A survey has found that more than

a third of gay HIV-positive men have had unprotected sex in the past year. The cross-sectional survey of men attending gay venues in three large cities (London, Brighton and Manchester) used a self-completed questionnaire to collect data on demographics, sexual health service use, HIV testing and status, diagnosed sexually transmitted infections (STIs) and sexual behaviour. The subjects were also asked to provide an anonymous saliva sample for HIV antibody testing.

Nearly 4,000 questionnaires were distributed and 2,640 were returned.

The prevalence of HIV infection ranged from 8.6 to 13.7%, with more than a third of infections undiagnosed. The prevalence of undiagnosed HIV infection was consistent with anonymous, unlinked seroprevalence surveillance reported by the Health Protection Agency.

Risk behaviours reported in all three cities were similar and rates were high. Eighteen per cent of HIV-negative men and 37% of HIV-positive men reported unprotected anal intercourse with more than one partner in the past year.

Although new cases (incidence)

of HIV are proportionally greater in the heterosexual population, the total number (prevalence) of cases of HIV

is still highest in men who have sex with men. The apparent complacency may be explained by improved effectiveness of antiretroviral therapy and the expectation that people will live longer and healthier lives.

However, effective use of condoms and reduction in the numbers of sexual partners remain the key aspects of health promotion strategies to reduce new cases of HIV infection. The recent NICE guidance on one-to-one interventions to reduce STIs and HIV infection recommends that health professionals identify risk groups and either refer for, or offer, brief interventions to address risky sexual behaviour; these have been shown

to be effective in changing behaviour to reduce the risk of HIV.

The key challenge is for men who have sex with men to feel comfortable about discussing their sexual behaviour with primary care professionals. This goes a lot further than appropriate training for primary care professionals in having behaviour change discussions. Primary care has to work hard to challenge the perception that it is 'not gay-friendly' and concerns about confidentiality by the public, which are well documented by HIV and sexual health charities.