Historically, HIV hit the gay community in the UK first and hardest. For the first 17 years of the epidemic, the highest number of new diagnoses of HIV were among gay men and men who have sex with men (MSM).
That changed in 1999 when the number of heterosexually acquired diagnoses overtook those among MSM. However, this was mostly linked to heterosexuals acquiring HIV outside the UK and the majority of these infections were among black Africans who had acquired HIV in sub-Saharan Africa. In 2011 the situation reversed again with MSM having the highest number of new infections. The continuing high rate is now taking over from heterosexuals as the number of heterosexual diagnoses acquired abroad continues to fall.
MSM have been and still are the group at highest risk of being infected in the UK. There has been a steady rise in the number of new diagnoses in MSM since 2000, after a plateau in the 1990s. It reached an all time peak in 2012 with 3,250 new diagnoses, the highest ever reported. This is partially due to increases in HIV testing, with 13 per cent more MSM testing for HIV in 2012 compared with the previous year.
In 2012, 84 per cent of those MSM attending sexual health clinics received an HIV test compared to 76 per cent of heterosexual men. This has led to a significantly lower level of late diagnosis among MSM than other risk groups with 34 per cent diagnosed late compared to 65 per cent in heterosexual males. MSM were the most likely of any high risk group to have had been recently infected (in the previous four to six months) at diagnosis at 19 per cent.
Numbers of MSM living with HIV remain high and continue to grow significantly. At the end of 2012, there were an estimated 41,000 MSM living with HIV of whom 18 per cent were undiagnosed. That means over 7,000 MSM are undiagnosed, not on treatment and potentially infectious. The prevalence of HIV in MSM is around one in 20 with nearly one in 12 in London.
MSM account for:
- 41 per cent of people living with HIV in the UK.
- 51 per cent of all new HIV diagnoses in 2012.
- Four out of five MSM probably acquired their infection in the UK and make up two thirds of those acquiring the infection in the UK.
Among MSM, the greatest number of new diagnoses (1,102) were in men aged 35-49, representing a third of MSM who were newly diagnosed with HIV in 2012. However, there are also more older people living with HIV than ever before, partly to do with an ageing population living with HIV and partly to do with increasing new infections in older men. In 2012, one in nine MSM who was newly diagnosed was 50 or over.