Reemergence of the HIV Epidemic Among Men Who Have Sex With Men in North America, Western Europe, and Australia, 1996–2005

Received 12 October 2008; accepted 3 March 2009.

Purpose

To describe and contextualize changes in rates of human immunodeficiency virus (HIV) notifications in men who have sex with men (MSM) in eight countries (Australia, Canada, France, Germany, Netherlands, Spain, United Kingdom, and United States) from 1996–2005.

Methods

We analyzed trends in HIV notification rates from 1996–2000 and 2000–2005 by generalized linear regression and estimated annual percentage change (EAPC) in rates of HIV notifications. To interpret trends, we visually examined graphs of primary and secondary syphilis reports among MSM and the prevalence of recent HIV testing.

Results

The rate of HIV notifications among MSM declined 5.2% per year (95% confidence interval [CI]: −5.8%, −4.7%) from 1996–2000, and increased 3.3% per year (95% CI: +2.9%,+3.7%) from 2000–2005. During the period of increasing HIV diagnoses, increases in primary and secondary syphilis diagnoses occurred among MSM, but recent HIV testing among MSM did not seem to increase.

Conclusions

After declining in the second half of the 1990s, HIV notification rates for MSM increased beginning in 2000. Increased HIV notifications in MSM are not wholly explained by changes in HIV testing. Urgent efforts are required to develop effective HIV prevention interventions for MSM, and implement them broadly in these countries.

Key Words: HIV, Surveillance, Men Who Have Sex With Men, Syphilis, Trends

Selected Abbreviations and Acronyms: MSM, Men who have sex with men, EAPC, Estimated annual percentage change

a Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA

b Centers for Disease Control and Prevention, Atlanta, GA

c Robert Koch Institute, Berlin, Germany

d Health Protection Agency, London, United Kingdom

e Public Health Agency of Canada, Ottawa, Canada

f Institut de Veille Sanitaire, Paris, France

g University of New South Wales, Sydney, Australia

h Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissión Sexual i Sida de Catalunya

i Ciber Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

j National Institute for Public Health and the Environment, Bilthoven, Netherlands

k HIV Monitoring Foundation, Amsterdam, Netherlands

Address correspondence to: Patrick Sullivan, DVM, PhD, Rollins School of Public Health, Department of Epidemiology, 1518 Clifton Road NE, 4th Floor, Atlanta, GA 30322. Tel.: 404-727-2038.

The Annecy MSM Epidemiology Study Group is comprised of Debra Hanson, Rongping Zhang, Hillard Weinstock, Timothy D. Mastro, and Richard Wolitski, Centers for Disease Control and Prevention, Atlanta, GA; Rafa Muñoz, and Nuria Vives, Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissión Sexual i Sida de Catalunya, Barcelona, Spain; Rossie Lugo, Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissión Sexual i Sida de Catalunya and Ciber Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Annie M. Velter, Institut de Veille Sanitaire, Paris, France; Azhar Nizam, Emory University, Atlanta, GA.

Required disclaimer: The findings and conclusions in this study are those of the authors and do not necessarily represent the views of the authors' organizations.

PII: S1047-2797(09)00075-1

doi:10.1016/j.annepidem.2009.03.004

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