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HIV and AIDS have posed new challenges to societies, communities and individuals. In many parts of the world, existing health and social services have been hard pressed to cope with the dermands of the epidemic. In hospitals and in the community, new approaches to health education, support and care have been developed. Non-governmental and community organizations have had a central role to play in responding to the challenge of HIV and AIDS. AIDS: Foundations for the Future highlights progress made over the last decade, and offers an agenda for future activism and research. This book examines

IntroductionART initiation in primary HIV infection (PHI) could reduce risk of transmission to sexual partners at a time of high viraemia, although health benefit for the individual remains unknown. We examined attitudes to early ART and associated beliefs in men who have sex with men (MSM) with PHI.Materials and MethodsSemi‐structured face‐to‐face in‐depth interviews were conducted with 13 MSM aged ≥16 years attending a central London HIV clinic, within 12 months of date of estimated HIV seroconversion. Audio recordings of interviews were transcribed verbatim and analyzed thematically.ResultsMedian age was 33 years (range 22–47), majority were white British (n=8), educated to university level (n=11) and were not on ART (n=10). Great diversity in ART knowledge and expectations around starting were observed, with some men assuming they would be prescribed ART immediately upon diagnosis. Deferral until CD4<350 came as a surprise and counterintuitive when put into the context of treating other diseases. For many, the decision to start ART was a balance of current and future health and quality of life. Fear of side effects was prevalent, with many believing them inevitable and a reason to avoid early ART. A perceived lack of "good quality" evidence showing a health benefit of early ART caused confusion. Avoiding the decision to start or deferring to their HIV clinician was common, however reported clinicians' views also varied. Some men voiced a desire to be proactive and start early ART to control viral replication. In these cases men also reported a belief that ART could be temporary as they expected a cure in their lifetime. Men commonly described feeling "infected" and reducing this infectiousness was seen as a major benefit of ART; not purely to reduce the risk of transmission to sexual partners but to facilitate disclosure to partners, reduce anxiety and guilt and restore sexual confidence commonly lost after HIV diagnosis. Having a long‐term HIV‐negative partner was a strong facilitator to starting ART to reduce transmission in the absence of good evidence of individual health benefit.ConclusionsFactors involved in the decision to start ART in PHI were complex. Uncertainty over individual health benefits in conjunction with fear of toxicities were barriers to starting ART early. By contrast ART was seen as a facilitator to disclosure, and as a way to limit the consequences of infection until a cure is found.

International audience ; There has been a large influx of Central and East European (CEE) migrants to the UK following the expansion of the European Union. This paper examines the factors associated with GUM clinic attendance and STI diagnosis among CEE migrants in London. We conducted a survey of sexual behaviour among CEE migrants attending two central London GUM clinics (n=299) and community venues in London (n=2276). Routinely-collected clinic data were also analysed. CEE migrants made up 2.9% of male and 7.0% of female attendees at the clinics. Half of the women attending sessions for female sex workers were from CEE countries and paying for sex was widely reported by men. Women were more likely than men to have attended a GUM clinic in the UK (7.6% vs 4.5%, p=0.002). GUM survey respondents were more likely than community survey respondents to report one or more new sexual partners in the past year (women: 67.9% vs 28.3%, p<0.001; men: 75.6% vs 45.1%, p<0.001) and homosexual partnership(s) in the past five years (men: 54.3% vs 1.8%, p<0.001); but were less likely to report assortative heterosexual mixing (women: 25.9% vs 74.2%, p<0.001; men: 56.5% vs 76.3%, p<0.001). CEE patients make up a notable proportion of patients attending two central London GUM clinics. Higher numbers of sexual partners, homosexual partnerships and sexual mixing with people from outside the country of origin are associated with GUM clinic attendance. Heterosexual CEE men report behaviours associated with HIV/STI acquisition but appear to be under-utilizing GUM services.

Abstract Background Following the expansion of the European Union, there has been a large influx of Central and East European (CEE) migrants to the UK. CEE men who have sex with men (MSM) represent a small minority within this population that are none-the-less important to capture in sexual health research among the CEE migrant community. This paper examines the feasibility of recruiting CEE MSM for a survey of sexual behaviour in London using respondent driven sampling (RDS), via gay websites and in GUM clinics. Methods We sought CEE MSM to start RDS chain referral among GUM clinic attendees, our personal contacts and at gay events and venues in central London. We recruited CEE MSM (n = 485) via two popular websites for gay men in Britain (March-May 2009) and at two central London GUM clinics (n = 51) (July 2008-March 2009). Results We found seventeen men who knew other CEE MSM in London and agreed to recruit contacts into the study. These men recruited only three men into the study, none of whom recruited any further respondents, and RDS was abandoned after 7 months (July 2008-January 2009). Half of the men that we approached to participate in RDS did not know any other CEE MSM in London. Men who agreed to recruit contacts for RDS were rather more likely to have been in the UK for more than one year (94.1% vs 70.0%, p = 0.052). Men recruited through gay websites and from GUM clinics were similar. Conclusions The Internet was the most successful method for collecting data on sexual risk behaviour among CEE MSM in London. CEE MSM in London were not well networked. RDS may also have failed because they did not fully understand the procedure and/or the financial incentive was not sufficient motivation to take part.

International audience ; Since May 2004, ten Central and East European (CEE) countries have joined the European Union. While HIV rates remain low among men who have sex with men (MSM) in CEE countries, there is no research on the sexual behaviour of CEE MSM in the UK. CEE MSM living in the UK (n=691) were recruited for an online questionnaire via two popular MSM websites. The majority of men had arrived in the UK since May 2004. A previous STI diagnosis was reported by 30.7% and 4.8% reported being HIV-positive, the majority diagnosed in the UK. Unprotected anal intercourse with a casual partner of unknown or discordant HIV status was reported by 22.8%. Men who had been in the UK for longer (>5 years vs 10 partners, p<0.001) and were less likely to report their most recent partner was from their home country (14.9% vs 33.6%, p<0.001). Among migrant CEE MSM living in London, 15.4% had been paid for sex in the UK and 41.5% had taken recreational drugs in the past year. CEE MSM in the UK are at risk for acquisition and transmission of STIs and HIV through UAI with non-concordant casual partners. Sexual mixing with men from other countries, commercial sex and increased partner numbers may introduce additional risk. This has important implications for cross-border transmission of infections between the UK and CEE countries.