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Increased high risk sexual behaviour in homosexual men

BMJ 2000; 321 doi: (Published 16 December 2000) Cite this as: BMJ 2000;321:1531

There is no evidence for a decreased incidence of HIV infection

  1. Neil Macdonald, senior scientist (,
  2. Barry Evans, consultant epidemiologist
  1. Public Health Laboratory Service HIV and STI Centre, London NW9 5EQ
  2. Warrington and Halton General Hospitals, Warrington WA5 1QG
  3. South Manchester Centre for Sexual Health, South Manchester University Hospital, Manchester M20 2LR
  4. School of Care Sciences, University of Glamorgan, Pontypridd CF37 1DL
  5. Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, London WC1E 6AU

    EDITOR—Dodds et al began their paper1 with the statement that the incidence of HIV infection among homosexual men in the United Kingdom is increasing despite efforts to reduce high risk behaviour and supported the statement of increasing incidence by referencing a report from the Public Health Laboratory Service.2

    This report, which featured national surveillance data on HIV infection acquired through sex between men, does, however, not suggest that the incidence in homosexual men is rising. Rather, together with the more recent update,3 it highlights the number of new diagnoses of HIV infection acquired through sex between men, which have remained fairly constant at around 1500 a year throughout the 1990s. The published erratum clarifies the situation (16 September, p 675), but the statement caused us to re-examine our data to see what we are able to say about recent trends in HIV among homosexual men.

    Although trends in the diagnosis of HIV relate more closely to the uptake of HIV testing than to the underlying incidence of infection, the fact that there has been little change in the median age or median CD4 lymphocyte count at diagnosis in this group over the past 10 years suggests that new infections have occurred at similar rates to diagnoses, through most of that period at least.4

    At best, however, such indicators provide only a broad measure of past incidence, and more sensitive and timely markers of likely changes in HIV incidence may be found in the surveillance of acute sexually transmitted infections and the type of monitoring of high risk sexual behaviour covered in the paper by Dodds et al.

    Increases in markers …

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