Australia has recorded the lowest number of HIV diagnoses since the start of the epidemic in the early 1980s.
In 2021, there were just 552 new diagnoses of HIV in Australia, according to a new national report released by the University of New South Wales’ Kirby Institute.
The report says the rate of new diagnoses has halved over the past 10 years, and that 98% of HIV-positive people on treatment had achieved viral suppression: meaning they couldn’t transmit the virus.
But it’s not all good news. Almost half (48%) of the new cases are ‘late diagnoses’ meaning the person could have been living with HIV for at least four years without knowing it.
And as is the case in numerous health screenings, the COVID-19 pandemic has caused a decline in testing for HIV, which hasn’t yet picked up to pre-pandemic levels.
“Australia should be very pleased with this sustained downward trend in diagnoses,” says Dr Skye McGregor, a researcher at the Kirby Institute.
“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.”
McGregor cites several different data sources for the decline in testing, including the Gay Community Periodic Surveys (where annual HIV testing dropped from 74% in 2019 to 56% in 2021) and the National Debrief Survey of 18-29-year-olds (where testing rates dropped from 36% in 2018 to 28% in 2021).
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While 68% of the new diagnoses were among gay and bisexual men, the report finds that this number has reduced by 52% over the past decade. The report highlights the scale-up of preventative medication PrEP as a particular success.
By contrast, HIV diagnoses among heterosexual people have declined more slowly. Late diagnoses of HIV are also more common among the 27% of people who contracted HIV through heterosexual sex in 2021.
“These communities may not have perceived themselves to be at risk,” says Scott Harlum, President of the National Association of People with HIV Australia.
“It is very important that we normalise HIV testing among heterosexual people. 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.”
McGregor agrees.
“There’s obviously a place for tailored testing programs that are developed in consultation with communities,” she says.
“But I really think the overall message is: let’s normalise HIV testing. If you’re getting a sexual health screen, ensure that HIV testing is in there.”
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McGregor adds that it’s difficult to predict whether this downward trend will continue, given the change in behaviours brought on by the end of lockdowns and border closures.
“We just don’t know, until we see the data next year, what’s going to happen. I think COVID made things unpredictable.”
Approximately 29,460 people in Australia were living with HIV at the end of 2021.
“It’s just something we need to talk about,” says McGregor.
“Sexual health is a normal part of a healthy life, so let’s focus on those conversations to take stigma and discrimination out of the equation.”