The Lancet, Volume 382, Issue 9898, Pages 1095 - 1096, 28 September 2013
doi:10.1016/S0140-6736(13)62020-6
Copyright © 2013 Elsevier Ltd All rights reserved.
Sean R Hosein a, David P Wilson b
The report by Tony Kirby and Michelle Thornber-Dunwell (July 27, p 295)1 uncovers an emerging and troubling public health and community issue. The intersection of unprotected sex and use of street and party drugs is likely to amplify the transmission of HIV, hepatitis C virus (HCV), and sexually transmitted infections (STI) in men who have sex with men (MSM).
Indeed the latest report from Public Health England indicates that a large increase in HIV incidence is occurring in MSM in London and that there is the potential for growing and harmful interacting epidemics of HIV, HCV, and drug use. The trends documented in London are likely a harbinger of what is happening in communities of MSM in other urban centres in high-income countries.
We have found that in New South Wales, Australia, HIV notifications have increased by 24% in 2012 compared with 2011—predominantly in MSM. Furthermore, 13·1% of people with HIV are co-infected with HCV and 38% of MSM report using recreational drugs in the past 6 months.2, 3
These findings demand that there be renewed, enhanced, and integrated HIV, HCV, and STI surveillance, prevention, and treatment services. Given the complexity of risk factors associated with transmission of HIV and HCV, the copromotion of STI testing and treatment services as well as ways to mitigate the secondary harms of substance use, all need to be coordinated so that overlapping viral disease epidemics can be targeted and contained.
Early diagnosis and treatment is increasingly becoming, or will likely become, the dominant approach to control STIs, HIV, and viral hepatitis. With use of a similar approach for these related infections, it might become more feasible to implement coordinated control strategies that are effective. However, one of the large dangers for which we provide warning is risk disinhibition and primary prevention fatigue, which we are seeing as starting to counteract the benefits of improved access to diagnostic testing and effective treatment.4 In the longer term, research with vulnerable MSM is needed to better understand the range of relevant factors including how these men perceive risk and balance that against pleasure and the causes of the increased incidence of unprotected sex and substance use.5 The results of such research can be used to strengthen the health and wellbeing of communities of MSM around the world.
We declare that we have no conflicts of interest.
References
1 Kirby T, Thornber-Dunwell M. New HIV diagnoses in London's gay men continue to soar. Lancet 2013; 382: 295. Full Text | PDF(145KB) | CrossRef | PubMed
2 Amin J, Kaye M, Skidmore S, et al. HIV and hepatitis C coinfection within the CAESAR study. HIV Med 2004; 5: 174-179. CrossRef | PubMed
3 Hull P, Mao L, Kao S-C, et al. Gay community periodic survey: Sydney. https://csrh.arts.unsw.edu.au/media/NCHSRFile/GCPS_Sydney_2013_Report.pdf. (accessed Sept 10, 2013).
4 Phillips AN, Cambiano V, Nakagawa F, et al. Increased HIV incidence in men who have sex with men despite high levels of ART-induced viral suppression: analysis of an extensively documented epidemic. PLoS One 2013; 8: e55312. CrossRef | PubMed
5 Prestage G, Down IA, Bradley J, et al. Is optimism enough? Gay men's beliefs about HIV and their perspectives on risk and pleasure. Sex Transm Dis 2012; 39: 167-172. CrossRef | PubMed
a Department of Research and Publications, CATIE, Toronto, ON M5V 3B1, Canada
b Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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