CONTINUING TRANSMISSION OF SEXUALLY-TRANSMITTED DISEASES AMONG PATIENTS INFECTED WITH HIV-1 ATTENDING GENITOURINARY MEDICINE CLINICS IN ENGLAND AND WALES

Objective-To determine whether those who are aware of being infected w ith HIV continue to adopt behaviours that place others at risk of HIV infection. Design-Ongoing survey of current diagnosis of sexually tran smitted disease and awareness of HIV infection among patients attendin g genitourinary medicine clinics. Setting-Six genitourinary medicine c linics in England and Wales (two in London and four outside) participa ting in unlinked anonymous HIV serosurveillance during 1990-3. Subject s-All attenders having blood drawn for syphilis serology for the first time during the calendar quarter of attendance. Main outcome measures -The proportion of syphilis serology specimens with antibody to HIV-1 detected by unlinked anonymous testing of the residue. The proportion of attenders infected with HIV-1 who remained clinically undetected, a nd the proportion who had another recently acquired sexually transmitt ed disease,Results-Of 85441 specimens tested, 2328 (2.7%) were positiv e for antibodies to HIV-1, About 30% of these specimens were from atte nders whose HIV-1 infection remained clinically undetected, HIV-1 infe ction was found to coexist with another recently acquired sexually tra nsmitted disease in 651 attenders, of whom 522 were homosexual or bise xual men. Of these, 245 (47%) already knew themselves to be infected w ith HIV-1, This proportion increased between 1990 and 1993.Conclusions -A considerable proportion of patients infected with HIV-1 are not ide ntified by voluntary confidential HIV testing in genitourinary medicin e clinics. Substantial numbers of homosexual or bisexual men attending genitourinary medicine clinics continue to practise unsafe sex despit e being aware of their infection with HIV-1.