title: A tale of three cities: persisting high HIV prevalence, risk behaviour and undiagnosed infection in community samples of men who have sex with men.
abstract: OBJECTIVE
  To examine the geographical variations in HIV prevalence (diagnosed and undiagnosed), use of sexual health services, sexually transmitted infections and sexual behaviour in a community sample of men who have sex with men in three cities in England, specifically London, Brighton and Manchester.
  
  
  METHODS
  Cross-sectional surveys of men visiting gay community venues in three large cities in England. Men self-completed a questionnaire and provided an anonymous oral fluid sample for HIV antibody testing.
  
  
  RESULTS
  HIV prevalence ranged from 8.6% to 13.7% in the three cities. Over one-third of HIV infection remained undiagnosed in all sites despite 69% of HIV-positive men reporting attending a genitourinary medicine clinic in the last year. Similar and high levels of risk behaviour were reported in all three cities. 18% of HIV-negative men and 37% of HIV-positive men reported unprotected anal intercourse with more than one partner in the last year. 20% of negative men and 41% of positive men reported an STI in the last year.
  
  
  CONCLUSIONS
  Across all cities, despite widespread availability of anti-retroviral treatment and national policy to promote HIV testing, many HIV infections remain undiagnosed. Data from this community sample demonstrate high levels of risk behaviour and STI incidence, especially among those who are HIV positive. Renewed efforts are needed to increase diagnosis and to reduce risk behaviour to stem the continuing transmission of HIV.
authors.affiliation: Department of Primary Care and Population Science, Centre for Sexual Health & HIV Research, University College London, Mortimer Market Centre, Mortimer Market, London, UK. jdodds@gum.ucl.ac.uk
authors.forename: Julie P
authors.initials: JP
authors.lastname: Dodds
authors.forename: Anne M
authors.initials: AM
authors.lastname: Johnson
authors.forename: John V
authors.initials: JV
authors.lastname: Parry
authors.forename: Danielle E
authors.initials: DE
authors.lastname: Mercey
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D004739:England; D015658:HIV Infections / Q000453:epidemiology* / Q000628:therapy; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D015995:Prevalence; D012111:Residence Characteristics; D012747:Sexual Partners; D012959:Socioeconomic Factors; D014342:Truth Disclosure; D047568:Unsafe Sex / Q000706:statistics & numerical data*