Australia’s HIV infection rates at 20-year high

Unprotected sex among men was the most common mode of HIV transmission. Image from shutterstock.com

The rate of newly diagnosed HIV infections in Australia has risen by 10% in 12 months – the largest increase in 20 years, a new report shows.

Last year, 1,253 cases of HIV were diagnosed, with unprotected sex among men the most common mode of transmission. The number of new diagnoses has been gradually increasing over the past 14 years, from 719 cases in 1999.

The data is outlined in the Kirby Institute’s Australia Annual Surveillance Report, which will be released today at the Australasian HIV/AIDS Conference 2013 in Darwin.

The report shows that over the past four years, two-thirds (67%) of new HIV diagnoses have occurred among men who have sex with men, 25% were attributed to heterosexual contact and 2% to injecting drug use.

Of the newly diagnosed heterosexual infections, 58% were among people born in Sub-Saharan Africa or Southeast Asia, or those who had partners from these regions.

Between 28,600 and 34,300 Australians have been diagnosed with HIV since the epidemic began.

Changing trends

Professor John de Wit, Director of the National Centre in HIV research said the key factor behind the rise was the “likelihood of being exposed to the virus through unprotected anal sex”.

Professor de Wit co-authored the Annual Report of Trends in Behaviour 2013, which will also be released today.

The report found that over the past decade, the number of gay men having unprotected casual sex has grown. In 2012, almost 40% of gay men with casual partners report having unprotected sex, with the trend most pronounced among HIV positive men and those aged under 25 years.

These young men are “less likely to have been exposed to HIV prevention”, Professor de Wit said, which means that they know condoms are important but haven’t quite got the message that when it comes to age, HIV doesn’t discriminate.

“What we need to do is to get across to people that they are personally at risk, which is very difficult because it also activates all the defences,” he said.

“But through testimonials and working with stories of people who are similar, we can achieve that.”

Professor de Wit said his report also contained some good news: men who were newly diagnosed with HIV were increasingly likely to take up treatment.

“Over the past decade, the number of HIV positive men initiating antiretroviral therapies increased from 60% to about 80%, which is wonderful news,” he said.

Reducing transmission

Infectious diseases expert Associate Professor Edwina Wright from the Alfred Hospital, Monash University and Burnet Institute said starting treatment early could play an important role in reducing transmission of HIV by dropping the carrier’s viral load.

“As soon as you drop your viral load to an undetectable level in the blood, within three to six months of treatment … your chance of transmission to your sexual partner is reduced by 96%,” Professor Wright said.

“Treatment has this amazing double benefit of improving an individual’s health and reducing their risk of transmitting HIV to their partners.”

But current restrictions mean HIV positive people who are well and have above 500 CD4+ cells cannot access subsidised antiretroviral treatment and face an annual bill of around A$15,000.

Professor Wright and her colleagues have made a submission to Australia’s Pharmaceutical Benefits Advisory Committee, which decides who gets access to subsidised medication, to lift the current restriction.

“There’s enough evidence to show that starting treatment early would deliver health benefits and would be cost-effective,” she said, particularly taking “into account that fewer partners would be infected”.

Professor Wright said another key area for reform was to increase access to rapid HIV testing, which could deliver a result within 20 minutes.

“We don’t yet have widespread, routine access to rapid testing, but we’ve made some gains,” she said, with 32 sites in cities around the Eastern seaboard and Perth offering the service.

“I think that’s important because up to 10,000 Australians do not know that they’re HIV positive and a lot of them are going to need incentives to face it, or think about it, or find the time to be tested. So the easier we make it, the better.”

Professor Wright is President of Australasian Society for HIV Medicine, which delivers its report card on Australia’s progress on HIV in Darwin today. The overall score is 21 out of 40.