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Objectives The aims of the study were (1) to measure the distance required to travel, and the distance actually travelled, to HIV services by HIV-infected adults, and (2) to calculate the proportion of patients who travelled beyond local services and identify socio-demographic and clinical predictors of use of non-local services. Methods The straight-line distance between a patient's residence and HIV services was determined for HIV infected patients in England in 2007. 'Local services' were defined as the closest HIV service to a patient's residence and other services within an additional 5 km radius. Multivariable logistic regression was used to identify socio-demographic and clinical predictors of accessing non-local services. Results In 2007, nearly 57000 adults with diagnosed HIV infection accessed HIV services in England; 42% lived in the most deprived areas. Overall, 81% of patients lived within 5 km of a service, and 8.7% used their closest HIV service. The median distance to the closest HIV service was 2.5 km [interquartile range (IQR) 1.5-4.2 km] and the median actual distance travelled was 4.8 km (IQR 2.5-9.7 km). A quarter of patients used a 'non-local' service. Patients living in the least deprived areas were twice as likely to use non-local services as those living in the most deprived areas [adjusted odds ratio (AOR) 2.16; 95% confidence interval (CI) 1.98-2.37]. Other predictors for accessing non-local services included living in an urban area (AOR 0.77; 95% CI 0.69-0.85) and being diagnosed more than 12 months (AOR 1.48; 95% CI 1.38-1.59). Conclusion In England, 81% of HIV-infected patients live within 5 km of HIV services and a quarter of HIV-infected adults travel to non-local HIV services. Those living in deprived areas are less likely to travel to non-local services. [ABSTRACT FROM AUTHOR]

Objectives: To examine the epidemiology of HIV among block and minority ethnic (BME) men who have sex with men (MSM) in England and Wales (E&W). Methods: Ethnicity data from two national HIV/AIDS surveillance systems were reviewed (1997-2002 inclusive), providing information on new HIV diagnoses and those accessing NHS HIV treatment and care services. In addition, undiagnosed HIV prevalence among MSM offending 14 genitourinary medicine (GUM) clinics participating in the Unlinked Anonymous Prevalence Monitoring Programme and having routine syphilis serology was examined by world region of birth. Results: Between 1997 and 2002, 1040 BME MSM were newly diagnosed with HIV in E&W, representing 12% of all new diagnoses reported among MSM. of the 1040 BME MSM, 27% were black Caribbean, 12% black African, 10% black other, 8% Indian/Pakistani/Bangladeshi, and 44% other/mixed. Where reported (n = 395), 58% of BME MSM were probably infected in the United Kingdom. An estimated 7.4% (approximate 95% CI: 4.4% to 12.5%) of BME MSM aged 16-44 in E&W were living with diagnosed HIV in 2002 compared with 3.2% (approximate 95% CI: 2.6% to 3.9%) of white MSM (p<0.001). Of Caribbean born MSM attending GUM clinics between 1997 and 2002, the proportion with undiagnosed HIV infection was 15.8% (95% CI: 11 .7% to 20.8%), while among MSM born in other regions it remained below 6.0%. Conclusions: Between 1997-2002, BME MSM accounted for just over one in 10 new HIV diagnoses among MSM in E&W; more than half probably acquired their infection in the United Kingdom. In 2002, the proportion of BME MSM living with diagnosed HIV in E&W was significantly higher than white MSM. Undiagnosed HIV prevalence in Caribbean born MSM was high. These data confirm the need to remain alert to the sexual health needs and evolving epidemiology of HIV among BME MSM in E&W. [ABSTRACT FROM AUTHOR]