Push for earlier HIV diagnoses

There has been a substantial decline in the number of new diagnoses of HIV over the past decade in Australia, new data show – but sexual health experts say higher testing rates and earlier diagnoses are needed to keep that momentum going.
 
Figures released by the Kirby Institute this week show the biggest decline among men who have sex with men, with a 57% fall since 2013 – a trend that has been hugely boosted by the introduction of pre-exposure prophylaxis (PReP) medication since 2016.
 
Overall, there were 555 new diagnoses in 2022, of whom 462 were male, 85 female, and eight transgender. That compares to 1037 total diagnoses recorded in 2013.
 
The level was marginally higher than the 552 recorded in 2021, with sexual health experts suggesting lower testing rates due to the pandemic may have had an impact.
 
Dr Skye McGregor, Lead of the Surveillance Innovation Group, called the trend ‘an amazing response’.
 
‘Australia really has been world-leading,’ she said. ‘But it’s really crucial now we sustain and enhance the response to HIV in Australia.’
 
The statistics show disparities in the rate of the decline, with the number of diagnoses having fallen significantly faster among Australian-born people when compared to those born overseas.
 
While gay and bisexual men still make up the majority of diagnoses, that proportion has fallen significantly, with 30% of diagnoses now among heterosexuals.
 
Of the overall diagnoses, 44% were also categorised as late, meaning the person could have lived with HIV for four or more years without being aware of their status.
 
For Dr McGregor, that reinforces the need for regular sexual health check-ups, including HIV tests, for those who are sexually active.
 
‘This has significant individual implications in terms of ill health, but also significant population level implications in terms of the possibility of onward transmission if someone’s unaware of their HIV status,’ she said.
 
‘We need to ensure appropriate support structures are in place to ensure timely diagnosis as well as care for people who are diagnosed late.’
 
Diagnoses remained low among Aboriginal and Torres Strait Islander people, but the numbers did rise slightly from 17 to 25.
 
Robert Monaghan, Manager of the Aboriginal and Torres Strait Islander Health Program at the institute, said the figures need to be monitored closely.
 
‘It’s a slight increase but it is concerning … and it could have huge impacts in our Aboriginal communities if it’s left unchecked,’ he said.
 
Meanwhile, Professor Andrew Grulich, Head of the Kirby Institute’s HIV Epidemiology and Prevention Program, highlighted the ‘extraordinary’ increase in PReP use.
 
He praised the impact of community-led health strategies and said a ‘partnership response’ between communities, clinicians, governments and researchers has contributed strong to the successful reduction in HIV diagnoses in Australia.
 
According to the institute figures, 62,632 people – 98% men – have taken the treatment since it was first introduced on the PBS in 2018.
 
This includes 39,643 in the past 12 months, with a record high in the final three months of 2022.
 
However, Professor Grulich also expressed concern about the difference in the rate of decline in diagnoses among Australian-born and overseas-born men who have sex with men.
 
He said heightened stigma against AIDS and homosexuality are likely be factors among the latter cohort and described further reducing the level of diagnoses as ‘a major challenge’.  
 
He also suggested expanding PReP PBS access to overseas students as among the measures that could help.
 
The data was released ahead of the 12th IAS Conference on HIV Science, which is being held in Brisbane this month.
 
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