Australia’s HIV numbers drop but late diagnoses concern experts

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HIV diagnoses in Australia have reached the lowest levels on record but more people are being diagnosed years into their infections, concerning experts.

In 2021, there were 552 new HIV diagnoses in Australia, according to the Kirby Institute’s annual surveillance report.

This is the lowest number of cases recorded since the beginning of the epidemic, report author Dr Skye McGregor explained.

“HIV has been declining in Australia since 2015,” she said.

“Australia should be very pleased with this sustained downward trend in diagnoses.”

She added, “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.

“However, we need to consider these particularly low numbers in 2020 and 2021 within a context of changes to testing and sexual behaviour brought on by the COVID-19 pandemic.

“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.”

In 2021, 66% of HIV-negative gay and bisexual men reported having had an HIV test in the previous 12 months. That’s down from 74% in 2019, before the pandemic.

“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,” Dr McGregor said.

“As HIV testing rates also return to pre-pandemic levels, it’s possible we’ll see increases in the number of HIV diagnoses.”

‘PrEP needs to reach all who need it’

Over the past 10 years, Australia has seen a 52% decrease in new diagnoses among gay and bi 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,” the Institute’s Professor Andrew Grulich explained.

“But there is more work to be done. PrEP needs to reach all people who could benefit from it.

“In particular, we need to improve access and promotion for gay and bisexual men living outside of inner-city areas, gay and bisexual men born overseas, and Aboriginal and Torres Strait Islander gay and bisexual men.

“And across the board, we need to increase HIV testing.”

Moreover, almost half (48%) of Australia’s new HIV diagnoses were “late diagnoses”. This means the person may have been living with HIV for four or more years without knowing.

National Association of People with HIV Australia (NAPWHA) President Scott Harlum said late diagnoses are more common among people who acquire the virus through heterosexual sex.

“It is very important that we normalise HIV testing among heterosexual people,” he said.

“Early diagnosis is crucial to support the health of individuals, as well as prevent onward transmission.”

Two thirds of new HIV cases are among gay and bi men

More than two-thirds (68%) of new HIV cases in 2021 were among gay and bisexual men. More than a quarter of cases (27%) were attributed to heterosexual sex.

At the end of 2021, the Kirby Institute estimated 29,460 people in Australia were living with HIV.

But experts warn an estimated close to one in 10 people living with the virus are unaware they have it.

By the end of 2021, 98% of people on HIV treatment had achieved viral suppression. This means they can no longer transmit the virus to their sexual partners.

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