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 Kirby Institute from UNSW at the Joint HIV and AIDS and Sexual Health Conferences on the Sunshine Coast. .
Dr Skye McGregor from 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 trend to the sustained decline in diagnoses.The declines are likely the result of greater uptake of HIV prevention measures such as 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 a backdrop of changes in sexual testing and behavior brought about by the COVID-19 pandemic. There is evidence of a decline 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 behaviours, it is important to remember to re-adopt the HIV prevention measures and getting tested frequently. As HIV testing rates also return to pre-pandemic levels, we may see an increase in the number of HIV diagnoses,” says Dr McGregor.
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The majority of new HIV cases continued to occur among 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 sex heterosexual While the proportion of cases attributed to heterosexual sex has increased, the number of diagnoses attributed to heterosexual sex has decreased, 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 years or more without knowing their HIV status and had an HIV-related illness.
Scott Harlum, president of the National HIV Association of Australia (NAPWHA), says late diagnoses are more common among people who acquire HIV through heterosexual sex.
“These communities may not have perceived themselves as at risk. It’s very important that we normalize HIV testing among heterosexual people. If you’re testing for sexually transmitted infections, you should also be testing for HIV. Early diagnosis is crucial to supporting people’s health, as well as preventing transmission,” he says.
In good news, HIV diagnoses remained very low among sex workers and people who inject drugs, 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 need to ensure that health programs and services that support these groups, such as needle and syringe programs and peer-led prevention programs for for people in sex work to remain. There is also more work to be done to challenge the stigma and discrimination faced by these groups, which creates social and legal barriers to accessing care,” says Dr McGregor .
Progress to be made on UNAIDS goals
UNAIDS has set global targets for the proportion of people with HIV who have been diagnosed, are on treatment and have achieved viral suppression, meaning their treatment has made their HIV undetectable and non-transmissible. The current target is 95-95-95 by 2025.
By the end of 2021, an estimated 29,460 people in Australia were living with HIV. An estimated 91% of these 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 record HIV diagnoses, additional investment and effort is needed for Australia to meet its UNAIDS targets,” says Kirby Institute Associate Professor Darryl O’Donnell, who is CEO of the Australian Federation of AIDS Organisations. AIDS (AFAO).
“It is encouraging that 91% of people with HIV know this status, but this proportion has not improved much in recent years. It is vital that people know their HIV status. Greater effort is needed to promote HIV testing among all those who may have HIV.
“AFAO and the community-led HIV response are ready and able to partner with government to go the last mile and fulfill our potential.”
UNAIDS 2025 targets and HIV diagnosis and care 2021 in Australia. Image: Kirby Institute.
Steady decline among 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, together with the uptake of PrEP, treatment as prevention and improved national prevention strategies, means that gay and bisexual men should be very proud of our collective efforts lecturing to reduce HIV,” says Kirby Institute Professor Andrew Grulich.
“But there is more work to do. PrEP must reach everyone who can benefit from it. In particular, we need to improve access and promotion for gay and bisexual men living outside urban areas, foreign-born gay and bisexual men and Aboriginal and Torres Strait Islander gay and bisexual men. And in general, we need to increase HIV testing,” he says.
Among participants in the 2021 UNSW Center for Social Research in Health (CSRH) Gay Community Periodic Survey, 66% of HIV-negative gay and bisexual men reported being tested for HIV in the 12 months before the survey, a drop. from 74% in 2019, before the start of the COVID-19 pandemic. This data is included in CSRH’s Annual Behavioral Trends Report, also released today at the HIV/sexual health conference.
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“We know that in 2021 gay and bisexual men continued to report fewer sexual partners than before COVID-19, and that the risk of HIV appeared to be lower,” says Professor Martin Holt of CSRH.
“HIV testing levels were suppressed compared to before COVID-19, and PrEP use was also slightly lower. Encouraging reactivation with HIV testing and prevention remains vital, especially when people they become more sexually active again.”
Programs targeting Aboriginal and Torres Strait Islander communities are needed
There were 17 new HIV diagnoses among Aboriginal and Torres Strait Islander people in both 2020 and 2021. This represents a 51% decrease over the past two years, but the numbers are very small, which makes it difficult to determine if this is a trend.
Robert Monaghan, Head of Aboriginal and Torres Strait Islander Health Research at the Kirby Institute, says: “Although the numbers are small in Aboriginal communities, Aboriginal people face additional barriers to accessing prevention and care. Tailored community campaigns focused on testing, treatment and PrEP are needed.”
Download the UNSW Center for Social Research in Health Annual Behavioral Trends Report 2022.