Will there be a heterosexual HIV epidemic in Britain?

Gus Cairns:

A couple of bits of data released in the last month, when put together, offer a suggestion that the UK might be starting to see the beginnings of a home-grown HIV epidemic among heterosexuals, particularly among people of Caribbean background.

A study of 344 patients attending the HIV clinic at King’s College Hospital found that a sizeable minority of patients were infected with strains of HIV more normally found in Africa, but had almost certainly acquired their HIV in the UK.

HIV comes in a number of sub-types worldwide, labelled from A to O, but in the developed west and especially among gay men the overwhelming majority have subtype B. Among Africans there are a variety of subtypes, but types A, C and D predominate.

If researchers start to find that a proportion of HIV infections clearly caught in the UK are not of subtype B, then this is indirect evidence – especially if those people are also heterosexual – that the division in the UK epidemic between a largely home-grown epidemic among gay men and a largely imported epidemic among heterosexual immigrants from Africa has started to break down.

This is exactly what the researchers from King’s found.

Of 344 patients studied, 47% had subtype B. Sixty-five per cent of them were white gay men and another 11% were black gay men, nearly all of whom had caught HIV in the UK. Of the 53% who had other subtypes, 81% were Africans. About a tenth of them had caught HIV in the UK rather than Africa, but all but four had had a partner who themselves had caught HIV in Africa.

This left 42 people who were not African and did not have subtype B – and 20 who were heterosexual and did have subtype B.

Of the heterosexuals who had subtype B, half were of Caribbean background and had nearly all caught HIV in the UK.

Of the 42 non-Africans without subtype B, 21 were white and 13 Caribbean. Two-thirds of the white people were gay men. But nearly all the Caribbeans (11 or the 13) were heterosexual. And ever one of them had clearly caught HIV in the UK.

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