Black gay men still at higher risk of HIV in the UK

Gay and bisexual men of black ethnicity are disproportionately more likely to be living with diagnosed HIV than white British men, with no evidence that this health inequality has narrowed since 2001, according to a report published online ahead of print in Sexually Transmitted Infections.

The data come from the 2014 Gay Men’s Sex Survey, a convenience sample of 15,388 men recruited online.

While 11.3% of white British men who had ever taken a test were diagnosed with HIV, this was the case for 12.9% of black men. After taking into account other factors likely to skew the results, black men were more likely to be diagnosed with HIV (adjusted odds ratio 1.53) and more likely to have been diagnosed in the year before the survey (adjusted odds ratio 2.57).

Glossary

odds ratio

Comparing one group with another, expresses differences in the odds of something happening. An odds ratio above 1 means something is more likely to happen in the group of interest; an odds ratio below 1 means it is less likely to happen. Similar to ‘relative risk’. 

sample

Studies aim to give information that will be applicable to a large group of people (e.g. adults with diagnosed HIV in the UK). Because it is impractical to conduct a study with such a large group, only a sub-group (a sample) takes part in a study. This isn’t a problem as long as the characteristics of the sample are similar to those of the wider group (e.g. in terms of age, gender, CD4 count and years since diagnosis).

depression

A mental health problem causing long-lasting low mood that interferes with everyday life.

systemic

Acting throughout the body rather than in just one part of the body.

 

condomless

Having sex without condoms, which used to be called ‘unprotected’ or ‘unsafe’ sex. However, it is now recognised that PrEP and U=U are effective HIV prevention tools, without condoms being required. Nonethless, PrEP and U=U do not protect against other STIs. 

This is comparable to results from the 2001 Gay Men’s Sex Survey, which also found black men more likely to have HIV (adjusted odds ratio 2.26). Other studies have had similar results – but also found that black men were less likely to engage in HIV risk behaviours and more likely to engage in HIV precautionary behaviours.

The 2014 survey found few differences in rates of anal sex without a condom between ethnic groups, but did find that black men were more likely to have had anal sex without a condom with at least two men in the past year (adjusted odds ratio 1.85).

‘White other’ men

The other ethnic group with elevated HIV rates was men of ‘white other’ ethnicity. Men in this group (11% of the respondents) were mostly born in other European countries, Australasia or North America.

Of men in this group who had ever taken an HIV test, 14.6% had diagnosed HIV. After adjustment, they were more likely to be diagnosed with HIV (adjusted odds ratio 1.23), but not more likely to have been diagnosed in the year before the survey. They were more likely than white British men to report anal sex without a condom (adjusted odds ratio 1.24).

Asian men

In previous studies, men of Indian, Pakistani and other Asian ethnicities were less likely to have HIV. However the new study found comparable rates of diagnosed HIV and condomless sex to white British men, but higher rates of anal sex without a condom with at least two men in the past year (adjusted odds ratio 1.46).

“This may be because whatever social, economic or cultural protective effects were shielding Asian GBM [gay and bisexual men] from HIV for the first 20 years of the epidemic are no longer operating,” the researchers comment. Without changes in risk behaviours, Asian men can expect to have a higher prevalence of HIV than the white majority in the future, they say.

Conclusion

The authors note that Public Health England data also show a significant year-on-year increase in new HIV diagnoses among Asian and black African gay and bisexual men for over a decade.

They suggest mental health is likely to be an important factor – black and Asian gay and bisexual men are more likely to have symptoms of depression, and black men are more likely to report suicidal thoughts.

However responses to the problem have been under-funded and not been supported over time. “Sustained systemic change across a wide range of social institutions is needed to change ethnic group inequities in HIV infection among gay and bisexual men,” they conclude.

References

Hickson F et al. HIV, sexual risk and ethnicity among gay and bisexual men in England: survey evidence for persisting health inequalities. Sexually Transmitted Infections, online ahead of print, 2017. (Abstract).