Update on HIV and STIs in Men Who Have Sex with Men in London
Men who have sex with men (MSM) in London face significant inequalities in sexual health, with high rates of STIs and HIV diagnoses. This update highlights the increasing numbers of new HIV diagnoses and endemic Shigella infections among MSM, emphasizing the need for targeted interventions and support services.
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Inequalities in Sexual Health. Update on HIV and STIs in men who have sex with men in London Field Epidemiology Services PHE Publications gateway number: 2015709
Summary men who have sex with men (MSM) experience substantial inequalities in sexual health MSM constitute 2% of adult population in London, but 90% of all syphilis diagnoses 69% of all gonorrhoea diagnoses 63% of new HIV diagnoses diagnoses of gonorrhoea and syphilis in MSM in London have increased dramatically in recent years 1 in 11 MSM aged 15 to 44 years in London are living with HIV (diagnosed or undiagnosed) numbers of new HIV diagnoses in MSM are increasing (1,586 in 2014) an estimated 2,400 MSM in London with HIV are undiagnosed Shigella infections are now endemic in MSM in London 2 Inequalities in Sexual Health. Update on HIV and STIs in men who have sex with men in London
Figure 1: SOPHID weighted estimates of the number of 16 to 44 year old MSM resident in each LA in London and the estimated proportion of males aged 16 to 44 years that are MSM Source: PHE Survey of Prevalent HIV Infections Diagnosed (SOPHID). Data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Personal communication with Dr Catherine Mercer at University College London. Ruf M DV, Osuagwu U, Brown AE, Robinson E & Chadborn T. Men who have sex with men: estimating the size of at-risk populations in London primary care trusts. Int J STD AIDS. 2011;22:25-9. 3 Inequalities in Sexual Health. Update on HIV and STIs in men who have sex with men in London
Table 1: percentage change in new STI, HIV and Shigella diagnoses in MSM from 2010 and 2013 to 2014. London Diagnoses 2014 % change 2010-2014 % change 2013-2014 New STIs Syphilis Gonorrhoea Chlamydia Genital Herpes Genital Warts 26,714 2,049 10,871 6,460 732 1,395 1,586 329 487 131% 180% 320% 154% 42% 37% 23% 227% 47% 26% 54% 31% 34% 3% 14% 1% 60% 38% HIV** Shigella* LGV*** GUMCAD started in 2009. Reporting of sexual orientation is less likely to be complete for earlier years, so rises seen may be partly artefactual. Any increase in gonorrhoea diagnoses may be due to the increased use of highly sensitive nucleic acid amplification tests (NAATs) and additional screening of extra-genital sites in MSM. Any decrease in genital wart diagnoses may be due to a moderately protective effect of HPV-16/18 vaccination. Any increase in genital herpes diagnoses may be due to the use of more sensitive NAATs. Any increase or decrease may reflect changes in testing. *The number of Shigella diagnoses in MSM is estimated by calculating the excess male cases aged 16 to 60 years diagnosed with Shigella with no known history of travel outside the UK ** Numbers adjusted for missing information on route of transmission *** Lymphogranuloma venereum, numbers reflect all LGV, however previous analysis has indicated that 99% are in MSM Source: Public Health England, for new STIs, Gonorrhoea, Chlamydia, Genital Herpes and Warts - GUMCAD, for HIV - HIV and Aids New Diagnosis Database (HANDD), for Shigella Gastro Data Warehouse, for LGV STBRU laboratory returns . 4 Inequalities in Sexual Health. Update on HIV and STIs in men who have sex with men in London
Figure 2: MSM as the proportion of different populations, including populations of people with STIs and HIV Adult population 2% Chlamydia 23% New STIs 28% New HIV diagnoses 63% Gonorrhoea 69% Syphilis 90% 0% 20% 40% 60% 80% 100% % MSM Source: Public Health England, Natsal, GUMCAD, HIV and Aids New Diagnosis Database (HANDD), 5 Inequalities in Sexual Health. Update on HIV and STIs in men who have sex with men in London
Figure 3: MSM as a proportion of male local authority residents with a known sexual orientation diagnosed with a new STI in sexual health clinics: London, 2014 80% 70% 72% 69% 60% 63% 61% 61% 50% 57% Percent 54% 53% 51% 40% 44% 44% 41% 41% 41% 41% 30% 34% 33% 33% 33% 32% 31% 30% 20% 28% 27% 23% 20% 19% 19% 19% 18% 17% 16% 10% 0% Local authority Sexual health clinic diagnoses only. Males with no information on sexual orientation are excluded from the calculation, Please note City of London has small numbers and has been excluded from this figure. Source: Public Health England, GUMCAD 6 Inequalities in Sexual Health. Update on HIV and STIs in men who have sex with men in London
Figure 4: MSM and heterosexual males diagnosed with a new STI in sexual health clinics, age distributions compared: London residents, 2014 30% 25% 20% Percent 15% MSM Heterosexual men 10% 5% 0% 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 Age group at diagnosis (years) Source: Public Health England, GUMCAD 7 Inequalities in Sexual Health. Update on HIV and STIs in men who have sex with men in London
Figure 5: MSM diagnosed with a new STI in London by ethnicity, 2014 76% 80% 70% 60% 50% Percent 40% 30% 20% 7% 6% 6% 10% 5% 0% White Black Asian Other Mixed Ethnic group Source: Public Health England, GUMCAD 8 Inequalities in Sexual Health. Update on HIV and STIs in men who have sex with men in London
Figure 6: number of diagnoses of acute STIs in MSM in sexual health clinics in London residents, 2008 to 2014. 12,000 10,871 10,000 Number of diagnoses 8,000 6,460 6,000 4,000 823 988 2,049 1,395 2,000 384 505 732 221 2008 0 2009 2010 2011 2012 2013 2014 Syphilis Gonorrhoea Chlamydia Genital Herpes Genital Warts GUMCAD started in 2009. Reporting of sexual orientation is less likely to be complete for earlier years, so rises seen may be partly artefactual. Any increase in gonorrhoea diagnoses may be due to the increased use of highly sensitive nucleic acid amplification tests (NAATs) and additional screening of extra-genital sites in MSM. Any decrease in genital wart diagnoses may be due to a moderately protective effect of HPV-16/18 vaccination. Any increase in genital herpes diagnoses may be due to the use of more sensitive NAATs. Any increase or decrease may reflect changes in testing. Source: Public Health England, GUMCAD 9 Inequalities in Sexual Health. Update on HIV and STIs in men who have sex with men in London
Figure 7: region of birth of MSM and heterosexual males diagnosed with a new STI in London 2014 70% 60% 62% MSM Heterosexual men 50% 40% Percent 30% 20% 6% 2% 10% 14% 9% 50% 25% 6% 7% 5% 8% 5% 0% United Kingdom Rest of Europe Asia Africa Latin America/ Caribbean North America/ Oceania World region of birth Source: Public Health England, GUMCAD 10 Inequalities in Sexual Health. Update on HIV and STIs in men who have sex with men in London
Figure 8: number of gonorrhoea diagnoses in MSM by London local authority of residence, 2014 Source: Public Health England, GUMCAD 11 Inequalities in Sexual Health. Update on HIV and STIs in men who have sex with men in London
Figure 9: LGV diagnoses by sexual health clinics in London, 2004 to 2015 600 513 500 400 LGV diagnoses 300 200 100 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Source: Public Health England, STBRU Laboratory Returns 12 Inequalities in Sexual Health. Update on HIV and STIs in men who have sex with men in London
Figure 10: excess male cases aged 16 to 60 years diagnosed with Shigella with no known history of travel outside the UK, by sex, London, 2011 to 2015 350 300 250 Excess - Male Number of cases 200 333 150 275 211 100 136 50 96 0 2011 2012 Year sample recieved by reporting laboratory 2013 2014 2015 Source: Public Health England, Gastro Data Warehouse. 13 Inequalities in Sexual Health. Update on HIV and STIs in men who have sex with men in London
Figure 11: proportions of MSM living with diagnosed HIV in London by age group, 2004, 2009 and 2014 30% 25% 2004 20% 2009 Percent 15% 2014 10% 5% 0% Age group Source: Public Health England, Survey of Prevalent HIV Infections Diagnosed (SOPHID). 14 Inequalities in Sexual Health. Update on HIV and STIs in men who have sex with men in London
Figure 12: numbers of MSM accessing care for diagnosed HIV by London local authority, 2014 Source: Public Health England, Survey of Prevalent HIV Infections Diagnosed (SOPHID). 15 Inequalities in Sexual Health. Update on HIV and STIs in men who have sex with men in London
Figure 13: new HIV diagnoses by probable route of infection (adjusted for missing route of infection information), London residents, 2005 to 2014 (please see footnote on interpreting trends)* 2,000 1,800 Number of new HIV diagnoses 1,600 1,400 1,200 1,000 MSM 800 Heterosexual contact 600 Other infection routes 400 200 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 The number of new diagnoses will depend on accessibility of testing as well as infection transmission. *Numbers may rise as further reports are received and more information is obtained on area of residence of those diagnosed. This is more likely to affect more recent year, particularly 2014. Please see important note on data earlier in this report. This will impact on interpretation of trends in more recent years. Source: Public Health England, HIV and Aids New Diagnosis Database (HANDD). 16 Inequalities in Sexual Health. Update on HIV and STIs in men who have sex with men in London
Figure 14: number of new HIV diagnoses in MSM by London local authority of residence, 2014 Source: Public Health England, HIV and Aids New Diagnosis Database (HANDD). 17 Inequalities in Sexual Health. Update on HIV and STIs in men who have sex with men in London
Acknowledgements Produced by Josh Forde, Paul Crook and Jenifer Smith from Public Health England Local sexual health and HIV clinics for supplying the STI and HIV data Institute of Child Health PHE Centre for Infectious Disease Surveillance and Control (CIDSC) HIV and STI surveillance teams for collection, analysis and distribution of data PHE CIDSC Gastrointestinal bacterial reference unit (GBRU) for Shigella Stefano Conti of the PHE CIDSC modelling team for providing estimates of the total number of people living with HIV and the proportion that remain undiagnosed 18 Inequalities in Sexual Health. Update on HIV and STIs in men who have sex with men in London
More information Please access the online Sexual and Reproductive Health Profiles for further information on a whole range of sexual health indicators: http://fingertips.phe.org.uk/profile/sexualhealth For more information on local sexual health data sources please access the PHE guide: https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil e/395207/PHE_Guide_to_National_Local_Sexual_Reproductive_Health_Da ta.pdf For an epidemiology summary of STIs in London https://www.gov.uk/government/publications/sexually-transmitted-infections- london-2014-data For an epidemiology summary of HIV in London https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil e/483335/2015_12_03LondonHIVSpotlight.pdf For more information please contact Field Epidemiology Services at fes.seal@phe.gov.uk 19 Inequalities in Sexual Health. Update on HIV and STIs in men who have sex with men in London
