HIV is increasing — but the Grim Reaper ad wouldn’t help

Australia’s leading sexual-health experts are calling for an end to complacency as new research reveals HIV diagnoses are increasing at an alarming rate.

The research, released today by The Centre for Social Research in Health and The Kirby Institute at the University of New South Wales, reports that young homosexual males are increasingly likely to engage in unprotected anal intercourse with casual partners and that the number of new HIV diagnoses increased by 10% in 2012 — the largest annual increase since the HIV epidemic of the late 1980s. An estimated 25,708 people were living with a diagnosed HIV infection in Australia at the end of 2012.

Does the 10% increase in diagnoses mean more people are being tested for HIV, or that more people are becoming infected? Associate Professor David Wilson, director of the Kirby Institute, says although some of the increase can be put down to more cases being caught, “better testing simply cannot explain the magnitude of these rising rates”.

In fact, the 2013 Annual Report of Trends in Behaviour, produced by the Centre for Social Research in Health, reports a gradual downward trend in the proportion of gay men who have ever undertaken HIV testing, although the proportion remains above 85% nationally, according to the Gay Community Periodic Surveys (GCPS). The proportion of gay men who reported four or more sexually transmitted infection tests in the previous year increased from just 15.5% in 2003 to 37.1% in 2012.

The Kirby Institute’s Annual Surveillance Report 2013 reports that the rate of new HIV diagnoses has increased every year since 1999 despite a period of consistent decline from 1987-1999. While increases vary by state, only South Australia has remained relatively stable over the last decade. In Queensland, diagnosis rates have increased from 4 cases per 100,000 people during 2003-07 to 4.9 cases per 100,000 people in 2008-12. In Victoria the rate has risen from 5 to 5.3 diagnoses per 100,000 people during the same period, from 3.1 to 4 diagnoses in Western Australia, and from 1.4 to 2.8 cases per 100,000 people in Tasmania. In NSW, the rate of diagnosis declined from 6.3 people infected per 100,000 population in 2003 to 4.7 in 2010, only to climb to 6.2 in 2012.

Of course, diagnosis rates can only be informed by those who undertake testing and treatment. Associate Professor Edwina Wright, an infectious disease physician at the Alfred Hospital and a clinical researcher at the Burnet Institute, estimates that between 5000 and 10,000 Australians infected with HIV don’t know it and are therefore not accessing treatment. An anonymous HIV prevalence study of gay men in Melbourne, published in the Journal of Acquired Immune Deficiency Syndromes, suggests that close to a third of gay men with HIV might not know they have it.

Source: Kirby Institute (2013), “HIV, viral hepatitis and sexual transmissible infection in Australia”

One potential cause of the nationwide increase in new HIV diagnoses is the growing rate of unprotected anal intercourse between casual partners (UAIC), particularly among men aged 25 years or younger. The research, based on GCPS data, concludes that 38.3% of all gay men with casual partners reported UAIC in the preceding six months — a trend that has been gradually and unevenly increasing for 10 years. Significant increases were recorded among those aged 25 or younger, with 35% of respondents reporting UAIC in 2012, compared with 30% in 2003.

Source: Centre for Social Research in Health (2013), “Annual report of trends in behaviour 2013”

Wilson believes young people don’t seem to be hearing the message that people received during the late 1980s and early 1990s. He told Crikey that while educating the general population might not be cost-effective and targeted enough, “we need to fundamentally rethink how we reach young gay men as they come out and start their sexual lives”.

But we don’t necessarily need to return to the controversial Grim Reaper-style campaigns of the late-1980s. Professor John de Wit, director of the National Centre in HIV Social Research at the University of NSW, told Crikey  “there is no evidence whatsoever in any sector of health promotion that shock tactics work, because people get defensive and think that it won’t happen to me. What does work is a more sophisticated dialogue with people that says that HIV might actually affect you personally.”

Thirteen years of increasing HIV diagnosis rates would suggest, however, that that dialogue is not happening. “This underscores the importance of tailored information for younger men who have a different experience of the HIV epidemic and are better reached via different information networks, such as social and electronic media,” de Wit said.

So who does this responsibility fall to? Bill Whittaker, a special representative of the National Association for People Living with HIV/AIDS, says it is the government’s responsibility to make sure the message is being heard. In July Australian health ministers made renewed attempts to address the problem by endorsing targets of reducing the sexual transmission of HIV by 50% and increasing treatment uptake by 90% by 2015.

“The first thing the new government needs to do is put in place a bold national strategy that reflects ambitious prevention and treatment targets. These strategies need to be about getting people to be tested regularly. If they’re positive, then to tell people about the new science and the benefits of treatment and of course, to galvanise the medical health community around new science and to build momentum,” Whittaker told Crikey.