Objectives Our objective was to present recent trends in the UK HIV epidemic (2007–2016) and the public health response. Methods HIV diagnoses and clinical markers were extracted from the HIV and AIDS Reporting System; HIV testing data in sexual health services ( SHS ) were taken from GUMCAD STI Surveillance System. HIV data were modelled to estimate the incidence in men who have sex with men ( MSM ) and post‐migration HIV acquisition in heterosexuals. Office for National Statistics ( ONS ) data enabled mortality rates to be calculated. Results New HIV diagnoses have declined in heterosexuals as a result of decreasing numbers of migrants from high HIV prevalence countries entering the UK . Among MSM , the number of HIV diagnoses fell from 3570 in 2015 to 2810 in 2016 (and from 1554 to 1096 in London). Preceding the decline in HIV diagnoses, modelled estimates indicate that transmission began to fall in 2012, from 2800 [credible interval (CrI) 2300–3200] to 1700 (CrI 900–2700) in 2016. The crude mortality rate among people promptly diagnosed with HIV infection was comparable to that in the general population (1.22 vs . 1.39 per 1000 aged 15–59 years, respectively). The number of MSM tested for HIV at SHS increased annually; 28% of MSM who were tested in 2016 had been tested in the preceding year. In 2016, 76% of people started antiretroviral therapy within 90 days of diagnosis (33% in 2007). Conclusions The dual successes of the HIV transmission decline in MSM and reduced mortality are attributable to frequent HIV testing and prompt treatment (combination prevention). Progress towards the elimination of HIV transmission, AIDS and HIV ‐related deaths could be achieved if combination prevention, including pre‐exposure prophylaxis, is replicated for all populations.
Novel STI prevention interventions, including doxycycline post-exposure prophylaxis (doxyPEP) and meningococcal B vaccination (4CMenB) against gonorrhoea, have been increasingly examined as tools to aid STI control. There is evidence of the efficacy of doxyPEP in preventing bacterial STIs; however, limited data exist on the extent of use in the UK. We examined self-reported knowledge and use of antibiotic post-exposure prophylaxis (PEP), and intention to use (ITU) doxyPEP and 4CMenB among a large, community sample of men and gender-diverse individuals who have sex with men in the UK. Using data collected by the RiiSH survey (November/December 2023), part of a series of online surveys of men and other gender-diverse individuals in the UK, we describe (%, [95% CI]) self-reported knowledge and use of antibiotic PEP (including doxyPEP) and doxyPEP and 4CMenB ITU. Using bivariate and multivariable logistic regression, we examined correlates of ever using antibiotic PEP, doxyPEP ITU, and 4CMenB ITU, respectively, adjusting for sociodemographic characteristics and a composite marker of sexual risk defined as reporting (in the last three months): ≥5 condomless anal sex partners, bacterial STI diagnosis, chemsex, and/or meeting partners at sex-on-premises venues, sex parties, or cruising locations. Of 1,106 participants (median age: 44 years [IQR: 34–54]), 34% (30%-37%) knew of antibiotic PEP; 8% (6%-10%) ever reported antibiotic PEP use. Among those who did, most reported use in the last year (84%, 73/87) and exclusively used doxycycline (69%, 60/87). Over half of participants reported doxyPEP ITU (51% [95% CI: 47%-56%], 568/1,106) while over two-thirds (64% [95% CI: 60%-69%], 713/1,106) reported 4CMenB ITU. Participants with markers of sexual risk and with uptake of other preventative interventions were more likely to report ever using antibiotic PEP as well as doxyPEP and 4CMenB ITU, respectively. HIV-PrEP users and people living with HIV (PLWHIV) were more likely to report antibiotic PEP use and doxyPEP and 4CMenB vaccination ITU than HIV-negative participants not reporting recent HIV-PrEP use. Findings demonstrate considerable interest in the use of novel STI prevention interventions, more so for 4CMenB vaccination relative to doxyPEP. Fewer than one in ten participants had reported ever using antibiotic PEP, with most using appropriate, evidence-based antibiotics. The use of antibiotic PEP and the report of doxyPEP ITU and 4CMenB ITU was more common among those at greater risk of STIs.
Background Gay, bisexual, and other men who have sex with men (GBMSM) face a disproportionate burden of sexually transmitted infections and are eligible for targeted vaccinations for hepatitis A (HAV), hepatitis B (HBV), human papilloma virus (HPV) and mpox. This study examines the sociodemographic characteristics, sexual behaviours, and sexual healthcare service (SHS) use associated with vaccination uptake. Methods We undertook analyses of RiiSH-Mpox - an online, community-based survey with GBMSM recruited via social media and dating apps. We calculated vaccination uptake (≥1 dose) among eligible GBMSM. Bivariate and multivariable logistic regression was performed to identify factors independently associated with vaccination uptake among eligible participants. Results Reported uptake in eligible GBMSM was around two-thirds for each of the vaccinations considered: mpox 69% (95% confidence interval (CI): 66%-72%), HAV 68% (CI:65%-70%), HBV 72% (CI:69%-74%) and HPV 65% (CI:61%-68%). Vaccination course completion (receiving all recommended doses) ranged from 75% (HBV) to 89% (HAV) among eligible GBMSM. Individuals who represented missed opportunities for vaccination ranged from 22 to 30% of eligible SHS attendees. Younger participants, individuals identifying as bisexual, reporting lower educational qualifications, or being unemployed reported lower uptake across multiple GBMSM-selective vaccinations. Individuals who reported greater levels of sexual behaviour and recent SHS use were more likely to report vaccinations. Conclusion Eligible participants reported high uptake of vaccinations; however, uptake was lower amongst young GBMSM and self-identifying bisexual men. Awareness of groups with lower vaccination uptake will help inform practice, delivery strategies and health promotion, to improve the reach and impact of vaccinations amongst GBMSM.
Background: After a decade of a treatment as prevention (TasP) strategy based on progressive HIV testing scale-up and earlier treatment, a reduction in the estimated number of new infections in men-who-have-sex-with-men (MSM) in England had yet to be identified by 2010. To achieve internationally agreed targets for HIV control and elimination, test-and-treat prevention efforts have been dramatically intensified over the period 2010-2015, and, from 2016, further strengthened by pre-exposure prophylaxis (PrEP). Methods: Application of a novel age-stratified back-calculation approach to data on new HIV diagnoses and CD4 count-at-diagnosis, enabled age-specific estimation of HIV incidence, undiagnosed infections and mean time-to-diagnosis across both the 2010-2015 and 2016-2018 periods. Estimated incidence trends were then extrapolated, to quantify the likelihood of achieving HIV elimination by 2030. Findings: A fall in HIV incidence in MSM is estimated to have started in 2012/3, eighteen months before the observed fall in new diagnoses. A steep decrease from 2,770 annual infections (95% credible interval 2.490-3,040) in 2013 to 1,740 (1,500-2,010) in 2015 is estimated, followed by steady decline from 2016, reaching 854 (441-1,540) infections in 2018. A decline is consistently estimated in all age groups, with a fall particularly marked in the 24-35 age group, and slowest in the 45+ group. Comparable declines are estimated in the number of undiagnosed infections. Interpretation: The peak and subsequent sharp decline in HIV incidence occurred prior to the phase-in of PrEP. Definining elimination as a public health threat to be < 50 new infections (1.1 infections per 10,000 at risk), 40% of incidence projections hit this threshold by 2030. In practice, targeted policies will be required, particularly among the 45+y where STIs are increasing most rapidly.
In response to the 2022 Mpox outbreak, targeted vaccination was offered to GBMSM at increased risk. We determined the uptake of Mpox vaccination among a community sample of GBMSM in the UK.
Methods
An online cross-sectional survey was deployed in December 2022 to examine Mpox diagnoses and vaccination uptake among a community sample of GBMSM in the UK. We describe Mpox diagnosis history (%, 95% CI) based on self-report of a positive Mpox test and self-reported behavioural risk modification to avoid Mpox infection from May 2022 through survey completion. Bivariate and multivariable logistic regression was used to assess sociodemographic, clinical, and behavioural characteristics associated with Mpox vaccination.
Results
Of 1,333 participants (median age 45 years [IQR: 35–55]; 92% White ethnicity), 2.6% (1.8%-3.6%; 35/1,333) had an Mpox diagnosis history. Half (53%; 707/1,333) reported behavioural risk modification measure(s), the most common being a reduction in number of sex partners (38%; 510/1,333). Vaccination uptake (>1 dose) was 52% (49%-55%; 692/1,333) among all participants, and 69% (65%-72%; 601/875) in those eligible. Among all participants, bisexual men (aOR: 0.43 [0.29–0.62] vs gay men), those with qualifications below degree-level (0.49 [0.39–0.62] vs degree-level), and those unemployed (0.59 [0.43–0.80]) were less likely to report Mpox vaccination, while those reporting either multiple sex partners (≥10 recent male sex partners [7.56 (4.95–11.6) vs 1 partner], PrEP use in the last year [7.11 (5.50–9.18)], or recent STI test positivity [4.06 (2.67–6.19)]) were more likely to report Mpox vaccination.
Discussion
While high Mpox vaccine uptake in those eligible and adoption of risk modification measures likely led to the reduction of Mpox incidence in July 2022, the contribution of each is unclear. To reduce the likelihood of any future Mpox outbreaks, provision of first Mpox vaccination doses and completion of the course of vaccination in those who have received their first dose must be prioritised.
Routine commissioning of PrEP delivery by specialist sexual health services (SHSs) in England was implemented during 2020/21. The UK Health Security Agency (UKHSA) developed a monitoring and evaluation framework to support PrEP delivery. To assess data completeness and quality, we analysed provisional data reported by SHSs.
Methods
We included all consultations in the GUMCAD STI Surveillance System between January to June 2021 where at least one PrEP code relating to eligibility or use (uptake, regimen, prescription) was reported. Data quality was assessed as the proportion of consultations with an incomplete or incompatible combination of PrEP codes based on current coding guidance.
Results
Overall, 27,227 consultations with any PrEP code were reported: 16% (n=4,431) contained an eligibility code only and 78% (n=21,311) contained an uptake, regimen or prescription code indicating current PrEP use. Among all consultations with any PrEP code, 20% (n=5,414) had an incompatible or incomplete combination of codes (Table 1). In the same period, 18,927 unique individuals with any PrEP code were reported. 82% (n=15,469) of individuals were reported as using PrEP, a 36% decrease compared to the total number of Impact Trial participants (n=24,268). Discussion/Conclusions Our findings suggest underreporting and inconsistent use of PrEP codes. Improving PrEP data quality in GUMCAD is essential to monitor and evaluate PrEP delivery and its contribution to combination HIV prevention in England. Guidance and support is available through the GUMCAD webpage and provisional PrEP data can be reviewed on the HIV/STI data exchange. UKHSA is actively working with services to support PrEP coding and reporting.
The STEIM pilot study aims to assess the feasibility and acceptability of longitudinal sample and data collection among MSM attending sexual health clinics (SHCs) to better understand the epidemiology of enteric infections. Participants completed a baseline questionnaire and provided an initial stool sample and rectal swab, followed by weekly questionnaires and rectal swabs for twelve weeks. We present findings from qualitative interviews with participants, investigating task completion and barriers and facilitators to future participation and retention.
Methods
Between October 2022-March 2023, we interviewed 21 of 193 MSM enrolled through SHCs in Brighton and West Sussex. Remote audio/video interviews between 53–90 minutes were conducted using MS Teams and a semi-structured topic guide. An analytic ‘framework’ approach derived initial deductive and inductive thematic codes from interview topics and 3 transcripts. Agreed codes were applied to all transcripts and data was charted, summarised and interpreted.
Results
Personal invitations from clinic staff were well received. Most participants perceived a chance to ‘help’ and were committed to a valid and useful research contribution. Baseline and weekly questionnaires were often omitted or delayed compared to one-off stool sample and weekly rectal swab collection. Barriers to completion included misunderstanding or forgetting information on study procedures and tasks, and competing interests. Developing a routine for undertaking tasks and text reminders encouraged compliance though reminders were interpreted in different ways (e.g tailored vs generic). Study procedures, tasks and timings were generally easy and acceptable, a minority would welcome a longer study or weekly stool collection.
Discussion
Findings suggest the study is of interest and tasks and schedule were acceptable and feasible. Relationships with clinic staff were important in encouraging and supporting participation. Modifications to text reminder content and study information materials may highlight, clarify, remind and prompt task completion. More frequent stool sample collection is likely to reduce acceptability and compliance.
COVID-19 restrictions severely reduced face-to-face sexual health services, an important access point for condoms. We examine whether gay, bisexual and other men who have sex with men (GBMSM) in the UK had difficulty accessing condoms during the first year of the pandemic, and if so, which groups were most affected.Questions about difficulty accessing condoms were asked as part of a short, online cross-sectional survey of GBMSM undertaken November/December 2021, recruited via social media and Grindr. Eligible participants were UK-resident GBMSM (cis/trans/gender-diverse person assigned male at birth [AMAB]), aged ≥16 years who were sexually active (reported sex with men in the last year). Multivariable logistic regression was used to examine if and how reporting this outcome varied by key sociodemographic, health and behavioural factors independent of the potential confounding effect of numbers of new male sex partners.Of all participants (N = 1039), 7.4% (n = 77) reported difficulty accessing condoms due to the pandemic. This was higher among younger GBMSM (aged 16-29 years vs. ≥45; 12.8% vs. 4.9%; aOR: 2.78); trans/gender-diverse AMAB participants (vs. cis gender males; 24.4% vs. 6.6%; aOR = 4.86); bisexually-identifying participants (vs. gay-identifying; 11.1% vs. 6.5%; aOR = 1.78); and those without degree level education (vs. having a degree; 9.8% vs. 5.6%; aOR = 2.01).A minority of sexually active GBMSM reported difficulty accessing condoms because of the pandemic, however, this was more common amongst those who already experience a disproportionate burden of poor sexual health. Interventions are needed to address these inequalities in accessing this important primary STI/HIV prevention measure.
During the 2022 multicountry mpox outbreak, the United Kingdom identified cases beginning in May. UK cases increased in June, peaked in July, then rapidly declined after September 2022. Public health responses included community-supported messaging and targeted mpox vaccination among eligible gay, bisexual, and other men who have sex with men (GBMSM). Using data from an online survey of GBMSM during November-December 2022, we examined self-reported mpox diagnoses, behavioral risk modification, and mpox vaccination offer and uptake. Among 1,333 participants, only 35 (2.6%) ever tested mpox-positive, but 707 (53%) reported behavior modification to avoid mpox. Among vaccine-eligible GBMSM, uptake was 69% (95% CI 65%-72%; 601/875) and was 92% (95% CI 89%-94%; 601/655) among those offered vaccine. GBMSM self-identifying as bisexual, reporting lower educational qualifications, or identifying as unemployed were less likely to be vaccinated. Equitable offer and provision of mpox vaccine are needed to minimize the risk for future outbreaks and mpox-related health inequalities.
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