Preventing the spread of HIV infection

A case control study of HIV seroconversion in gay men, 1988-1993: what are the current risk factors?

OBJECTIVE

To investigate current risk factors for HIV seroconversion among homo/bisexual men.

DESIGN

Matched case control study in a large STD clinic in central London. Data on risk factors were obtained by case note review.

METHODS

Fifty-six cases who had at least one negative HIV test followed by a positive test between June 1988 and July 1993, and two homo/bisexual controls (having two or more negative HIV tests) matched to each case on age, total number of HIV tests and test interval period were identified. Univariate and multivariate odds ratio were calculated for acute STD, ano-genital intercourse, condom use and HIV status of sexual partners.

RESULTS

Adjusted odds ratios (95% confidence intervals) for HIV seroconversion were 4.1 (1.3-13.3) for having an acute interval STD and 4.6 (1.4-15.4) for having a known HIV infected sexual partner. Compared with men who always used condoms, odds ratios for men who sometimes or never used condoms were 7.9 (2.2-28.9) and 16.2 (3.0-86.0) respectively. Unprotected ano-genital intercourse was commonly reported by both cases and controls, and reported condom use was no greater with a known HIV infected partner than with a partner of unknown HIV status.

CONCLUSION

HIV seroconversion among homo/bisexual men attending STD clinics is strongly related to having an acute STD, a known HIV infected partner and not using condoms. Although consistent use of condoms is highly protective, knowing that a partner is HIV infected does not ensure condom use between serodiscordant men. More effective, well-evaluated interventions are needed to reduce sexual risk-taking in this population.

The health needs of gay men: a discussion of the literature and implications for nursing

Although there is a general dearth of nursing literature on health issues specific to gay (homosexual) men, the literature reviewed shows that gay men have particular concerns related to anti-homosexual feelings anticipated and experienced from health professionals. The effects of homophobia in wider society may cause high levels of emotional distress in some gay men, which is associated with a higher incidence of substance misuse, parasuicide, bipolar psychiatric disorders and depression. Gay men also have specific needs with regard to general medical problems, including hepatitis, HIV infection and some other sexually transmitted diseases. Gay men may also present to health services for a wide range of general medical, surgical and mental health problems. Some specific health needs are discussed: general health, sexual health and bereavement counselling. These issues may affect individuals differently through various stages in the lifespan, and nurses should be cognizant of them during their assessment of client needs. Minimum counselling skills, together with appropriate training about gay issues, are required if nurses are to deal effectively with clients' needs.

Regular partners and risky behaviour: why do gay men have unprotected intercourse?

Studies in both the UK and the USA continue to show that gay and bisexual men put themselves at risk of exposure to HIV through unprotected intercourse, most often with regular partners. As part of a larger study of homosexually active men, 310 men who had had unprotected anal intercourse with a man in the previous year were asked to describe the last occasion on which this had happened. The majority of men had had unprotected intercourse with a regular partner and did not perceived it as risky, although most did not know the HIV status of their partner. Regular and non-regular partners were perceived differently. Men were more likely to be emotionally involved in regular partners and to perceive unprotected penetrative sex with a regular partner as not risky. Future health education initiatives must take into account men's emotional involvement in regular partners and their perception of unprotected intercourse with such partners as not risky.

Neisseria gonorrhoeae isolated at St. Mary's Hospital London, 1980-91

OBJECTIVE

To describe and discuss the trends in the isolation of Neisseria gonorrhoeae from patients attending the Genitourinary Medicine Clinic at St. Mary's Hospital, Paddington, London between 1980 and 1991.

DESIGN

A retrospective study of the total number of gonococci isolated over an eleven year period was performed. In addition, for the years 1988-1991 the number of isolates from homosexual men was analysed by age of the patient, site of infection and HIV antibody status of the patient.

RESULTS

The total number of N. gonorrhoeae isolates identified declined markedly between 1980 and 1989 from 3670 to 750 isolates. Over the same time period the number of specimens screened for N. gonorrhoeae fell by 50%. In 1990 there was an increase in N. gonorrhoeae isolates but this was not maintained, and in 1991 the number of N. gonorrhoeae fell to its lowest level of 638 isolates. The decrease since 1980 occurred in both men and women although the number of rectal isolates from men showed a steeper decline reaching its lowest level of 24 isolates in 1988. The number of rectal isolates from homosexual men has since increased with a peak in 1990. Many of the infections among homosexual men occurred in older men and included insignificant number of patients who were HIV positive.

CONCLUSION

Gonorrhoea among attenders at St. Mary's Hospital has declined dramatically since 1980 following trends reported from much of Europe. The increase in gonococcal isolates since 1989 and the peak in 1990 are unexplained but are coincident with a higher number of isolates from homosexual men.

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.

Sexually transmitted diseases and HIV-1 infection among homosexual men in England and Wales

OBJECTIVE

To examine surveillance data for evidence of changing sexual behaviour and continuing transmission of HIV-1 among men who have sex with men.

DESIGN

Analytic study of surveillance data on sexually transmitted diseases.

SETTING

England and Wales.

MAIN OUTCOME MEASURES

Number of cases of rectal gonorrhoea and newly diagnosed HIV infection in homosexual men.

RESULTS

New cases of gonorrhoea among men attending genitourinary medicine clinics increased by 7.7% in 1989 and by 4.2% in 1990. Reports of rectal isolates of Neisseria gonorrhoeae also rose and the male to female ratio for patients with rectal gonorrhoea changed from 0.3:1 during 1988-9 to 2.6:1 in 1990-1. Although the overall number of cases of acute hepatitis B fell during 1988-91, 81 and 82 homosexual men were infected in 1990 and 1991 respectively compared with 50 and 42 in 1988 and 1989. 1526 men had HIV-1 infection diagnosed in 1991, the largest number since 1987. Twenty eight of the 97 (29%) men who seroconverted between January 1989 and December 1991 were aged less than 25. The proportion of men aged 15-19 who were found to be infected with HIV-1 at their first test increased from an average of 2.4% up to 1990 to 4.7% in the first nine months of 1991. The prevalence of HIV infection in men under 25 attending genitourinary medicine clinics in London was 17% compared with 7.8% outside London.

CONCLUSION

Unsafe sexual behaviour and HIV transmissions have increased among homosexual men after a period of decline. Recent HIV transmissions may disproportionately affect younger men.

A theoretical problem of interpreting the recently reported increase in homosexual gonorrhoea

There has been considerable interest recently in using the occurrence of gonorrhoea infection as an indicator of sexual behaviour relevant to the transmission of human immunodeficiency virus. Mathematical models of gonorrhoea transmission can predict increasing incidence with decreasing sexual activity in the population, due to a resultant concentration of sexual activity in an active 'core' group. Increases in the incidence of gonorrhoea reported recently should therefore be interpreted with caution.