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Undiagnosed HIV infections among gay and bisexual men increasingly contribute to new infections in Australia.

ABSTRACT: INTRODUCTION:We determined the contribution of undiagnosed HIV to new infections among gay and bisexual men (GBM) over a 12-year period in Australia where there has been increasing focus on improving testing and HIV treatment coverage. METHODS:We generated annual estimates for each step of the HIV cascade and the number of new HIV infections for GBM in Australia over 2004 to 2015 using relevant national data. Using Bayesian melding we then fitted a quantitative model to the cascade and incidence estimates to infer relative transmission coefficients associated with being undiagnosed, diagnosed and not on ART, on ART with unsuppressed virus, or on ART with suppressed virus. RESULTS:Between 2004 and 2015, we estimated the percentage of GBM with HIV in Australia who were unaware of their status to have decreased from 14.5% to 7.5%. During the same period, there was a substantial increase in the number and proportion of GBM living with HIV on treatment and with suppressed virus, with the number of virally suppressed GBM increasing from around 3900 (30.2% of all GBM living with HIV) in 2004 to around 14,000 (73.7% of all GBM living with HIV) in 2015. Despite the increase in viral suppression, the annual number of new infections rose from around 660 to around 760 over this period. Our results have a wide range due to the uncertainty in the cascade estimates and transmission coefficients. Nevertheless, undiagnosed GBM increasingly appear to contribute to new infections. The proportion of new infections attributable to undiagnosed GBM almost doubled from 33% in 2004 to 59% in 2015. Only a small proportion (<7%) originated from GBM with suppressed virus. DISCUSSION:Our study suggests that an increase in HIV treatment coverage in Australia has reduced the overall risk of HIV transmission from people living with HIV. However, the proportion of infections and the rate of transmission from undiagnosed GBM has increased substantially. These findings highlight the importance of HIV testing and intensified prevention for Australian GBM at high risk of HIV.

SUBMITTER: Gray RT

PROVIDER: S-EPMC5894250 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe purpose of this study was to evaluate the relationship between cognitive performance, risk factors for cardiovascular and cerebrovascular disease (CVD), and HIV infection in the era of highly active antiretroviral therapy.MethodsWe evaluated the cognitive functions of men enrolled in the cardiovascular disease substudy of the Multicenter AIDS Cohort Study who were aged > or =40 years, with no self-reported history of heart disease or cerebrovascular disease. Results from comprehensive neuropsychological evaluations were used to construct composite scores of psychomotor speed and memory performance. Subclinical CVD was assessed by measuring coronary artery calcium and carotid artery intima-media thickness (IMT), as well as laboratory measures, including total cholesterol, fasting glucose, glycosylated hemoglobin, glomerular filtration rate (estimated), and standardized blood pressure and heart rate measures.ResultsAfter accounting for education, depression, and race, carotid IMT and glomerular filtration rate were significantly associated with psychomotor speed, whereas IMT was associated with memory test performance. HIV serostatus was not significantly associated with poorer cognitive test performance. However, among the HIV-infected individuals, the presence of detectable HIV RNA in plasma was linked to lower memory performance.ConclusionsThese findings suggest that HIV infection may not be the most important predictor of cognitive performance among older gay and bisexual men in the post-highly active antiretroviral therapy era, at least among those with access to medical care and to appropriate medications. Medical factors associated with normal aging are significantly associated with performance on neuropsychological tests, and good clinical management of these factors both in HIV-infected individuals and those at risk for infection may have beneficial effects in the short term and could reduce the risk of subsequent cognitive decline.

Project description:IntroductionGlobally, young gay, bisexual and other men who have sex with men (gbMSM) continue to experience disproportionately high rates of HIV and other sexually transmitted and blood-borne infections (STBBIs). As such, there are strong public health imperatives to evaluate innovative prevention, treatment and care interventions, including online interventions. This study reviewed and assessed the status of published research (e.g. effectiveness; acceptability; differential effects across subgroups) involving online interventions that address HIV/STBBIs among young gbMSM.MethodsWe searched Medline, Embase, PsycINFO, CINAHL, and Google Scholar to identify relevant English-language publications from inception to November 2016. Studies that assessed an online intervention regarding the prevention, care, or treatment of HIV/STBBIs were included. Studies with <50% gbMSM or with a mean age ?30 years were excluded.ResultsOf the 3465 articles screened, 17 studies met inclusion criteria. Sixteen studies assessed interventions at the "proof-of-concept" phase, while one study assessed an intervention in the dissemination phase. All of the studies focused on behavioural or knowledge outcomes at the individual level (e.g. condom use, testing behaviour), and all but one reported a statistically significant effect on ?1 primary outcomes. Twelve studies described theory-based interventions. Twelve were conducted in the United States, with study samples focusing mainly on White, African-American and/or Latino populations; the remaining were conducted in Hong Kong, Peru, China, and Thailand. Thirteen studies included gay and bisexual men; four studies did not assess sexual identity. Two studies reported including both HIV+ and HIV- participants, and all but one study included one or more measure of socio-economic status. Few studies reported on the differential intervention effects by socio-economic status, sexual identity, race or serostatus.ConclusionWhile online interventions show promise at addressing HIV/STBBI among young gbMSM, to date, little emphasis has been placed on assessing: (i) potential differential effects of interventions across subgroups of young gbMSM; (ii) effectiveness studies of interventions in the dissemination phase; and (iii) on some "key" populations of young gbMSM (e.g. those who are: transgender, from low-income settings and/or HIV positive). Future research that unpacks the potentially distinctive experiences of particular subgroups with "real world" interventions is needed.

Project description:Increasing overall rates, and frequency, of HIV testing in populations at risk is a key public health objective and a critical dimension of HIV prevention efforts. In the UK, men who have sex with men (MSM) remain one of the communities most at risk of HIV and, within this, young gay men are a key risk group. Understanding HIV testing practices is important in the development of interventions to promote testing among young gay and bisexual men.Qualitative interviews were conducted with thirty young gay and bisexual men (aged 18-29) in Scotland. Thematic analysis of men's accounts of their approach to HIV testing identified three overarching patterns of testing: 'habitual', 'reactive' and ' ad hoc'.This qualitative study, the first to explore patterns of HIV testing practices among young gay and bisexual men in the UK, contributes novel findings around the role of social support and 'community' in shaping young men's approaches to HIV testing. The findings suggest that social support can play an important role in encouraging and facilitating HIV testing among young gay men, however, social norms of non-testing also have the potential to act as a barrier to development of a regular routine. Men with habitual testing practices framed HIV testing as both a personal and 'community' responsibility, and more effective than testing in response to risk events or emergent symptoms. Men who reported reactive testing practices described testing for HIV primarily in response to perceived exposure to sexual risk, along with 'transitional moments' such as starting, ending or changes to a relationship. Among young men who reported testing on an ad hoc basis, inconvenience and disruptions to HIV testing practices, particularly where men lacked social support, acted as a barrier to developing a routine of regular testing.Our findings suggest that interventions which seek to increase rates of HIV testing and testing frequency among young gay and bisexual men should include a specific focus on promoting and supporting positive testing practices within young men's friendship groups and wider gay communities.

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Undiagnosed HIV infections among gay and bisexual men increasingly contribute to new infections in Australia.

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