HIV on rise in Australia – but no crisis

The number of new HIV diagnoses continues to rise in Australia although

overall prevalence remains low, according to surveillance data released at

the 15th Annual Conference of the Australasian Society for HIV Medicine in

Cairns, Australia.

Produced by the government-funded National Centres in HIV Research, two

surveillance reports show that new HIV diagnoses rose from 759 in 2001 to

823 in 2002 – an 8.4% increase. Rises occurred in the eastern states of

Queensland, New South Wales (NSW) and Victoria while the number of new

diagnoses remained steady in other states and territories. Most HIV

infections in Australia continue to occur among men who have sex with men.

Lisa Ryan from the NSW Department of Health reported that HIV notifications

in New South Wales (the state which includes the city of Sydney) increased

by 15% in 2002. Preliminary NSW data from 2003 show these upward trends

continuing.

At the national level, the number of newly acquired cases of HIV climbed by

17% in 2002, and 90% of these new infections were acquired through gay sex.

Two hundred and forty people contracted HIV in 2002 compared with 150 in

1998.

The challenges facing HIV educators in Australia have received considerable

attention at the conference. Several sessions have focused on social

research into gay communities and innovative programs and initiatives to

reduce HIV transmission.

A session entitled ‘Responding to increasing HIV diagnoses in Australia’ was

told today of renewed efforts at health promotion and HIV prevention through

NSW Health, NSW Health Services and community organisations. Lisa Ryan

described the Action Plan for inner city Sydney which involved three key

objectives: increased and targeted social marketing which explores the

reasons which have contributed to the increased rate of HIV transmission

among inner city gay men; support for GPs, sexual health services and HIV

clinicians through improved training opportunities and resources, and

increased testing and treatment of sexually transmitted infections amongst

gay men.

Dermot Ryan from the Australian Federation of AIDS Organisations had a

different approach to reinvigorating HIV prevention efforts. “We are not in

a crisis and a crisis response is not required,” he said.

Instead, he suggested a ‘combination prevention education response’ to

inform renewed HIV prevention efforts. He outlined several principles to

guide this combination approach. These policies include a planned and

collaborative approach to HIV prevention programs and consideration of the

complexity and diversity of gay mens’ lives in prevention education. Dermot

Ryan said that prevention education should aim to reduce both risk

behaviours and vulnerability to HIV infection, signalling a broader social

focus to HIV prevention efforts in Australia. He reiterated the principle of

involving HIV-positive and HIV-negative men in development of education

initiatives and focused on the need to develop appropriate and common

language of HIV prevention.

Indigenous Australians and HIV

Another major finding of the surveillance reports is the change in the

nature of the HIV epidemic among indigenous Australians. For the first time,

transmission via heterosexual sex became the most common route of HIV

transmission.

Between 1993 and 2002, 180 Aborigines and Torres Strait Islanders have been

diagnosed with HIV. Over the last five years, the majority of cases of HIV

infection among indigenous Australians have been attributed to male-to-male

sex. However, in 2002 40% of indigenous people newly diagnosed with HIV

contracted the virus through heterosexual sex HIV and 36% acquired HIV

through gay sex. Indigenous Australians remain at greater risk of

contracting HIV through the sharing of injecting equipment than

non-indigenous Australians (20% versus 4% for 1998-2002).

However, the overall numbers involved are small and several experts warned

against over dramatising the figures. Associate Professor Cindy Shannon,

Chair of the Indigenous Australians’ Sexual Health Committee, told the

plenary session this morning “We should be cautious not to create hype

unnecessarily because the numbers involved are low.” Nevertheless, leading

epidemiologist Professor John Kaldor at the launch of the surveillance data

said that we ignore the figures on indigenous infections “at our peril”.