The research, principally from the Communicable Disease Surveillance Centre of the Public Health Laboratory Service, shows that HIV and AIDS awareness campaigns in the mid and late 1980s cut STI rates. They also probably helped prevent the kinds of levels of HIV infection of most of the rest of Europe, which are up to six times higher than those in the UK. But since the 1980s, HIV infection has remained high, while in the past five years bacterial infections, such as gonorrhoea and syphilis, have soared.
The researchers looked trends in rates of HIV transmission among gay men, and new cases of syphilis, gonorrhoea, genital warts, and genital herpes diagnosed at genitourinary medicine clinics in England between 1971 and 1999. Rates were then plotted against the impact of AIDS awareness activities between 1983 and 1984, which were organised by and targeted primarily at gay men, and official campaigns targeted at the general population between 1986 and 1987.
Overall attendances at the clinics tripled between 1971 and 1999. The gay male awareness campaigns of 1983-4 coincided with substantial declines in HIV transmission rates in this group from 6,000 to 1400 a year. Diagnoses of syphilis among men also fell during this period
The 1986-7 official campaigns increased the numbers of "worried well" attending clinics but dramatically cut new attendances requiring treatment, probably because of the adoption of "safer" sex practises. Rates of gonorrhoea and genital herpes also fell significantly, and previous rises in rates of genital warts were halted. But since 1995 rates of gonorrhoea and genital warts have risen sharply.
The authors conclude that the patterns seen over time reflect the impact of sexual health awareness campaigns, which produced behavioural changes and heightened awareness of risky sexual practices. But they conclude: "The evidence of recent, ongoing HIV transmission among [gay men], and increasing STI diagnoses in the general population is especially disquieting," adding that the forthcoming Sexual Health Strategy for England will need "comprehensive and vigorous" measures will be needed to tackle these trends.
Dr Angus Nicoll, Director, Communicable Disease Surveillance Centre, Public Health Laboratory Service, London.
Tel: 0208 358 3004 (Simon Gregor in the press office) Email: Sgregor@phls.org.uk