multiple casual partners for anal intercourse, unprotected anal intercourse and recreational use of amyl nitrite. Reported rates of orogenital intercourse remained the same during the period, whilst the total number of seroconversions fell from 17 for the period 1982-84 to 8 for 1985-88. High-risk sexual and related social behaviour among homosexual men, as assessed by patterns of anal intercourse behaviour and nitrite intake, changed over the 7-year period, with the greatest changes apparent before the widespread availability of HIV antibody testing and public education campaigns. This highlights the effectiveness of peer-group and community-based programmes in modifying the sexual behaviour of their members.

AIDS and promiscuity: muddles in the models of HIV prevention

AIDS has been blamed on promiscuity and the promiscuous, and a major goal of many HIV-prevention programs has been to induce people to reduce the number of their sexual partners. Despite the salience of this concept in the AIDS discourse of scientists, policymakers, the media, religious leaders, and the gay community, critical analysis of the role of promiscuity in this epidemic has been lacking. Following a review of promiscuity in various genres of AIDS discourse, this article discusses promiscuity in American society and in HIV-prevention campaigns. The relative risks associated with monogamy, abstinence and promiscuity are examined, and the author concludes that the partner-reduction strategy, instead of contributing to a reduction in HIV transmission has been an impediment to AIDS prevention efforts, exacerbating the problem by undermining the sex-positive approaches to risk reduction that have proven effective. Responsibility for this misguided strategy is attributed to a moralistic approach to AIDS and to the misapplication of epidemiological concepts and inappropriate social science models to the task of promoting healthy forms of sexuality.

Seasonal variation in gonorrhoea

Seasonal variations in the incidence of gonorrhoea were observed in the 1970's with a peak in the third quarter of the year and a trough in the first and fourth quarters. The aim of this study was to determine what, if any, seasonal trends were present in Scotland and Lothian between 1984 and 1989 and postulate mechanisms to explain our observations. We observed a change in the previously reported pattern with regular peaks of infection in the first and third quarters of the year for Scotland but no regular trend in the Lothian region. The most likely explanation for the observed trends are changes in sexual behaviour related to summer vacations and seasonal work patterns but other unidentified factors probably also contribute.

A serovar analysis of heterosexual gonorrhoea in Edinburgh 1986-90

OBJECTIVE

To analyse the frequency of different gonococcal serovars within Edinburgh, Scotland and to describe changes that occurred in the frequency of such serovars over time.

METHODS

All heterosexual patients with a diagnosis of gonorrhoea confirmed on culture between January 1986 and December 1990 had their gonococcal strain serotyped. Temporal changes in the prevalence of gonorrhoea and the serovar of the isolates were analysed.

RESULTS

Isolates of Neisseria gonorrhoeae from 1356 episodes of gonorrhoea were serotyped. Three serovars, Bajk (IB-3/IB-6), Bacejk (IB-1/IB-2) and Aedgkih (IA-1/IA-2), dominated, occurring in two-thirds of all infections. Over the study period Bajk (IB-3/IB-6) and Aedgkih (IA-1/IA-2) isolates declined in frequency in parallel with an overall fall in the prevalence of gonorrhoea but Bacejk (IB-1/IB-2) persisted at a lower but fairly constant level. Despite a fall in the number of gonococcal infections the variety of new serovars being isolated fluctuated.

CONCLUSIONS

The ability of some serovars to persist while others decline in incidence may be partially related to antibiotic sensitivities but other factors such as an ability to evade the immune response and transfer of serovars from one population group to another may also be important.

Changing trends of gonococcal infection in homosexual men in Edinburgh

In an attempt to explain the recent resurgence of homosexually-acquired gonorrhoea in the Lothian region of Scotland the number of infections and pattern of infection (urethral, rectal and pharyngeal) of all gonococcal isolates from homosexual men attending the Department of Genitourinary Medicine at Edinburgh Royal Infirmary between 1985 and 1990 were analysed. Serovar typing data were available from infections acquired between January 1986 and December 1990. A correlation between one serovar, Bacejk/Brpyust, and the overall pattern of gonorrhoea was observed. The number of infections caused by minor serovars also correlated with rates of gonococcal infection. The number of minor serovars isolated, which may represent strains from other geographical locations, is related to the total incidence of gonorrhoea. It is possible that the incidence of Bacejk/Brpyust may be determined by the size of the infected pool of gonorrhoea. The most likely explanation for the recent increase in gonorrhoea is a change in sexual behaviour and/or an influx of strains from other geographical areas.

Sexually transmitted diseases in prostitutes in Moshi and Arusha, Northern Tanzania

Sexually transmitted diseases are thought to be important in facilitating transmission of HIV in sub-Saharan Africa. This study reports the prevalence of several sexually transmitted diseases in 106 prostitutes in Arusha and Moshi Northern Tanzania. The seroprevalence of HIV was 73% compared with 3% for local blood donors. Over half (51%) of the subjects had evidence of N. gonorrhoeae infection. Seventy-four per cent had a positive TPHA and 27% a positive RPR. Of 47 subjects tested 12 (25%) had Chlamydia trachomatis antigen detected in endocervical swabs. No significant statistical association was found between the presence of any of the STDs investigated and HIV seropositivity.

Unlinked surveillance of the prevalence of HIV infection in antenatal patients in the West Midlands, England

In the course of an unlinked, anonymous survey of anti-HIV seroprevalence among antenatal patients in the West Midlands, carried out between November 1986 and March 1990, seven out of 202,012 patient samples were anti-HIV seropositive. Although the numbers of women infected by heterosexual contact are still low in this region, it is likely that HIV infection is no longer limited to well-defined, male risk groups. It is therefore increasingly important to monitor the course of the epidemic through large-scale unbiased surveys of the heterosexual population in order to plan future preventive and health-care strategies.

Prevention of sexually transmitted diseases: a randomised community trial

STUDY OBJECTIVE

The aim was to evaluate the effectiveness of a programme for the prevention of sexually transmitted diseases which affect fertility. DESIGN OF THE PREVENTION PROGRAMME: The programme took place in six French geographical departments. Three of these, randomly selected, served as experimental departments while the other three were matched with the first three and served as controls. DESIGN OF THE EVALUATION: Genital discharge was used as the indicator of a sexually transmitted disease. In each department, about 40 voluntarily participating general practitioners (263 in total) gathered information on the frequency of infected patients and on their characteristics, both before and after the campaign.

PATIENTS

Before and after the programme respectively, 412 and 288 women and 117 and 94 men with a genital discharge were described.

MEASUREMENTS AND MAIN RESULTS

After the programme, tests for chlamydia trachomatis were prescribed more often to both women and men with a discharge in the experimental departments. The characteristics of women having consulted a general practitioner with a discharge differed according to the department group studied. In the experimental departments, the women were younger than those in the control departments and had fewer sexual partners. In contrast to the results obtained for women, no behavioural changes were observed among men with a discharge.

CONCLUSIONS

The results may indicate a decreased risk in spread of infection. Methodological problems associated with such a design are discussed. There is a need to develop specific messages aimed at changing male sexual behaviour. The study design has implications for the best strategy in delivering prevention messages to the general population which are relevant to the present AIDS epidemic.

An update on nursing research and HIV infection

More than 16,000 citations related to AIDS and HIV infection between May 1987 and June 1990 (38 months) were surveyed to summarize nursing research related to HIV infection; 731 nonresearch and 54 research articles, averaging about 20/month, were found. However, only 20 of the research articles addressed the five topic areas set as priority by the National Center for Nursing Research Priority Expert Panel (physiological and psychosocial aspects of care, prevention of transmission, care delivery systems, and applied ethics). There is a continued gap in the research literature related to the care aspects of HIV infection. This gap needs to be filled by nursing investigation.

Condom use in a large cohort of homosexually active men in England and Wales

As part of a prospective study of the seroprevalence of HIV, a cohort of 930 men were interviewed regarding their condom use. Of the 270 respondents that engaged in insertive anal intercourse in the month preceding interview 38.9% always used a condom, 49.6% never used one, and 11.5% sometimes used one. Of the 254 respondents that engaged in receptive anal intercourse in the same time period 42.5% always used a condom, 45.7% never used one, and 11.8% sometimes used one. Compared to other research the proportion of respondents who always use a condom for anal intercourse is relatively high, though use is by no means universal. Condom use is more widespread and consistent with casual rather than regular sexual partners, and it is significantly more common within open rather than monogamous relationships. Out of a wide range of other factors only geographical location (London against outside), marital status, perceived HIV status, number of sexual partners, and how seriously respondents take safer sex are correlated with condom use.

The HIV test and sexual behaviour in a sample of homosexually active men

This paper aims to assess the effects of voluntary anti-HIV testing on homosexual sexual behaviour. A sample of 502 men were recruited from four different areas of England. The criterion for inclusion was 'any man who had had sex with another man in the previous 5 years'. Men were interviewed about their recent sexual behaviour, histories of sexually transmitted diseases, experience of HIV tests and attitudes to the test. Men with a history of sexually transmitted diseases were more likely to have had the test. Thirty-one percent of men reported passive anal sex in the last month and 19% had had unprotected passive anal sex. These behaviours were most often reported by those testing HIV antibody positive and least by those never tested. The findings suggest that homosexually active men who volunteer for an anti-HIV test are broadly similar to those who do not. The absence of any clear effects of the test alone on sexual behaviour suggests that the quality of counselling in this area needs urgent attention.

Seroprevalence of HIV-1 infection in a cohort of homosexually active men

A non-clinic cohort of 525 homosexually active men from London and South Wales were recruited in 1988 for a study by interview of sexual behaviour. A sample of blood was tested for HIV-1 antibodies. Seropositivity in London was 9.2% compared with 3.4% in South Wales. Men who were not regular STD clinic attenders had a lower rate of seropositivity than did those who were regular attenders. Men who were seropositive reported more sexual partners with whom they had anal intercourse and also reported more episodes of syphilis. Overall, rates of seropositivity were lower than those reported by studies from STD clinics.

Sexually transmitted causes of gastrointestinal symptoms in homosexual men

The possible etiologic agents that may cause gastrointestinal complaints in homosexually active men are multiple, and their diagnosis is complex. This article presents a logical approach to the work-up and diagnosis of gastrointestinal complaints in homosexually active men and to discuss their treatment and disease intervention.

Factors influencing condom use in a sample of homosexually active men

A sample of 502 homosexually active men were recruited from genitourinary medicine clinics and non clinic sources and interviewed in relation to their sexual behaviour and factors that might influence their use of condoms. Three hundred and eighty three men (76%) reported penetrative anal sex in the previous year. Ninety four (25%) had not used condoms in penetrative sex. Failure to use condoms was associated with unfavourable attitudes to them, not knowing close friends or partners who had HIV-related health problems, having fewer sexual partners and being in a closed monogamous relationship. On the other hand levels of awareness about the risks of unprotected anal sex and involvement in gay networks and social groups were not predictors of condom use.

Survey of human immunodeficiency virus infection and sexually transmitted diseases in homosexual and bisexual men attending genitourinary medicine clinics in the UK during 1986-88. The British Cooperative Clinical Group

A multicentre investigation was made into the prevalence of sexually transmitted diseases and HIV infection amongst homosexual/bisexual (HS/BS) men attending genitourinary medicine clinics in the UK during the final quarters of 1986, 1987, and 1988. The results from individual clinics have been collated into regional groupings in order to assess geographical and temporal trends. A statistical analysis has also been performed on the data from 19 large teaching hospital clinics which contributed to both the 1986 and 1988 studies. There was a marked decline in the numbers of HS/BS men attending clinics and a statistically significant decrease in the prevalence of infectious syphilis and gonorrhoea. Although there was a concomitant fall in HIV testing rates, the prevalence of newly detected HIV antibody positive patients remained virtually constant. In 1988, 12.2% of 544 HS/BS men attending clinics in the Thames regions compared with 5.9% of 895 attending clinics elsewhere in the UK were found to be seropositive. No less than 30% of the 122 newly diagnosed individuals had been seronegative at a previous test during 1987/88. In addition to these new diagnoses, there were 953 attenders who had been previously diagnosed as being HIV seropositive. Total HIV seropositivity rates amongst HS/BS attenders ranged from 15-29% in different regions. These overall figures may underestimate the true size of the seropositive HS/BS clinic population because of the large number of untested individuals which constituted 33-51% of clinic attenders. The proportion of seropositives with clinical manifestations of chronic HIV infection was 54% nationally and was highest in the Thames regions and lowest in North England. Despite changes in the sexual behaviour of HS/BS men in the UK during the mid-eighties, a large proportion have been infected with HIV which has become the most widespread and prevalent sexually transmitted disease in patients attending genitourinary medicine clinics.

Behavioral characteristics and laboratory parameters in homo- and bisexual men in West Berlin: an evaluation of five years of testing and counselling on AIDS

Sera of 1980 homo- and bisexual men who visited the Landesinstitut für Tropenmedizin Berlin (West) between April 1983 and December 1987 were tested for HIV antibodies; 24.3% were positive. Of HIV-antibody-positive men, 78.9% reported both active and passive anal intercourse, 58.8%, rectal enemas, and 53.3%, use of butyl nitrite. There was a sexual partner with known positive HIV-antibody status or AIDS in 33.9%, and in 32.4% there was a history of sexual activity in the USA. In the year before the test, 18.8% had had more than 50 partners. All these behavioral characteristics were found to be significantly correlated to HIV antibodies. We noted a substantial reduction of high-risk behavior from 1983 to 1987. The most important behavioral factor for HIV infection in 1983 and 1984 was sexual activity in the USA, and from 1984 to 1987, the numbers of lifetime partners. Persons infected with HIV were significantly more often carriers of antibodies against HAV, HBV, CMV, EBV, and syphilis. Prevalence of antibodies against HIV, HAV, HBV, and syphilis increased with age, duration of homosexual practice, and the number of partners. Overall crude prevalence rates of HIV antibodies, anti-HBc, anti-HAV, and antibodies to syphilis declined during the observation period. Clinical findings such as fever, oral lesions, and lymphadenopathy syndrome (LAS) were found to be highly indicative of HIV infection. Lower hemoglobin values, a reduced white cell count, and hyperimmunoglobulinemia were significantly more frequent in subjects with HIV antibodies.

The natural history of human immunodeficiency virus infection: a five year study in a London cohort of homosexual men

Progression rates from asymptomatic to symptomatic Human Immunodeficiency Virus (HIV) infection according to the CDC classification were prospectively studied in a cohort of 172 seropositive homosexual and bisexual men. The median follow-up time was 4 years. The progression from data of entry to the study to any group IV disease was 56% (SE 7%) at 5 years. However, the progression from an estimated date of seroconversion to any group IV disease was 36% (SE 4%) at 5 years. This was more than double the progression rate to AIDS-14% (SE 3%) at 5 years calculated in the same way. There were no differences in progression to AIDS from group IV A (systemic symptoms such as unexplained fever, weight loss or persistent diarrhoea) and group IV C-2 (oral candida or oral hairy leukoplakia). Progression rates to AIDS were significantly lower (p = 0.02) in patients who were under 25 years of age at entry than in those over 25. A review of progression rates to AIDS among homosexual cohorts shows that they tend to be higher than in cohorts of haemophiliac patients, in the early stage of infection. However, when Pneumocystis carinii pneumonia is the outcome measure, progression rates in all studies are remarkably similar.

Diminished response to recombinant hepatitis B vaccine in homosexual men with HIV antibody: an indicator of poor prognosis

Three doses of a recombinant DNA HBV vaccine (MSD) were given to healthy male homosexuals. Seventy-eight out of 104 (77.6%) participants had detectable antibody (anti-HBs) two months after the third dose. Seroconversion occurred in only 9 out of 27 subjects (33.3%) who were anti-HIV positive compared with 69 out of 77 (89.6%) who were negative (chi 2 = 30.8; P less than .001). Fifteen of the 18 anti-HIV positive who did not mount an antibody response to the hepatitis B vaccine (anti-HBs) later progressed to persistent generalised lymphadenopathy syndrome (5), AIDS-related complex (5), and AIDS (5). Only one of the nine anti-HIV positive anti-HBs responders developed PGL (chi 2 = 10.14; P less than .005). Our results show that anti-HIV positive homosexuals are poor responders to the recombinant hepatitis B vaccine and anti-HIV positive non-responders are more likely to develop clinically apparent HIV infection.

Projections of the HIV/AIDS epidemic for homosexual/bisexual men in France, the Federal Republic of Germany and the United Kingdom

Projections of the spread of the acquired immunodeficiency syndrome (AIDS) and of its etiologic agent, the human immunodeficiency virus (HIV), are presented for homosexual/bisexual men in the three European countries with the largest caseloads. The results suggest that the HIV epidemic for French, German, and British homosexual/bisexual men has peaked around 1985 and declined rapidly thereafter. By the end of the century, and for a median incubation period of AIDS equal to 8 years, the total numbers infected in these groups are predicted to be about 31,200, 10,400 and 9,800, respectively. (These estimates more than double if the median incubation period is 12 years). In all cases the annual incidence of AIDS will reach its maximum in the early to mid-1990s. However, the AIDS epidemic will be protracted because of the long incubation period.

The sexual behaviour and knowledge about AIDS in a group of young adolescent girls in Leeds

A questionnaire was given to 56 sexually active girls 12-16 years old, in a juvenile assessment centre or attending a genitourinary medicine clinic. Sexual behaviour, drug use, contraceptive practice and knowledge and attitudes about AIDS were evaluated. The girls were similar in demographic characteristics from both centres and were regarded as one group. Sexual experience ranged from 1 partner ever to 70 clients/week; 19 girls had contracted a sexually transmitted disease at some time. Half had never used a contraceptive. Twenty eight had used illicit drugs, with two girls experimenting with intravenous misuse. Misconceptions about modes of transmission of HIV were common, but most girls knew some basic facts about the virus. Most girls realised they were at risk, were anxious about contracting HIV infection in the future, but had not modified their behaviour in terms of condom usage. This study indicates that high risk adolescents need to be targeted for effective health education in order to modify behaviour patterns which put them at risk of acquiring HIV in the future.

Time trends of HIV-I antibody prevalence in homosexual men

1840 homosexual and bisexual men were tested for human immunodeficiency virus type I (HIV) infection at the Landesinstitut für Tropenmedizin, Berlin between April 1983 and December 1987. A total of 25.1% were seropositive for HIV, but the percentage was seemingly declining. During the study period we observed also a steady decrease in the prevalence of lymphadenopathy syndrome (LAS), antibodies to hepatitis B and syphilis, and high-risk sexual behaviour in the study population. By adjusting for these changes of population characteristics we assessed the odds of HIV infection which had more than doubled between 1983 and 1986 (prevalence odds ratio 2.43, 95% confidence interval 1.58 to 3.76). In 1987 the HIV prevalence odds showed a drop which, however, was not significant (p = 0.34) when compared with the odds in 1986. Methodological aspects of time trend estimation based on data of voluntary HIV testing are discussed.