Australia records lowest ever HIV numbers

Last year, Australia recorded its lowest annual number of HIV cases since the epidemic emerged, a new report released by UNSW’s Kirby Institute has revealed.
 
The annual surveillance report, published at the joint Australasian HIV&AIDS and Sexual Health Conferences on the Sunshine Coast, shows there were just 552 new diagnoses in 2021, a 48% reduction since 2012 and 39% decrease since 2019.
 
Kirby Institute epidemiologist Dr Skye McGregor said Australia should be ‘very pleased’ with the sustained downward trend in diagnoses, but warned the recent low numbers may have been influenced by the COVID-19 pandemic.
 
‘The declines are likely the result of high uptake of HIV prevention measures including pre-exposure prophylaxis, testing, and high levels of treatment among people living with HIV,’ she said.
 
‘[But] there is evidence of a decrease in testing, a decrease in casual sexual partners, as well as a decrease in the movement of people in and out of Australia.
 
‘As we emerge from the pandemic and return to pre-pandemic behaviours, it’s important to remember to re-adopt HIV prevention measures, and to test frequently. As HIV testing rates also return to pre-pandemic levels, it is possible we will see increases in the number of HIV diagnoses.’
 
According to the report, most new HIV cases continue to be among gay and bisexual men (68% in 2021), while 27% were attributed to heterosexual sex and less than 2% were a result of injection drug use.
 
However, even though there was a record low number of new cases in 2021, nearly half were considered to be ‘late diagnoses’ – meaning the person diagnosed may have been living with the virus for four or more years without knowing and could be experiencing HIV-related illness.
 
Scott Harlum, President of National Association of People with HIV Australia (NAPWHA) says late diagnoses are more common among people who acquire HIV through heterosexual sex that it is important to ‘normalise’ testing among this cohort.
 
‘These communities may not have perceived themselves to be at risk,’ he said.
 
‘If you are getting tested for sexually transmissible infections, you should test for HIV too. Early diagnosis is crucial to support the health of individuals, as well as prevent onward transmission.’
 
The report indicates that the very low number of HIV diagnoses among female sex workers and people who inject drugs reflects the ongoing success HIV prevention programs can have.
 
‘Australia is very fortunate to have low HIV rates among these populations,’ Dr McGregor said.
 
‘We need to ensure that health programs and services supporting these groups, such as needle and syringe programs and peer-led prevention programs for people engaged in sex work, are sustained.
 
‘There is also more work to be done to challenge the stigma and discrimination experienced by these groups, which creates social and legal barriers to accessing care.’
 
The report suggests progress is also still required if Australia is to reach global targets set by UNAIDS related to the proportion of people with HIV who have been diagnosed and are on treatment.
 
At the end of 2021, an estimated 91% of the projected 29,460 people in Australia living with HIV were diagnosed, while 92% of those diagnosed were on antiretroviral therapy (ART). Both these rates will need to increase to 95% by 2025 to meet the targets, while the 98% of people on ART who had achieved viral suppression will also need to remain above 95%.
 
‘It is encouraging that 91% of people with HIV are aware of this status; however, this proportion has not improved very much in the last few years,’ CEO of the Australian Federation of AIDS Organisations (AFAO) Adjunct Professor Darryl O’Donnell said.
 
‘It’s vital that people know their HIV status. Greater effort is needed to promote HIV testing among all those who may have HIV.
 
‘Additional investment and effort is [also] needed for Australia to achieve its UNAIDS targets.’
 
Meanwhile, Kirby Institute researcher Professor Andrew Grulich believes effort is needed to improve access and promotion of PrEP for gay and bisexual men born overseas or who live of inner-city areas, as well as Aboriginal and Torres Strait Islander gay and bisexual men.
 
‘The downward trend over recent years, alongside the uptake of PrEP, treatment as prevention, and enhanced national prevention strategies, means gay and bisexual men should be very proud of our collective efforts to drive down HIV,’ he said.
 
‘But there is more work to be done. PrEP needs to reach all people who could benefit from it ... and across the board, we need to increase HIV testing.’
 
Sixty-six per cent of HIV-negative gay and bisexual male participants in the 2021 Gay Community Periodic Survey reported having had an HIV test in the 12 months prior to the survey, down from 74% in 2019.
 
‘We know that in 2021 gay and bisexual men continued to report fewer sex partners than before COVID-19, and that HIV risk appeared to be lower,’ Professor Martin Holt said.
 
‘HIV testing levels were suppressed compared to before COVID-19, and PrEP use was also slightly lower. Encouraging re-engagement with HIV testing and prevention remains vital, particularly as people become more sexually active again.’
 
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