‘Action required’ in response to increase in HIV and other STIs in Northern Ireland

“Action is required to stem the rise in STIs in Northern Ireland,” claim the authors of a new report in the latest issue of Eurosurveillance Weekly, which has revealed that rates of new infections of HIV and other sexually transmitted infections (STIs) are on the increase. Northern Ireland is not routinely included in figures for HIV and other sexually transmitted infections (STIs) by the Health Protection Agency (HPA) when reporting about the UK’s sexual health.

Although absolute numbers are relatively small for this country of 1.7 million, newly diagnosed HIV infections increased 23% between 2002 and 2003; a syphilis outbreak has been ongoing since 2001, with 128 cases diagnosed between January 2001 and September 2004; and rates of diagnosed chlamydia have increased by 63% between 1999 and 2003.

HIV

The annual number of new diagnoses of HIV infection in Northern Ireland has increased every year since 1999. Thirty-one cases have already been reported in the first nine months of 2004, making it likely that the record number of 32 new diagnoses seen in 2003 will again be beaten.

There were 189 people receiving treatment for HIV disease in 2003, 85% of whom were of white ethnic background. Since the beginning of the AIDS pandemic, a total of 322 people have been diagnosed with HIV infection in Northern Ireland, 54% of whom were gay men, whilst 34% were heterosexual men and women.

The authors comment, “While small numbers of diagnoses in any one year make analysis difficult, it is likely that key factors driving this increase in Northern Ireland are the same as for the UK as a whole, namely sustained (and possibly increased) HIV transmission in men who have sex with men, and the migration of HIV-infected heterosexual men and women from countries with epidemic levels of HIV.”

Although around two per cent of those living with HIV acquired their infection through injecting drug use, it appears, say the authors “that injecting drug users (IDUs) are taking more risks than in the rest of the UK, with 44% of those who had injected in the four weeks prior to the study reporting the direct sharing of needles and syringes, compared to 35% in Wales, 34% in Scotland and 23-37% in the English regions. This emphasises the need for a continued focus on harm reduction measures among the Northern Ireland IDU population.”

Syphilis and Chlamydia

There has been an outbreak of syphilis in Northern Ireland since 2001. Although this was initially linked to the Dublin outbreak, most of the reports from people being newly diagnosed with syphilis suggest that they are now acquiring the disease within Northern Ireland. Ninety-eight (77%) of the total 128 cases reported since the beginning of the outbreak have been in gay men; 15% in heterosexual men, and 9% in heterosexual women. However, unlike in England, where around 25-30% of syphilis infections have occurred in HIV-positive gay men, only 9% (11/128) were also HIV-positive, although three of the eleven were newly diagnosed concurrently with both HIV and syphilis.

One of the problems regarding prevention campaigns targeted specifically at gay men in Northern Ireland, say the authors, has been “a lack of readily identifiable social and sexual networks.”

The rate of new cases of chlamydia has also increased, from a rate of around 45 per 100,000 in 1999 to around 70 per 100,000 in 2003. Although this is lower than the rates per 100,000 in England and Wales, the authors note that “the percentage increase in rate per 100,000...(63%) is similar to that for England, Wales and Northern Ireland (64%) as a whole.”

Action required

The authors argue that these data suggest that “action is required to stem the rise in STIs in Northern Ireland.” Although Northern Ireland’s Department of Health has a five year Sexual Health Promotion Strategy and Action Plan, there is only one broad target: ‘a reduction of 25% in the number of newly acquired acute sexually transmitted infections, including HIV and AIDS, by 2009’.

“However,” the authors say, “little information is available on the sexual behaviour, lifestyles and attitudes of the Northern Ireland population which could be used to inform prevention initiatives,” despite a feasibility study showing that a survey similar to the England and Wales ‘National Surveys of Sexual Attitudes and Lifestyles’ is “necessary to inform prevention activities.”

In addition, say the authors, “there is now evidence that Genitourinary Medicine services in Northern Ireland, as well as other parts of the UK, have long waiting times for appointments. This is a matter for concern, because the absence of timely intervention may contribute to ongoing transmission of infection.”