A study presented at the 20th International AIDS Conference (AIDS 2014) in Melbourne today compared the HIV epidemics in gay men in San Francisco, US and London, UK and confirmed that while HIV incidence in San Francisco was falling, it was static and even rising in London.
The chief reason appeared to be that gay men in London not only test for HIV less often than men in San Francisco, but that they also test far less often than they say they do. The difference is stark: whereas in the last gay men’s sexual health survey in 2011, 58% of gay men in community surveys said they had an HIV test within the last year, actual figures taken from the number of tests performed at sexual health clinics in London suggest that 20% or less of all the HIV-negative gay men in London (including the ones that don’t attend clinics) test every year, at least 50% lower than the rate in San Francisco.
Testing does not in itself lead to less HIV risk, of course: but higher testing rates in San Francisco appeared to lead to higher rates of HIV status disclosure between gay men and, as a result, much higher rates of effective serosorting that were based securely on men’s real HIV status; there was a falling rate of unprotected sex with partners of opposite or unknown status in San Francisco compared with no change in London.
Presenter Colin Brown of Public Health England (PHE) said that, historically, HIV prevalence in gay men in San Francisco has been higher – it is 24% in San Francisco but falling, compared with London where it has risen from 10% in 2009 to about 13% today. Because of this, he suggested, there has always been a culture of disclosure in San Francisco. The challenge will be how to encourage greater disclosure in London, a much larger and more diverse city with overall lower prevalence, and where there is evidence of greater anti-HIV stigma.
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