The latest data on HIV diagnoses in Australia show where health leaders can focus their efforts for the rest of the decade.
Over the last decade, HIV diagnoses in Australia have continued to follow a downward trend, says new data released today by the Kirby Institute at UNSW Sydney.
While there were 722 new HIV diagnoses reported nationally in 2023 - up from 553 in 2022 - the researchers still reported a lower number of annual cases compared to pre-pandemic levels, and a long-term trend of declining diagnoses.
"The increase in 2023, compared to COVID pandemic years, is likely associated with the resumption of pre-COVID sexual behaviours, testing and the movement of people in and out of the country. However, encouragingly, new diagnoses are still lower than pre-pandemic levels, and there is no interruption to our long-term trend of decline," says Dr Skye McGregor, lead of the Surveillance Innovation Group at the Kirby Institute.
"Any increase in HIV cases is concerning, however we need to interpret a single year of data with caution, particularly in the context of COVID. Importantly, the long-term trends show a decline."
According to the data released today, overall HIV diagnoses have reduced by 33 per cent over the last decade, with particularly significant reductions among Australian-born gay and bisexual men, where diagnoses have reduced by 64 per cent.
"These long-term reductions tell us our strategies to eliminate HIV transmission - such as testing, HIV pre-exposure prophylaxis (PrEP) and treatment - are working. With effective treatment, levels of HIV in the blood are so low they are undetectable, meaning HIV can't be transmitted to sexual partners. In other words, undetectable = untransmittable, or U=U. However, we also need to look carefully at the inequities revealed by the data and intensify our efforts to respond to HIV," Dr McGregor says.
Despite overall declines in HIV diagnoses in Australia, there has been a slight increase over the past 10 years among the small number of people living with HIV acquired through heterosexual sex. There have also been increases among people born overseas.
"While these are only small increases, when viewed against a backdrop of declines overall, this highlights where we need to focus additional efforts over the next decade," says Dr McGregor.
"The Minister for Health and Aged Care, Mark Butler, convened a National HIV Taskforce to respond to HIV and made recommendations around innovative new programs that can help reach these populations. It is fantastic that these programs are funded and it's important that they are implemented swiftly.
"In particular, there is an urgent need for culturally appropriate health services and programs designed with communities to engage overseas-born people in HIV prevention, testing and care as early as possible."
As has been the case for many years, rates of HIV among sex workers and people who inject drugs remain exceptionally low in Australia, thanks to decades of successful peer education prevention strategies developed and delivered by affected communities, which need to be sustained to ensure these low rates are maintained.
HIV testing is up, but more timely testing is needed
"Testing is central to any HIV strategy and, encouragingly, the number of people tested for HIV increased in 2023 following considerable declines over the peak of the COVID-19 pandemic," says Dr McGregor.
However, last year more than a third of diagnoses were classified as late, which means the person diagnosed may have been living with HIV for four or more years without knowing their HIV status and may be experiencing HIV-related illness. Among heterosexual people diagnosed with HIV, more than half were diagnosed with late-stage HIV.
"The number of late diagnoses is very concerning. We need to increase access to testing, treatment and prevention in a targeted and equitable way, to ensure those most in need can easily access services," says Dr McGregor.
"Regular sexual-health testing is important for anyone who has changed sexual partners or who hasn't used a condom. A blood test for syphilis and HIV should be part of your routine sexual health screen with your GP."
Mixed outcomes for gay men and other men who have sex with men
While most new HIV diagnoses continue to be among gay and bisexual men, diagnoses among this group have reduced by 43 per cent over the past 10 years, showcasing the success of comprehensive approaches to HIV prevention within this population.
"We've had tremendous success reducing HIV among gay and bisexual men in Australia, and in 2023, we saw record numbers of people prescribed PrEP for HIV prevention. However, when we look at the trends in overseas-born gay and bisexual men, we can see there is actually a small 4 per cent increase in diagnoses over the past 10 years," says Professor Andrew Grulich, head of the HIV Epidemiology and Prevention Program at the Kirby Institute.
"We have the strategies and technologies to eliminate HIV transmission in Australia. But we need to make sure PrEP and other prevention strategies are reaching the populations that most need them, including gay and bisexual men who were born overseas."
According to the Annual Report of Trends in Behaviour 2024 report, produced by the UNSW's Centre for Social Research in Health, there are inconsistencies in HIV prevention coverage among gay and bisexual men. While overall coverage is high, at 80.5 per cent in 2023, younger participants (<25 years), bisexual men, and participants living in suburban and regional areas are less likely to report PrEP use and more likely to report some risk of HIV transmission.
Professor Martin Holt from the Centre for Social Research in Health says: "Addressing disparities in prevention access and use remains critical to increasing consistency in prevention coverage across the country and in different communities. By doing so, we can build on the success seen in some parts of the country and get closer to the goal of eliminating HIV transmission nationally."
Targeted strategies needed for Aboriginal and Torres Strait Islander populations
HIV diagnoses among Aboriginal and Torres Strait Islander peoples remained stable, with 24 diagnoses in 2023.
Robert Monaghan, Manager of Aboriginal and Torres Strait Islander Health research at the Kirby Institute, says: "Although the number of HIV diagnoses remains low compared to the general population, there has not been a marked decline since the start of the HIV pandemic. Eliminating HIV among Aboriginal and Torres Strait Islander peoples must remain a critical national priority, particularly given we have the prevention and treatment tools available to achieve this.
"We know that Aboriginal and Torres Strait Islander peoples face additional barriers to accessing health care as a consequence of the ongoing traumatic legacy of colonisation and the consequences of racism and discrimination within the health system. Co-designed awareness campaigns in partnership with local community organisations are needed, focused on testing, treatment and PrEP," he says.
This data snapshot has been released ahead of the Australasian HIV&AIDS Conference, which takes place in Sydney from 16-18 September. A full report will be available on the Kirby Institute website later this year.
