HIV diagnoses among gay and bisexual men more than halved in last decade

Australia is on track to eliminate Human Immunodeficiency Virus (HIV) in the community, but experts say vigilance among authorities and individuals is important to keep momentum towards eradication.

The UNSW Kirby Institute has today released up-to-date data from the past decade of HIV from across Australia’s states and territories, showing new diagnoses among gay and bisexual men have reduced by 57% in the past 10 years.

Overall, new HIV diagnoses have been cut by 43% in Australia, most of which are accounted for by sharp declines among men since 2019.

The proportion of HIV by exposure classification has also shifted in the last 10 years, reflecting the marked declines of cases among those engaged in male-to-male sex. In 2013, this group accounted for 70% of notifications, it’s now 57%, with heterosexual notifications now accounting for 30% (up from 21% in 2013).

But in real terms, heterosexual notifications have also seen a steady decrease nationwide. Other findings include:

• From a peak of 2,412 annual notifications in 1987, new HIV notifications declined to 541 in 2022. They’ve been halved in the past decade.
• Every Australian state and territory has seen reductions in new HIV reports over the past decade.
• The number of people infected through heterosexual sex has declined since a 2017 peak but is still higher than rates recorded in 2000.
• There has been little change in exposure due to male-to-male sex involving drug use, though an increase in new exposures up to 2020 has since declined back to 2013 levels.
• HIV rates among Aboriginal and Torres Strait Islander peoples are the same as pre-pandemic levels and slightly lower than 20 years ago.

Overall, says the Kirby Institute’s Surveillance Innovation Group lead Dr Skye McGregor, these results have been realised thanks to HIV testing and the use of pre-exposure prophylaxis (PrEP) treatments.

But the COVID-19 pandemic and restrictions imposed as part of it likely played an important role in lowering exposure risk.

“We’ve seen sustained low HIV diagnoses in Australia and the response really has been characterised by partnerships between community research and government sectors,” McGregor says.

“There’s no doubt that COVID has impacted the declines, we’ve seen evidence of reduced risk behaviour, reduced HIV testing, as well as restrictions on the movement of people in and out and around Australia.”

A 40-year journey to turn around HIV transmission

HIV is the virus that causes acquired immunodeficiency syndrome – AIDS for short. It’s a zoonotic disease that potentially jumped from chimpanzees in Central Africa to humans at the end of the 19^th century. The first reported cases of AIDS emerged in 1981 and spread globally over the following decades.

HIV attacks the immune system, leading a person to become immunocompromised and susceptible to other infections. Transmission is from exposure to the virus in bodily fluids during unprotected sex or through shared drug use apparatus like needles.

In Australia, exposure to the disease peaked at just under 2,500 in 1987, but concerted sexual health education campaigns, testing services and advances in treatments have seen the number of annual notifications decrease consistently and substantially.

“Why was it that high [in 1987]? Well, there was a combination that the actual incidence of disease was high, and that a lot of gay men didn’t immediately get tested, and it took a few years to make up the backlog,” says the Kirby Institute’s head of HIV Epidemiology and Prevention, Scientia Professor Andrew Grulich.

But medical professionals and community advocates are unlikely to rest on the encouraging downward trend, given a similar decline in the 1990s was gradually reversed at the turn of the century.

The biggest risk now is complacency

By 1999, new HIV notifications had already halved from those 10 years prior, but the trajectory of decline was undone with a steady increase over the following decade.

“What was underlying that was that from ‘95/96 we had the introduction of effective therapies for HIV,” Grulich says.

“Suddenly, it’s no longer a death sentence, there was a lot more optimism, and there was a well-documented decline in condom use among people at highest risk: gay and bisexual men.”

The rapid drop in new HIV notifications since its most recent peak in 2014 owes a lot to biomedical interventions: earlier diagnoses and treatments.

While there is no cure for HIV/AIDS, combination antiretroviral therapies where patients are prescribed multiple drug classes to combat infection, provide a lifeline for many living with the infection. Usually, therapy is lifelong, although some individuals have been declared free of the virus. 

Health authorities have spent the last eight years driving the message that ‘undetectable equals untransmissible’, that is, testing of HIV patients who fail to show signs of viral load can no longer pass the disease to other people via sexual activity.

“People go on treatment, get their viral load undetectable and they the cannot transmit [HIV],” Grulich says.

“Then from 2016, the declines are added a bit further with the introduction of PrEP, a once-a-day pill that an HIV negative man can take to prevent them getting HIV.”

Grulich and his colleagues at the Kirby Institute praise the efforts of advocacy organisations’ efforts to ramp up education around sexual health and the use of barrier and medical protections as being instrumental in driving reportable HIV down.

However, McGregor says further education and lessening taboos around sexual health conversations is needed to ensure Australia’s momentum is maintained.

“There’s education work [needed] to ensure that discussions around sexual health are normalised and that HIV testing is accessible and normalised,” McGregor says.

“There are a range of options including opt-out testing in hospital settings, self-testing, and I think it just needs to be communication of that and understanding from people that those options are available and that it’s important to have an HIV test, and a screening.”