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Sex Transm Infect. 2004 Jun; 80(3): 236–240.
PMCID: PMC1744829

Increasing risk behaviour and high levels of undiagnosed HIV infection in a community sample of homosexual men


Objectives: To estimate changes in sexual behaviour over time. To examine the proportion of undiagnosed HIV infection in a community sample of homosexual men. To explore the relation between HIV status, diagnosis, and sexual behaviour.

Methods: Five cross sectional surveys of men attending selected gay community venues in London between 1996 and 2000 (n = 8052). Men were recruited in 45 to 58 social venues (including bars, clubs, and saunas) across London. Participants self completed an anonymous behavioural questionnaire. In 2000, participants in community venues provided anonymous saliva samples for testing for anti-HIV antibody.

Results: The proportion of men having unprotected anal intercourse (UAI) increased significantly each year from 30% in 1996 to 42% in 2000 (p<<0.001). In 2000, 132 of 1206 (10.9%) saliva samples were HIV antibody positive. Of the HIV saliva antibody positive samples, 43/132 (32.5%) were undiagnosed. Around half of both diagnosed and undiagnosed HIV saliva positive men reported UAI in the past year. Of the 83% of men who reported their current perceived HIV status, 4.1% reported an incorrect status. HIV antibody positivity was associated with increasing numbers of UAI partners, and having a sexually transmitted infection (STI) in the past year (OR 2.15).

Conclusions: Homosexual men continue to report increasing levels of UAI. HIV prevalence is high in this group, with many infections remaining undiagnosed. The high level of risky behaviour in HIV positive men, regardless of whether they are diagnosed, is of public health concern, in an era when HIV prevalence, antiretroviral resistance, and STI incidence are increasing.

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Selected References

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  • Dodds JP, Nardone A, Mercey DE, Johnson AM. Increase in high risk sexual behaviour among homosexual men, London 1996-8: cross sectional, questionnaire study. BMJ. 2000 Jun 3;320(7248):1510–1511. [PMC free article] [PubMed]
  • Elford J, Bolding G, Maguire M, Sherr L. Sexual risk behaviour among gay men in a relationship. AIDS. 1999 Jul 30;13(11):1407–1411. [PubMed]
  • Van de Ven P, Kippax S, Crawford J, Rawstorne P, Prestage G, Grulich A, Murphy D. In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex. AIDS Care. 2002 Aug;14(4):471–480. [PubMed]
  • Kippax S, Crawford J, Davis M, Rodden P, Dowsett G. Sustaining safe sex: a longitudinal study of a sample of homosexual men. AIDS. 1993 Feb;7(2):257–263. [PubMed]
  • Hunt AJ, Davies PM, McManus TJ, Weatherburn P, Hickson FC, Christofinis G, Coxon AP, Sutherland S. HIV infection in a cohort of homosexual and bisexual men. BMJ. 1992 Sep 5;305(6853):561–562. [PMC free article] [PubMed]
  • Nardone A, Dodds JP, Mercey DE, Johnson AM. Active surveillance of sexual behaviour among homosexual men in London. Commun Dis Public Health. 1998 Sep;1(3):197–201. [PubMed]
  • Parry JV, Perry KR, Mortimer PP. Sensitive assays for viral antibodies in saliva: an alternative to tests on serum. Lancet. 1987 Jul 11;2(8550):72–75. [PubMed]
  • Connell JA, Parry JV, Mortimer PP, Duncan J. Novel assay for the detection of immunoglobulin G antihuman immunodeficiency virus in untreated saliva and urine. J Med Virol. 1993 Oct;41(2):159–164. [PubMed]
  • Nardone A, Mercey DE, Johnson AM. Surveillance of sexual behaviour among homosexual men in a central London health authority. Genitourin Med. 1997 Jun;73(3):198–202. [PMC free article] [PubMed]
  • Johnson AM, Parry JV, Best SJ, Smith AM, de Silva M, Mortimer PP. HIV surveillance by testing saliva. AIDS. 1988 Oct;2(5):369–371. [PubMed]
  • Hunt AJ, Connell J, Christofinis G, Parry JV, Weatherburn P, Hickson FC, Coxon AP, Davies PM, McManus TJ, Sutherland S. The testing of saliva samples for HIV-1 antibodies: reliability in a non-clinic setting. Genitourin Med. 1993 Feb;69(1):29–30. [PMC free article] [PubMed]
  • Kippax S, Noble J, Prestage G, Crawford JM, Campbell D, Baxter D, Cooper D. Sexual negotiation in the AIDS era: negotiated safety revisited. AIDS. 1997 Feb;11(2):191–197. [PubMed]
  • Ekstrand M, Stall R, Kegeles S, Hays R, DeMayo M, Coates T. Safer sex among gay men: what is the ultimate goal? AIDS. 1993 Feb;7(2):281–282. [PubMed]
  • Elford Jonathan, Bolding Graham, Sherr Lorraine. High-risk sexual behaviour increases among London gay men between 1998 and 2001: what is the role of HIV optimism? AIDS. 2002 Jul 26;16(11):1537–1544. [PubMed]

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