Late HIV Diagnoses in Australia and Delayed HIV Testing

Late HIV Diagnoses in Australia and Delayed HIV Testing

Phillip Keen | 19 April 2016

Australian Definitions

2

Late HIV Diagnoses and Delayed HIV Testing

Delayed HIV diagnoses (<350 cells/µl)

– Late HIV diagnoses (200-349 cells/µl)

– Advanced HIV infection (<200 cells/µl)

– Excludes cases with evidence of primary HIV infection (<12 months)

Figure 38: The proportion of late diagnoses in people who report heterosexual sex as an exposure risk, 2010-2014, by sub-category (n=891)

3

TasmaniaNorthern Territory

South AustraliaVictoria

QueenslandNew South WalesWestern Australia

Australian Capital TerritoryMajor cities

Inner regionalOuter regional

Remote and very remoteMale

Female50+

40-4930-39

<30Aboriginal and Torres Strait Islander

Australian-born non-IndigenousSouth East Asia

Sub-Saharan AfricaOther

AustraliaFrom high prevalence country

Heterosexual sex not further specifiedPartner high prevalence country

Partner HIV risk

Coun

try/

regi

on o

f birt

hSe

x

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Source: State and Territory health authorities

2015 Annual Surveillance Report

Proportion of late and advanced HIV diagnoses in MSM, 2005-2014, by exposure category

2005-2006 2007-2008 2009-2010 2011-2012 2013-20140%

10%

20%

30%

40%

50%

60%

70%

26.4% 23.9% 25.3%22.8% 21.4%

14.8%12.3% 12.5% 13.1% 11.3%

Late, MSM and MSMIDU Late, bisexualAdvanced MSM and MSMIDU Advanced, bisexual

Year

Prop

ortio

n (%

)


Figure 37: The proportion of late diagnoses in men who reported sex with men as an exposure risk, 2010-2014, by sub-category (n=3 159)

5

TasmaniaNorthern Territory

South AustraliaVictoria

QueenslandNew South WalesWestern Australia

Australian Capital TerritoryMajor cities

Inner regionalOuter regional

Remote and very remote50+

40-4930-39

<30Aboriginal and Torres Strait Islander

Australian-born non-IndigenousSouth East Asia

Sub-Saharan AfricaOther

AustraliaBisexual*

Male-to-male sex and injecting drug useMale-to-male sex

Age

grou

p (y

ears

)Ex

posu

re m

ale-

to-m

ale

sex

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


* Men who reported male-to-male sex and also sex with women

Contributions to total late diagnoses

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• High rates of late HIV diagnosis among people in non-MSM exposure categories

• Between 2010-2014, 56% of all late HIV diagnoses in Australia were among MSM

• 81% of late HIV diagnoses among MSM were among men who lived in urban areas


Late diagnoses in MSM by exposure sub-category, 2010-2014

Source: The ACCESS project

* Includes men who have sex with men and also sex with women

Bisexual* Male-to-male sex and injecting drug

use

Male-to-male sex All MSM diagnoses0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

41%

26%22%

32%

14%

5%

81%

100%

Proportion late diagnoses Contribution to MSM late diagnoses


Late diagnoses in MSM by State/Territory, 2010-2014


TAS NT SA VIC QLD NSW WA ACT0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%


State/Territory

Prop

ortio

n la

te d

iagn

oses

(%)


Late diagnoses in MSM by location, 2010-2014


Major cities Inner regional Outer regional Remote and very remote

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

23%

37% 39%

29%

82%

11%5%

1%


Region of residence

Prop

ortio

n la

te d

iagn

oses

(%)


Late diagnoses in MSM by country/region of birth, 2010-2014

South East Asia Sub-Saharan Africa

Other Australia0%

10%

20%

30%

40%

50%

60%

70%

37%33%

23% 22%19%

2%

19%

61%


Country/region of birth

Prop

ortio

n la

te d

iagn

oses

(%)


Contributions to total late diagnoses in MSM

11


• Higher rates of late HIV diagnosis among MSM who are:

– Bisexual, MSM+IDU, non-urban, Tas, NT, SA, born in Sub-Saharan Africa or SE Asia

• But most late HIV among MSM were among Australian born men who lived in urban areas

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NSW HIV Strategy 2015 Annual data Report

HIV Viral Load and Stage of Diagnosis

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NSW HIV Strategy 2015 Annual data Report

Diagnosing Doctor/Service


The Seroconversion Study

• Among GBM, multiple reasons why avoided or delayed testing prior to diagnosis• Belief that not done anything ‘risky’

• Fear of being given a positive result

• Structural barriers less commonly nominated as reasons for delaying testing than surveys of GBM

• Less socially connected men more likely to avoid or delay testing

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Experiences of HIV – The Seroconversion Study Final Report 2007-2015

SCS – Time since last negative test among GBM

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SCS – Reasons for delayed testing among GBM

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SCS – Reasons for delayed testing among GBM

Overcoming fear of testing

“I was always too scared to go for a test. And the … first couple of experiences with going for a test was through my family GP that I’d been seeing since I was a teenager, and they didn’t know much about HIV. And they were kind of, I can remember some of the things they’d say to me, like, ‘You're playing Russian roulette.’ I didn’t feel comfortable. And it wasn’t until … I actually did a test through M Clinic, when I actually felt more comfortable knowing the support would be there.”

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ACON Ending HIV Testing Campaign 2016

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•Higher rates of late diagnoses among all other exposure categories, but around half of late diagnoses are among GBM (‘MSM’) who report homosexual contact only in urban areas.

•Addressing psychological barriers to testing

•Raising awareness of HIV testing among GPs in areas of high HIV prevalence

Conclusions

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Late HIV Diagnoses in Australia and Delayed HIV Testing

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