Modelling the impact of HIV disease on mortality in gay and bisexual men

British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, Canada.

OBJECTIVE: To assess how HIV infection and AIDS (HIV/AIDS) impacts on mortality rates for gay and bisexual men.

METHODS: Vital statistics data were obtained for a large Canadian urban centre from 1987 to 1992. Three scenarios were utilized with assumed proportions of gay and bisexual men of 3%, 6% and 9% among the male population age 20 years. For each scenario, non-HIV deaths were distributed according to the assumed proportion of the total population (3%, 6% or 9%) but 95% of HIV deaths were distributed to gay and bisexual men as this is the proportion of AIDS cases in gay and bisexual men in this centre. The main outcome measures of interest were age-specific patterns of death, life expectancy and life expectancy lost due to HIV/AIDS at exact age 20 years, and the probability of living from age 20 to 65 years.

RESULTS: Estimates of the mid-period gay and bisexual population ranged from 5406 to 16,219 for the three scenarios, and total deaths in these men from 953 to 1703. Age-specific mortality was significantly higher for gay and bisexual men than all men aged 30-44. Life expectancy at age 20 for gay and bisexual men ranged from 34.0 years to 46.3 years for the 3% and 9% scenarios respectively. These were all lower than the 54.3 year life expectancy at age 20 for all men. The probability of living from age 20 to 65 years for gay and bisexual men ranged from 32% for the 3% scenario, to 59% for the 9% scenario. These figures were the probability of living from 20 to 65 was 78%.

CONCLUSION: In a major Canadian centre, life expectancy at age 20 years for gay and bisexual men is 8 to 20 years less than for all men. If the same pattern of mortality were to continue, we estimate that nearly half of gay and bisexual men currently aged 20 years will not reach their 65th birthday. Under even the most liberal assumptions, gay and bisexual men in this urban centre are now experiencing a life expectancy similar to that experienced by all men in Canada in the year 1871.

Number of Russians with HIV jumps nearly 10-fold: official

Agence France Presse - November 24, 2003

MOSCOW, Nov 24 (AFP) - The number of HIV-positive Russians has increased nearly ten-fold during the past three years, a top health official said Monday.

"Only 20 per 100,000 Russians were HIV-positive in early 2000 and the rate has increased by nearly 10 times to 180 per 100,000 by November 2003," the Interfax news agency quoted Vadim Pokrovsky, head of the federal center to fight HIV/AIDS, as saying Monday.

In May Pokrovsky said that up to 1.5 million Russians may have the HIV virus, which causes AIDS, although the officially registered figure stands at some 238,000.

He said that some experts in his department estimate that deaths from AIDS may become as numerous as those from car accidents in Russia within a few years.

Most of those infected with the virus are men between 15 and 30 years of age, he said.

Pokrovsky had earlier reported that than 15 percent of Russia's HIV sufferers are in jail.

Experts have long said that Russia has one of the world's fastest growing HIV contamination rates, together with China and India.

Russia

http://www.aegis.org/channel/s/AF031127.html

Britain

http://news.independent.co.uk/uk/health/story.jsp?story=467023

HIV cases in Britain reach 49,500 after record rise
By Jeremy Laurance, Health Editor

25 November 2003

The global epidemic of HIV, the virus that causes Aids, is tightening its grip on Britain with a record number of new cases diagnosed last year.

Soaring rates of all sexually transmitted infections are fuelling the rise, with an estimated 49,500 people living with HIV in 2002, an increase of 20 per cent on the previous year.

Over 15,000 of these - one third - do not know they are infected, increasing the potential for further spread, according to the Health Protection Agency (HPA) which released the figures ahead of World Aids Day on 1 December.

The epidemic in the UK has also speeded up because of complacency among young people about the risks of unprotected sex and the mistaken belief that the disease has been beaten by modern treatments.

There were 5,711 new diagnoses of HIV to the end of September last year, the highest since records began in 1987. The rest of the increase, from a total of 41,700 diagnosed cases in 2001, was due to sufferers' blood being tested without their knowledge.

The number of new cases was 15 per cent up on the 4,982 diagnosed in 2001 and is expected to rise to 6,400 when all the reports are received. The rate of infection has more than doubled since 1997.

Two-thirds of the cases were acquired outside the UK, triggering renewed calls yesterday for immigrants to be screened. The cases' overseas origin - most from sub-Saharan Africa - has changed the nature of the epidemic, with heterosexual cases now outnumbering homosexual/bisexual infections two to one.

Here's one for you. Unfortunately the link is broken. It's from the University of California San Francisco.

"May 2, 2001

UCSF Study Finds Gay/Bisexual Men Who Were Sexually Abused
(RAPED) as Children Are More Likely to Engage in Unsafe Sex

Men who have sex with men (MSM) who are victims of childhood sexual abuse are more likely to engage in risky sexual behavior than other MSMs, say researchers from UCSF’s Center for AIDS Prevention (CAPS).

The study, published in the April issue of Child Abuse & Neglect, found that about one fifth (20.6%) of all MSMs experienced childhood sexual abuse--a rate that is higher than general prevalence estimates for the general male population. These men's early sexual victimization experiences typically involved physical force, penetrative sex, and were highly distressing. Researchers found that greater severity of childhood abuse (more incidents) was associated with higher rates of risky sexual behavior. Findings were similar using two different definitions of risky sexual behavior (unprotected anal intercourse with a non-primary partner; unprotected anal intercourse with a male whose HIV status was different from their own). As further evidence of their greater sexual risk-taking, those reporting childhood sexual abuse were more likely to be HIV-positive (24% vs. 14%).

To better understand the linkages between childhood sexual abuse and current sexual risk, the researchers examined other behaviors that are both associated with sexual risk taking, and with childhood sexual abuse. Researchers found that the men who had been victimized had higher rates of sex under the influence of alcohol/drugs, "one-night stands," and intimate partner violence. The current risk behavior of sexually abused men could be related to these variables, which were also linked to other measures of disturbed family functioning (e.g., childhood physical abuse, parental substance abuse).

"These findings clearly indicate that there is a need to consider childhood sexual abuse in developing and delivering HIV prevention interventions. Messages that emphasize the avoidance of 'sex under the influence' may not be effective for those men whose use of substances may be a form of coping with the disturbing aftermath of early sexual traumatization. Work can be done to identify prevention strategies that consider the after-effects of childhood sexual abuse," said lead author, Jay Paul, PhD, a specialist in the division of medicine at UCSF’s Center for AIDS Prevention Studies.

"In addition, given the extent to which this is a problem among MSM, community services should be reviewed to ensure that appropriate referrals are offered at points where these men may contact mental health, substance abuse, social services and medical services. The multiple health-related negative consequences of childhood sexual abuse emphasize the need to give this issue appropriate attention," said Paul.

The study analyzed data collected in the Urban Men’s Health Study, a telephone sample of MSMs in San Francisco, New York, Chicago, and Los Angeles. These four cities were selected due to their importance as regional centers, being the source of two thirds of U.S. MSM AIDS cases, and the estimated size and concentration of their MSM population. This sample, conducted between November 1996 and February 1998, interviewed 2881 MSMs. The interviews covered numerous health issues; other findings (such as overall levels of risk behavior) have been reported elsewhere.

Study co-investigators are Joseph Catania, PhD, professor of medicine with UCSF CAPS, Lance Pollack, PhD, specialist at UCSF CAPS, and Ron Stall, PhD, MPH, Chief of the Behavioral Interventions Research Branch at the Division of HIV/AIDS Prevention at the Centers for Disease Control.

The research was supported by grants from the National Institute of Mental Health, the National Institute of Alcohol Abuse and Alcoholism, and the Centers for Disease Control and Prevention’s Division of HIV/AIDS Prevention. Further research to gain a clearer understanding of these issues has been funded by the National Institute of Mental Health."

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