‘Big task’: Late testers a target in bid to beat HIV

A rising proportion of HIV-positive people are being diagnosed years into their infections, leading to warnings from experts that testing must be normalised among all sexually active people for Australia to eliminate the virus.

There were 552 new HIV diagnoses in Australia in 2021, the lowest figure on record, according to the Kirby Institute’s annual surveillance report released on Tuesday.

However, 48 per cent of people diagnosed with HIV during the year were deemed to have been infected for at least four years, the highest proportion since 1990. Advanced HIV is more difficult to treat, and people who test positive after several years are more likely to have given the virus to someone else.

Dr Skye McGregor, one of the authors of the report, said the rising rate of “late” diagnoses could be attributed to the impact of the COVID-19 pandemic on testing numbers, but also indicated the need to encourage testing outside of groups historically impacted by HIV.

HIV notifications among men who have sex with men declined from 70 to 60 per cent of all new infections between 2012 and 2021.

But the proportion of new cases likely exposed through heterosexual sex rose from 19 per cent to 27 per cent, although the cases in this group still declined over the decade.

“We need to normalise testing across the whole sexually active population: it’s cheap and it’s easy to do,” said McGregor, noting 58 per cent of infections likely contracted through heterosexual sex were late detections.

Lower testing rates due to the pandemic also likely contributed to the record low number of HIV cases, but McGregor said the figure was also consistent with a broader trend of falling infections.

The report cited community surveys showing increased use and awareness of pre-exposure prophylaxis – or pRep – medication among gay men. “As we get closer to elimination we do need to look at more granular approaches,” McGregor said.

The UNAIDS organisation has set global targets to achieve 95 per cent of people with HIV diagnosed, on treatment and having achieved viral suppression by 2025.

In Australia, 98 per cent of people with HIV are estimated to have achieved viral suppression, which is when treatment has made their HIV untransmissible and undetectable. However, modelling suggests only 91 per cent of people with the virus know their HIV-positive status, meaning about 3000 people are not aware they have the virus.

“We are well on a journey to achieving those UNAIDS targets, but we don’t want to underestimate the work to be done,” said adjunct professor Darryl O’Donnell, CEO of the Australian Federation of AIDS Organisations.

“The big task is to make HIV testing really normal for all sexually active adults, for all adults who are having sex with new partners,” he said, expressing optimism Australia could achieve virus elimination.

The National Association of People with HIV in Australia is developing a mail-out HIV national testing service, targeted at groups understood to be under-tested and more commonly diagnosed late – heterosexual men, women, Aboriginal and Torres Strait Islander groups, and people not eligible for a Medicare card. It is due to start early next year.

“As we get to the end of the epidemic, [detecting cases] becomes much more difficult,” said the association’s executive director, Aaron Cogle.

In NSW, mail-order dried blood spot tests are already available for men who have sex with men, first- or second-generation migrants, people who speak a language other than English at home, Aboriginal people, people with a history of injecting drugs and current and former prison inmates.

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