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.