French Gay Men – Half Diagnosed Recently Infected?

posted: 21/12/2009

Over the last five years, half of the gay men diagnosed with HIV in France were infected in the six months before their diagnosis, researchers report in Eurosurveillance. In the UK, a study in Brighton gave a similar result in 2007, but more recent work suggests the true UK figure is much lower – about 1 in 5 gay men diagnosed were recently infected.

The French study suggests that the rate of new infections among gay men in France is very high. However it could also be due to high rates of testing among some gay men.

After many years in which only AIDS diagnoses had to be reported in France, recently there have been big improvements in the French public health HIV reporting system. Since 2003, HIV diagnosis must be reported. A test to identify recent infections is also now usually performed as well.

Recent infections tests

Testing for recent infections (known as STARHS or incidence tests) looks for antibody markers that change depending on how long ago the infection happened.

There are now around 6,500 - 7,500 people newly diagnosed with HIV every year in France. [In the UK, in 2008, 7298 people were newly diagnosed, 2,760 of them gay men.] The numbers of gay men in France diagnosed with HIV has increased from below 2,000 in 2003 to around 2,500 for each of the last three years.

Epidemiologists analysed the available data on gay men diagnosed between 2003 and 2008, although quite a lot of information is missing. Recent infection results were only available for 4,819 gay men.

The average age for gay men diagnosed was 37. Doctors judged that around 1 in 5 gay men were in the primary infection stage. The test for recent infections showed that in fact 48% of men had been infected in the previous six months. This figure remained stable between 2003 and 2008.

More frequent testers
Men who had taken at least three HIV tests in their life were four times more likely to be diagnosed with recent infection than men who were diagnosed on their first HIV test. Being diagnosed in recent infection was more common both for men with French nationality and those with higher socio-economic status.

Younger men more likely to be recently infected, older men to be diagnosed late
Moreover, recent infection was more common for younger men, with 57% of those diagnosed aged 15-29 having recent infection, compared to 30% of men aged 50 and over. In line with this, whereas 11% of all gay men were diagnosed very late (with an AIDS-defining illness) this figure rose to 27% for those men aged over 50. The numbers of men diagnosed late fell during the study.

Older men were more likely to take a test because of symptoms, but younger men usually tested because of their risk-taking.

The authors note that the high number of recent infections in gay men probably reflects both testing behaviour and HIV incidence. They plan to publish a study estimating incidence rates in 2010.

Describing their data as worrying, they comment: “Prevention campaigns remain crucial, but they do not seem sufficient to contain sexual risk behaviours among MSM in France, despite the wide availability of screening, condoms and information and the fact that MSM represent a highly educated sub-population”.

In the United Kingdom, the Health Protection Agency (HPA) is also rolling out the use of recent infection tests. Whereas a 2007 study from Brighton estimated that half of new diagnoses in gay men were recent infections, the HPA’s preliminary results for 2008 suggest it is much lower - one-in-five for gay men, and one-in-ten for heterosexuals.

Source

image credit - from a map of HIV testing places produced by the Mayor of Paris

Reference
Semaille C et al. Recently acquired HIV infection in men who have sex with men (MSM) in France, 2003-2008. Euro Surveill 48: 5-8, 2009.
 

USA - Treatment as Prevention

posted: 10/12/2009

The USA has joined the list of countries producing national statements about how effective HIV treatment can make passing on HIV during sex very unlikely. 

The USA statement uses much the same evidence as the earlier Swiss, French and German statements on HIV treatment as prevention that we have reported. However, it is a lot more cautious, urging continued consistent condom use.

"In summary, for couples in which one member is HIV-infected, treatment of the infected partner with effective ART and suppression of viral load to undetectable levels should greatly reduce the risk of transmission to the uninfected partner. However, this risk is not eliminated and it may not be maximally reduced at all times due to some of the factors discussed above. Moreover, the likelihood of transmission may be expected to increase with repeated exposures over time."

"In a model which estimated transmission risk in the setting of suppressed viral load (<50 copies/mL) without intercurrent STIs, the number of expected transmission events occurring within a population of 10,000 serodiscordant couples over 10 years was estimated to be 215 for female-to-male transmission, 425 for male-to-female transmission, and 3,524 for male-to male transmissions [31]."

"In a meta-analysis of data from 11 cohorts including 5,021 heterosexual couples observed no transmissions among persons receiving ART with a viral load of <400 copies/mL; however, analysis of the data was compatible with the possibility of one event per 70 person-years [32]. For this reason, it is important that individual couples recognize the risk, and use additional preventive methods (e.g., condoms) in order to further minimize the chance of transmission."

So they advise condoms for heterosexual couples to prevent a 1 in 70 person years possibility of transmission.

This statement and advice comes from the US Centers for Disease Control.

Effective HIV treatment where the viral load is undetectable reduces the risk of HIV transmission but some slight risk remains. The risk is higher for gay men than most heterosexual people, and sexually transmitted infections especially raise the risk of transmission.

US Centers for Disease Control statement Effect of Antiretroviral Therapy on Risk of Sexual Transmission of HIV Infection and Superinfection [read on webpage] OR download it as a pdf

French statement

German statement

Swiss statement

Mental Health and HIV Survey

posted: 13/08/2009

NAM (National AIDS Manual) are involved in a survey to help understand better the mental health support needs of people living with HIV in the UK.

If you are interested in taking part in this survey, it is online here. The survey is anonymous and confidential. It will take about 15 minutes.
 

In French too

Ce questionaire est disponible en Français.

NAM (and we) thank you for your help. Hearing about your experiences is very valuable for organisations providing support and information services.

Mental Health and HIV booklet

NAM's Mental Health and HIV booklet is here.

HIV - the Basics

posted: 13/05/2009

NAM's new information resources, the basics, are now available online. Written in simple, plain English - and in French - the series of ten leaflets covers the top questions people have.

This completely new series of ten illustrated fact sheets covers key health messages and is intended to help in discussions between healthcare workers and people with HIV. Awarded the Crystal Mark by the Plain English Campaign, the simple language and pictures really bring the information to life.

Each leaflet focuses on a few key facts, and uses simple language and colourful diagrams to make the information accessible and useful.

The leaflets can be used by individuals as an introduction to HIV healthcare issues.

Available in English and in French, the basics are free to download and print - and NAM welcome your feedback on them.

Leaflets

• HIV and the immune system
• 7 ways to look after your health
• CD4 and Viral Load
• An HIV Treatment Journey
• When should I start treatment?
• How Treatment Works
• Undetectable Viral Load
• Taking Drugs on Time
• Side Effects
• Having a Baby

Copies for clinics and groups
 

If you work in a UK clinic or support group, these leaflets are available to order in bulk as part of the free booklet scheme. Please call Rose at NAM on 020 7840 0060 or email her for details.

English Basics leaflets

French Basics leaflets