How close is Sydney to ending HIV? It depends on where you live

Sydney suburbs once ravaged by the AIDS epidemic are on the verge of becoming the first in the world to virtually eliminate HIV transmission, as public health efforts expand to the outer suburbs.

New HIV infections in Sydney postcodes with the highest proportion of gay men have dropped 88 per cent since 2010, new figures show, the most dramatic reduction in cases reported anywhere in the world.

A much smaller decline of 31 per cent in the outer suburbs of Sydney over the same period shows the success of HIV prevention campaigns has not been as effective in postcodes with a lower proportion of gay men, said Kirby Institute Professor Andrew Grulich, who will present the research at the International AIDS Society Conference in Brisbane this week.

“It is a real challenge for us now to build our prevention services outside the inner city and to work with more diverse communities,” he said. “That’s going to be a challenge, but the inner-city shows that it can be done.”

Former NSW Liberal health minister Jillian Skinner became an unlikely gay icon when she championed a trial introducing the pre-exposure prophylaxis medication known as PrEP in 2016.

Using PrEP reduces the risk of contracting HIV by 99 per cent, but uptake of the daily pill and regular HIV testing has not been as high in suburbs with a lower proportion of gay men, Grulich said.

ACON – the leading provider of homosexual health services in NSW – has increased efforts to expand its education and healthcare initiatives outside the inner city.

Director for HIV and sexual health, Matthew Vaughan, said the organisation was providing hundreds of testing kits at workshops in western Sydney which allow people to test discreetly at home.

“We can’t just pick up messages that we run in the inner city, we make sure that we’re working alongside communities because we know that the messages will be much more effective that way,” he said.

ACON offers booking and clinical services in multiple languages, and has translated its website into Thai and simplified Chinese, making it easier for more people to access tests and other prevention measures.

University of NSW adjunct professor and strategic health policy adviser Bill Bowtell.Credit: Alex Ellinghausen

Nationwide figures, released by the Kirby Institute on Thursday, show rates of new HIV cases among recently arrived gay and bisexual men born overseas have stagnated since 2020.

Vaughan said Australia’s comparatively low HIV rates can lead to people arriving in Australia to drop their guard. Stigma remains an issue.

“If you’re coming from, for example, Indonesia, where being gay means you could be persecuted, you’re more likely to have a distrust of government and government services when you arrive in Australia,” he said.

Bill Bowtell, an adjunct professor at the University of NSW and a key government adviser during the AIDS epidemic of the 1980s, said the reduction in cases in the inner-city was a “remarkable achievement”, but Australia could not afford to be complacent.

“The great experience in Australia is effective, frank, targeted messaging to each of the communities at risk is the way to go,” he said. “We can’t say that the battle is won. What keeps that figure down, and what will keep it down into the future, is continual pressure, continual funding and continual active intervention with people at risk of infection.”

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