Australia records lowest HIV numbers ever, but late diagnoses are cause for concern

There were 552 new HIV diagnoses in Australia in 2021, meaning the number of new diagnoses has halved over the past 10 years, according to a new National HIV Report released today by the Institute. UNSW’s Kirby at the Joint Conferences on HIV and AIDS and Sexual Health on the Sunshine Coast. .

Dr Skye McGregor of the Kirby Institute says: “HIV has been declining in Australia since 2015 and this is the lowest number recorded since the start of the HIV epidemic. Australia should be very pleased with this sustained downward trend in diagnoses. The declines are likely the result of high use of HIV prevention measures, including pre-exposure prophylaxis, testing and high levels of treatment among people living with HIV.

“However, we must consider these particularly low numbers in 2020 and 2021 against the backdrop of changes in sexual testing and behaviors caused by the COVID-19 pandemic. There is evidence of a decrease in testing, a decrease in casual sex 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 behaviors, it is important to remember to re-enact HIV prevention measures and test yourself frequently. As HIV testing rates also return to pre-pandemic levels, it is possible that we will see an increase in the number of HIV diagnoses,” says Dr McGregor.

Read more: Australia’s HIV diagnoses are at their lowest since the 1980s, but COVID-19 is likely a driver

Most new HIV cases continued to be in gay and bisexual men, who accounted for more than two-thirds (68%) of cases in 2021. More than a quarter of cases (27%) were attributed to heterosexual relationships. While the proportion of cases attributed to heterosexual relationships has increased, the number of diagnoses attributed to heterosexual relationships has declined, but at a slower rate compared to the decline in cases among gay and bisexual men.

Almost half of all new HIV diagnoses in 2021 were considered late diagnoses. This means that the person diagnosed had been living with HIV for four or more years without knowing their HIV status and had an HIV-related illness.

Scott Harlum, president of the Australian National Association of People Living with HIV (NAPWHA), says late diagnoses are more common among people who contract HIV through heterosexual sex.

“These communities may not have perceived themselves to be at risk. It is very important that we normalize HIV testing among heterosexual people. If you are being tested for sexually transmitted infections, you should also be tested for HIV. Early diagnosis is crucial to supporting the health of individuals, as well as preventing onward transmission,” he says.

Good news, HIV diagnoses have remained very low among female sex workers and injecting drug users, reflecting the continued success of HIV prevention programs targeting these populations.

“Australia is very fortunate to have low rates of HIV among these populations. We must ensure that health programs and services supporting these groups, such as needle and syringe programs and peer-led prevention programs for people who engage in sex work, are maintained. . There is also work to be done to address the stigma and discrimination faced by these groups, which create social and legal barriers to accessing care,” says Dr McGregor.

Progress on UNAIDS targets

UNAIDS has set global targets for the proportion of people living with HIV who have been diagnosed, are on treatment and have achieved viral suppression – this means that their treatment has made their HIV undetectable and untransmissible. The current target is 95-95-95 by 2025.

At the end of 2021, an estimated 29,460 people in Australia were living with HIV. An estimated 91% of those were diagnosed, 92% of those diagnosed were on antiretroviral therapy (ART), and 98% of those on ART had achieved viral suppression (91-92-98).

“Despite extremely low HIV diagnoses, further investment and effort is needed if Australia is to meet its UNAIDS targets,” says Darryl O’Donnell, Assistant Professor at the Kirby Institute, who is CEO of the Australian Federation Aids organizations (AFAO).

“It is encouraging that 91% of people living with HIV are aware of this status, but this proportion has not improved much in recent years. It is vital that people know their HIV status. Increased efforts are needed to promote HIV testing to all who may have HIV.

“WAWA and the community response to HIV are ready and able to partner with government to walk the last mile and realize our potential.”

UNAIDS 2025 targets and HIV diagnosis and care in 2021 in Australia. Image: Kirby Institute.

Continued decline in gay and bisexual men

Over the past 10 years, there has been a 52% decrease in new diagnoses among gay and bisexual men.

“The downward trend in recent years, alongside the adoption of PrEP, treatment as prevention and improved national prevention strategies, means that gay and bisexual men should be very proud of our collective efforts to reduce HIV,” says Professor Andrew Grulich of the Kirby Institute.

“But there is still work to be done. PrEP must reach everyone who could benefit from it. In particular, we need to improve access and promotion for gay and bisexual men living outside of inner cities, foreign-born gay and bisexual men, and Aboriginal and Torres Strait Islander gay and bisexual men. And in all areas, we need to increase the number of HIV tests,” he says.

Among participants in the periodic survey of the gay community conducted by the Center for Social Research in Health (CSRH) at UNSW in 2021, 66% of HIV-negative gay and bisexual men reported having been tested for HIV in in the 12 months preceding the survey, down 74% in 2019, before the start of the COVID-19 pandemic. These data are included in the annual CSRH Behavioral Trends Report, also released today at the HIV and Sexual Health Conference.

Read more: HIV history cannot repeat itself with monkeypox, warns UNSW social scientist

“We know that in 2021, gay and bisexual men continued to report fewer sexual partners than before COVID-19, and HIV risk appeared to be lower,” says Professor Martin Holt of the CSRH.

“HIV testing levels were suppressed compared to pre-COVID-19, and PrEP use was also slightly lower. Encouraging re-engagement in HIV testing and prevention remains vital, especially as people become more sexually active again.

Targeted programs needed for Aboriginal and Torres Strait Islander communities

There were 17 new HIV diagnoses among Aboriginal and Torres Strait Islander peoples in 2020 and 2021. This represents a 51% decrease over the past two years, but the numbers are very low, making it difficult to determine if it is a trend.

Mr Robert Monaghan, Head of Aboriginal and Torres Strait Islander Health Research at the Kirby Institute, said: “While numbers are low in Aboriginal communities, Aboriginal people face additional barriers. to access prevention and treatment. Community-tailored campaigns are needed, focusing on testing, treatment and PrEP. »

Download the 2022 Annual Behavioral Trends Report from the UNSW Center for Social Health Research.

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