Over fifty and living with HIV in London.

OBJECTIVE: To examine age at diagnosis, sexual behaviour and some social characteristics of people living with HIV in London who are over the age of 50 years, with particular reference to gay men. METHODS: Patients with HIV infection attending National Health Service outpatient clinics in north-east London between June 2004 and June 2005 were asked to complete a confidential, self-administered questionnaire. RESULTS: 1687 people with diagnosed HIV were recruited (63% response rate) including 758 gay men, 480 black African heterosexual women and 224 black African heterosexual men. Just over 10% of the whole sample (184/1687, 10.9%) were aged 50 years or above; gay men 13.1%, black African heterosexual men 8.5%, black African heterosexual women 6.9% (p<0.01). A third of the HIV-positive gay men over 50 years were diagnosed with HIV in their 50s or 60s (33.3%, 32/96). Overall, one in five HIV-positive gay men (20.1%, 144/715) reported high-risk sexual behaviour in the previous 3 months. This did not vary significantly by age (p = 0.2). CONCLUSION: In this study of people living with HIV in London, one in seven gay men were over the age of 50 years. A third of the HIV-positive gay men over 50 years were diagnosed in their 50s or 60s, highlighting that this group is not just an ageing cohort of people who were diagnosed in their 30s or 40s. Positive prevention programmes should target HIV-positive gay men of all ages because older gay men with HIV were just as likely to report high-risk sexual behaviour as younger men.

Social and economic hardship among people living with HIV in London.

OBJECTIVES: To examine the social and economic circumstances of people living with HIV in London. METHODS: Between June 2004 and June 2005, 1687 people living with HIV (73% response) receiving treatment and care in north-east London National Health Service out-patient clinics completed a confidential, self-administered questionnaire. The questionnaire sought information on employment, income, education, residency status in the UK and housing. RESULTS: In total, 1604 respondents were included in the analysis: Black African heterosexual women (n=480) and men (224); White (646) and ethnic minority (i.e. non-White) homosexual men (112); White heterosexual men (64) and women (39); and Black Caribbean heterosexual women (26) and men (13). Black African heterosexual men and women consistently reported more difficulties than any other group in relation to employment, income, housing and residency status. Half the Black African heterosexual men (46.8%) and women (51.2%) reported insecure residency status in the UK, significantly more than any other group (P<0.001). Just under half the respondents (46.6%) were employed at the time of the survey; Black African heterosexual women (35.3%) and men (45.4%) were less likely to be employed than White (57.6%) or ethnic minority (53.7%) homosexual men (P<0.001). Forty per cent of Black African heterosexual men and women, 22.9% of ethnic minority homosexual men and 9.6% of White homosexual men did not have enough money to cover their basic needs (P<0.001). CONCLUSIONS: In this study of people living with HIV in London, a substantial number faced social and economic hardship, particularly Black African and other ethnic minority respondents. Our findings provide further evidence that in London HIV is associated with poverty, particularly among migrant and ethnic minority populations.

Uptake of antiretroviral treatment among people living with HIV in London: ethnicity, gender and sexual orientation.

OBJECTIVE: To examine, by ethnicity, gender and sexual orientation, uptake of antiretroviral treatment among people living with HIV in London. METHODS: Between June 2004 and June 2005, 1687 people living with HIV (73% response) receiving treatment and care in North East London National Health Service outpatient clinics completed a confidential, self administered, questionnaire. Respondents were asked whether they were currently taking HIV treatments (antiretroviral or combination therapy) RESULTS: Overall, 73.7% (1057/1435) of respondents said they were currently taking HIV treatments: white men who have sex with men (MSM) 70.7%; ethnic minority MSM 70.9%; black African heterosexual women 75.0%; black African heterosexual men 80.8% (p<0.05). In all groups, taking HIV treatments was strongly associated with having a low CD4 cell count at diagnosis (p<0.001); 30.1% of white and ethnic minority MSM had a CD4 cell count less than 200 cells/mm(3) at diagnosis compared with 53.1% of the black African heterosexual women and 66.3% of the black African heterosexual men (p<0.001). After adjusting for CD4 cell count at diagnosis, no significant differences in uptake of HIV treatments remained between the groups: MSM AOR 1.00 (reference group); black African heterosexual women AOR 1.15, 95% CI 0.71 to 1.88, p = 0.6; black African heterosexual men AOR 0.88, 95% CI 0.43 to 1.80, p = 0.7. CONCLUSION: Our analysis suggests that in London, once HIV infection is diagnosed, people from the two main risk groups-MSM (mostly white men) and black African heterosexual men and women-receive HIV treatment according to clinical need regardless of their ethnicity, gender or sexual orientation.