Abstract
An increase in the number of new HIV diagnoses among men who have sex with men (MSM) has been observed in several countries in the early 2000s. In this article, we explore the trends in MSM in France between 2003 and 2008. To estimate the number of MSM newly diagnosed with HIV, we take into account the reporting delay, underreporting and missing data for HIV case notification. To identify recent infections (RI) (acquired an average of six months before diagnosis), we used an enzyme immunoassay for recent HIV-1 infections (EIA-RI) which has been performed routinely for new HIV diagnoses since 2003. Multivariate analysis was used to identify factors associated with RI. We estimate that between 1,900 and 2,400 MSM have been newly diagnosed with HIV every year: the proportion of MSM among all newly diagnosed with HIV cases has increased from 25.2% (95% confidence interval (CI): 23.3-27.1) in 2003 to 37.0% (95% CI: 35.2-38.7) in 2008 and was stable during the period 2006-2008. In 2008, the rate of newly diagnosed HIV cases per 10,000 MSM living in France was 72.5. The proportion of non-B subtypes of HIV-1 among cases diagnosed in MSM was 11.7% (2003-2008). The assessment of RI was performed for 4,819 MSM newly diagnosed with HIV in 2003-2008. Of these, 47.6% (95%CI = 46.2-49.0) (2,295 cases) were shown to have been recently infected. The risk of RI was greater for those of French nationality (adjusted odds ratio (aOR) =1.6 [95% CI: 1.4-1.9]), those with high economic status (aOR =1.4 [95% CI: 1.2-1.8]), those tested after a risk exposure (aOR =1.6[95% CI: 1.3-1.8]) or after presenting with clinical symptoms or abnormal biological markers (aOR =1.8 [95% CI: 1.5-2.0]), those who had tested for HIV three or more times during their life-time (aOR =4.2 [95% CI: 3.4-5.2]) and those living in the Paris area (aOR =1.2 [95% CI: 1.0-1.3]). The risk of RI decreased with age. The HIV situation among MSM living in France is a cause of concern, despite the prevention campaigns dedicated to this highly educated sub-population.
Highlights
Men who have sex with men (MSM) were one of the largest groups of reported AIDS cases until 1999 in France
When the multiple imputation method is applied and underreporting is taken into account, men who have sex with men (MSM) account for 32.0% and male heterosexuals for 28.3% of all new HIV diagnoses reported between 2003 and 2008
Sex between men represented the only risk category for which an increase was observed during the study period: the proportion of MSM among all newly diagnosed HIV cases has increased from 25.2% in 2003 to 37.0% in 2008, and the estimated number of MSM newly diagnosed with HIV increased from 1,858 in 2003 to 2,409 in 2006 and remained stable in 2007 and 2008 (Figure)
Summary
Men who have sex with men (MSM) were one of the largest groups of reported AIDS cases until 1999 in France. In the early 1990s, MSM in most countries adopted strategies for reducing the risk of HIV transmission. Since 1996, an increase in sexual risk practices has been observed in North America, Australia and most Western European countries [1,2,3,4]. The increase of sexual risk practices among MSM may have an impact on the incidence of sexually transmitted infections (STI), including HIV. We analyse trends and characteristics of MSM newly diagnosed with HIV from 2003 to the end of 2008 in France and describe factors associated with recent infection (RI) defined as HIV transmission in the last six months preceding diagnosis [6]
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