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Are HIV Rates in the French MSM community Really ‘Out of Control’?


Some anti-gay activists use  the following study publiched in the Lancet entitled “Population-based HIV-1 incidence in France, 2003–08: a modelling analysis”  to try and disprove what LGBT rights activists have said about HIV and the criminalisation of buggery/ homosexual activity:

Lancet Study: http://tinyurl.com/7cfz69v

Population-based HIV-1 incidence in France, 2003-08: a modelling analysis.

Le Vu SLe Strat YBarin FPillonel JCazein FBousquet VBrunet SThierry DSemaille CMeyer LDesenclos JC.
Source
Institut de Veille Sanitaire, Saint-Maurice, France. s.levu@invs.sante.fr
Erratum in
  • Lancet Infect Dis. 2011 Mar;11(3):159.
Abstract
BACKGROUND:
Routine national incidence testing with enzyme immunoassay for recent HIV-1 infections (EIA-RI) has been done in France since January, 2003. From the reported number of HIV infections diagnosed as recent, and accounting for testing patterns and under-reporting, we aimed to estimate the incidence of HIV infection in France in 2003-08.
METHODS:
We analysed reports from the French National Institute for Public Health Surveillance for patients who were newly diagnosed with HIV between January, 2003, and December, 2008. Missing data were imputed with multiple imputation. Patients were classified with non-recent or recent infection on the basis of an EIA-RI test, which was calibrated with serial measurements from HIV seroconverters from the French ANRS-PRIMO cohort. We used an adapted stratified extrapolation approach to calculate the number of new HIV infections in men who have sex with men (MSM), injecting drug users (IDUs), and heterosexual men and women by nationality. Population sizes were obtained from the national census and national behavioural studies.
FINDINGS:
After accounting for under-reporting, there were 6480 (95% CI 6190-6780) new diagnoses of HIV infection in France in 2008. We estimate that there were 6940 (6200-7690) new HIV infections in 2008, suggesting an HIV incidence of 17 per 100 000 person-years. In 2008, there were 3550 (3040-4050) new infections in heterosexuals (incidence of 9 per 100 000 person-years), 3320 (2830-3810) in MSM (incidence of 1006 per 100 000 person-years), and 70 (0-190) in IDUs (incidence of 86 per 100 000 person-years). Overall HIV incidence decreased between 2003 and 2008 (p<0·0001), but remained comparatively high and stable in MSM.
INTERPRETATION:
In France, HIV transmission disproportionately affects certain risk groups and seems to be out of control in the MSM population. Incidence should be tracked to monitor transmission dynamics in the various population risk groups and to help to target and assess prevention strategies.
FUNDING:
French National Institute for Public Health Surveillance (InVS) and French National Agency for Research on AIDS and Viral Hepatitis (ANRS).

Analysis

The authors described the situation in France as “out of control” (imagine what they would think of Jamaica!)because that is their opinion of France. How much does the situation really fit the subjective term “out of control”?

The Study said:

Overall HIV incidence decreased significantly from 8930 new infections in 2003 to 6940 in 2008 (p=0·002). This decrease was recordedfor all heterosexual groups, whereas HIV incidence was high and stable among MSM and low and stable among IDUs.

Does “stable” = “out of control?

The Lancet authors used statistical analysis to estimate HIV transmission rates based on a reference population of 298 people in France between 1996 and 2006. From their results they concluded that the HIV incidence rate was high and stable for MSMs. Though the incidence is high does stable mean something is out of control? The study was not a measure of the MSM prevalence rate in France (which Jamaica would surely top) and neither did the study show any increase in the HIV incidence rate for MSMs. It however showed that MSMs formed a larger part of the incidence rate because less heterosexuals were contracting the disease. Though the rate is higher than heterosexuals because of a rate that is not falling and not because it is increasing, France is nowhere close to the disaster of Jamaica some of us choose to hide and sweep under the rug when it doesn’t suit our agenda.

Also, the limitations of the study said: “Potentially socially stigmatised behaviours such as sex between men or drug use are prone to under-reporting in questionnaire surveys. Therefore, use of national behavioural data to extrapolate these behaviours to the overall population might have led to an underestimate of the size of the at-risk populations, and thus an overestimate of incidences.

Unlike certain groups present on the island who believe the label of “second highest MSM HIV prevalence rate in the world” means you should continue doing the same thing and expect different results, the authors of the study recommended renewed safer-sex strategies because times change and many things are affecting MSMs that were not previously issues such as the growth of the internet to find sex partners and a growing complacent attitude to the epidemic as less people are dying of AIDS and HIV is treated as nothing more than the common cold. The study said:

Renewed safer-sex initiatives or new alternative prevention strategies targeting MSM are urgently needed.

Does a buggery law on average lead to lesser rates of unprotected sex and decreased prevalence of sexually transmitted infections than jurisdictions without?

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