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New South Wales reports record drop in HIV diagnoses: fewest this year since records began
Gus Cairns, 2017-08-25 08:50:00
Australia’s most populous state, New South Wales (NSW), has reported
a steep drop in HIV diagnoses in gay and other men who have sex with men (MSM) in the
last year, and particularly since the beginning of 2017. This is despite an
equally notable increase in HIV testing, which took
a sharp upward turn around March 2016, at the time the EPIC-NSW demonstration study
of PrEP started in the state. The quarterly figures for HIV diagnoses reported
in 2017 are the lowest since records began in 1985.
These declines are seen as vindications of NSW’s policy which aims to virtually eliminate HIV transmission by 2020. This combines increasing HIV
testing (including distributing self-sampling kits), the PrEP study, and rapid
referral and treatment of those diagnosed.
The strategy also includes education campaigns about the effectiveness
of testing and treatment: this has resulted in the proportion of people in
opinion surveys who agreed with the statement “HIV treatments significantly
reduce the risk of passing on HIV” from 33% in February 2013 to 83% in
September 2016. There was an increase during the same period from 48% to
86% in the proportion of people agreeing
that “Everything has changed, we can now dramatically reduce HIV transmission.”
Nonetheless, 94% of people in September 2016 still agreed that “condoms
continue to be the most effective way of preventing HIV transmission”, a virtually
unchanged proportion from 2013.
Particularly notable is a large drop in recent HIV
infections in MSM. HIV infections that were determined to be less than three
months old by an incidence assay declined by 40% in the first half of 2017, relative
to recent infections in the first halves of the years 2013-16. And there was a
58% decline in the proportion of gay men diagnosed with HIV who had had a
negative test in the previous twelve months.
Ninety-five per cent of people who have been diagnosed are on
treatment, with 59% placed on antiretroviral therapy within six weeks of diagnosis,
and of those on treatment, 94% are virally undetectable.
In contrast, the absolute number of infections in
heterosexuals remained steady between 2011 and mid-2016 but actually increased in
the last year. The proportion of people diagnosed who were heterosexuals
increased by 46% relative to the average number in the previous five years, as diagnoses in MSM have
There was also an increase in the proportion of people
diagnosed with advanced HIV infection (with a CD4 count of below 200 cells/mm3),
including amongst MSM. The average age of people diagnosed with advanced HIV
has increased in the last two years due to a sharp increase in late diagnoses
in people aged over 50.
People born overseas, including MSM, have also seen no
decrease in diagnoses.