Renewed prevention measures must be initiated and consistent surveillance measures for HIV and sexually transmitted infections (STIs) established, to combat the spread of HIV in western Europe, according to an article by European public health doctors in the 1 June edition of the British Medical Journal.
Rates of HIV and gonorrhoea and syphilis, the STIs which are most indicative of “risky” sexual behaviour and can help to facilitate the transmission of HIV, were examined between 1995 and 2000 in ten western European countries (Belgium, Germany, Iceland, Ireland, Norway, Luxembourg, Sweden, Switzerland, and the United Kingdom).
In total 43,866 new cases of HIV were diagnosed in the ten collaborating countries during this period. Of these 37% were attributed to sex between men, 35% to sex between men and women, 8% to injecting drug use and 3% to other modes of transmission, such as mother-to-baby or infected blood products. Overall, the number of reported diagnoses of HIV remained relatively unchanged between 1995 and 2000, but trends differed between risk groups. Most notably annual diagnoses attributed to sex between men fell by 12%, but new cases attributed to heterosexual sex increased by 48%. The vast majority of new heterosexual cases, 64% were diagnosed in people originating from countries outside western Europe that have high HIV prevalence.
The researchers were concerned to note that rates of gonorrhoea and syphilis increased greatly across Europe between 1995 and 2000, particularly amongst gay men. In The UK, cases of gonorrhoea increased by 102% in the five years after 1995, in France by 170%, and in Sweden by 154%. In addition, rates of anorectal gonorrhoea amongst gay men in Amsterdam doubled during this period. Outbreaks of syphilis amongst gay men, some of whom were already HIV-positive, occurred in the UK, Netherlands, Ireland, France and Norway.
“The incidences of gonorrhoea and syphilis reported after 1995 are worrying” says the article as “the recent trends are consistent with increasing amounts of unsafe sex, perhaps representing a loss of impact of the HIV prevention campaigns of the 1980s and early 1990s.” The trends amongst gay men are identified as particularly worrying with “the data on gonorrhoea and syphilis …imply[ing] that increased risk taking is a phenomenon occurring in older and younger homosexual and bisexual men.”
Because of the success of HAART, the prevalence of HIV in Europe is increasing as HIV-positive people live longer, and the article suggests that as people with HIV are living healthier lives, they may be more sexually active and having “sex that is not necessarily safe.” However, on a more optimistic note the article suggest that “because many men and women are taking highly active antiretroviral drugs and their viral loads are well controlled, the overall force of infection might fall.”
In conclusion, the investigators attribute worsening sexual health across Europe to complacency about HIV amongst both individuals and some governments, meaning more “risky” sexual behaviour and the chance of increased HIV transmission rates, which “has probably already happened in the United States.” They call for prevention measures and consistent STI surveillance across Europe.
Reference:
Nicoll A et al. Are trends in HIV, gonorrhoea, and syphilis worsening in western Europe? BMJ 324: 1324-1327, 2002