UK gay men of black Caribbean and African ethnicity are more than twice as likely, and gay men of Asian ethnicity are three-times less likely, as gay white British men to be HIV-positive, and these differences can at least be partially explained by differences in sexual HIV risk behaviour, according to a paper based on the fifth national ‘Gay Men’s Sex Survey’, recently published online in the journal of Sexually Transmitted Infections.
In order to ascertain ethnic group differences in demographics, HIV testing and sexual HIV risk behaviour, investigators from the UK’s Sigma Research analysed data from the fifth Gay Men’s Sex Survey, which took place over the summer of 2001.
This survey used three distinct but complementary methods of distribution - a questionnaire at seven UK Pride events, a survey booklet sent to 185 HIV health promotion agencies, and an online survey promoted via uk.gay.com - in order to ascertain information regarding sexual behaviour, HIV risk-taking, testing and serostatus, and various other demographic data. Of a total of 17,205 respondants, 13,369 predominantly gay men (only 7% had ever also had sex with a woman) living in England, were included in this analysis.
The data was compared with the 2001 census, and the researchers grouped the men according to the following ethnic categories:
- White British
- White Other (including Irish)
- Black (including Caribbean, African, mixed and other)
- Asian (including Indian, Pakistani, Bangladeshi, mixed and other)
- All others (including Chinese, other mixed, all others)
Compared to the UK population of gay men based on 2001 census data, white British men and Asian men were underrepresented in this survey, and ‘white other ‘and ‘all others’ were overrepresented. Men with mixed Asian-white ethnicity were also overrepresented. Within the black group, men with mixed ethnicities predominated, with African and Caribbean men less well represented.
HIV testing history
Overall, almost 55% of respondents had ever taken the HIV antibody test. After adjusting for recruitment method, residence, age and education, compared with white British men, the ‘white other’ group were 1.83 times more likely, black men 1.54 times more likely, and Asian men 0.71 times as likely to have ever tested for HIV.
HIV prevalence
Almost ten percent (705/7147) of the men who had ever taken an HIV antibody test had received a positive result. After adjusting for recruitment method and demographic differences, black men (of whom 11.6% were HIV-positive) were 2.26 times more likely and Asian men (of whom 1.5% were HIV-positive) 0.32 times as likely to be living with HIV than white British men, of whom 8.2% were living with HIV.
HIV sexual risk behaviours
Of the 94.6% of respondents who were not HIV-positive, and who had sex with a male partner in the previous year, 9.6% had some kind of sexual contact with a man they knew to be HIV-positive. ‘White other’ gay men, as well as men living in London, with higher education, and men in their thirties and forties, were more likely to have had sex with a known HIV-positive man, and Asian men were less likely to have had sex with a known HIV-positive man. Although a very small proportion (under 2%) had either insertive or receptive unprotected anal intercourse (UAI) with a known HIV-positive man, compared with white British men, black men were 2.76 times more likely to have had insertive UAI with a known HIV-positive man, after adjusting for recruitment method and demographic differences. There was no difference between ethnic groups for the 1.2% of the ‘not HIV-positive’ men who knowingly had receptive UAI with an HIV-positive man.
Sex of any kind with men of unknown HIV status was common, with almost 77% of ‘not HIV-positive’ men having done so in the past year. Just under 20% of the 94.6% of respondents who were ‘not HIV-positive’ had insertive UAI, and black men were 1.46 times more likely than white British men to have done so, after adjusting for recruitment method and demographic differences. Almost 18% had receptive UAI with men of unknown HIV status, but this did not significantly vary by ethnic group.
Discussion
The authors say that the 2001 data “lends weight to the hypothesis that among [men who have sex with men (MSM)], HIV incidence is higher among black men and lower among Asian men when compared to the ethnic majority,” and supports the notion that “HIV prevalence (the proportion infected) is higher among black men than among other groups because HIV incidence (the rate at which men become infected) is higher.”
They add that “HIV incidence is higher” among black men “because black men are more likely to be involved in sexual HIV exposure, especially while engaging in unprotected insertive anal intercourse.” They warn that “there is a danger that [sexual health promotion] programmes targeted at MSM underserve black MSM and conversely that programmes targeted at black people underserve black MSM.”
The authors conclude by recommending that “black men [should be] overserved by HIV interventions and programmes,” but that it is important to distinguish between African men and Caribbean men, and that “it may be particularly fruitful to address black men’s knowledge and beliefs about the risks of infection when an uninfected man is insertive in unprotected anal intercourse with an HIV-positive partner.”
They also suggest that migration “is often the context in which men’s HIV prevention needs are elevated” and, finally, they “stress the need to ensure that it is the less well-off strata of [these ethnic] groups which benefit from health promotion interventions.”
Hickson F et al. HIV, sexual risk, and ethnicity among men in England who have sex with men. Sex Transm Infect 80; 443-450, 2004.