Incident HIV infection has fallen rapidly in men who have sex with men in Melbourne, Australia (2013–2017) but not in the newly-arrived Asian-born

Abstract

BackgroundWe examined differences in incident HIV infection between newly-arrived Asian-born and other men who have sex with men (MSM) after the introduction of universal HIV treatment guidelines in 2015 and pre-exposure prophylaxis in 2016.MethodsClinical, demographic, laboratory and behavioural data on MSM presenting for HIV testing at the Melbourne Sexual Health Centre from July 2013 to June 2017 were extracted. We compared the proportion of newly-arrived (four years or less in Australia), Asian-born and other MSM tested each year who were diagnosed with incident HIV infection (negative test within one year or diagnosis with indeterminate or negative Western Blot).ResultsWe analysed 35,743 testing episodes in 12,180 MSM, including 2781 testing episodes in 1047 newly-arrived Asian-born MSM. The proportion of other MSM tested each year who were diagnosed with incident HIV infection fell from 0.83% in 2014 to 0.38% in 2017 (p = .001), but did not fall in newly-arrived Asian-born MSM (from 1.18% in 2014 to 1.56% in 2017, p = .76). In the multivariate logistic regression, in 2016/2017 but not in 2014/2015, being newly-arrived Asian-born was associated with an increased odds of diagnosis of incident HIV infection (aOR 3.29, 95%CI 1.82–5.94, p < .001).ConclusionsThe epidemiology of HIV in Melbourne Australia has changed dramatically. While there has been an overall reduction amongst MSM, the incidence of HIV in newly-arrived Asian-born MSM remains high. Failing to address these new inequalities leaves individuals at risk and may offset the population benefit of biomedical HIV prevention.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3325-0) contains supplementary material, which is available to authorized users.

Gaps in the HIV diagnosis and care cascade for migrants in Australia, 2013–2017: A cross-sectional study

“…A review by Tanser and colleagues (2015) also identified poorer HIV diagnosis and care cascades among migrants and found that existing health system structures failed to properly account for migrants who still present late and have poor retention [29]. In Australia, the incidence of HIV in newly arrived Asian-born MSM was found to be higher than other subpopulations [30]. Although Medicare ineligibility is a significant barrier, it is known that migrants are less likely to be offered or less likely to initiate early ART despite having access [31,32].…”

Characteristics of recently arrived Asian men who have sex with men diagnosed with HIV through sexual health services in Melbourne and Sydney

“…Reports suggest recently arrived Asian MSM are an emergent risk group for HIV in Australia 3,4 . In Victoria, of 299 new HIV diagnoses reported in 2017, 125 were of overseas‐born individuals, 60% of whom were born in Asia 5 .…”

The Guttmacher– Lancet Commission on sexual and reproductive health and rights: how does Australia measure up?

“…Enhanced testing for early diagnosis, effective antiretroviral treatment and the recent Pharmaceutical Benefits Scheme listing of pre‐exposure prophylaxis have reduced new HIV infections in high risk populations. This reduction is greatest in men who have sex with men (MSM), a broad term which includes gay‐identified men, heterosexually identified MSM and bisexual men . Significant improvements in early initiation of antiretroviral treatment provide individual as well as public health benefits .…”

“…However, new diagnoses in the Aboriginal and Torres Strait Islander population increased by 41% compared with a decline of 12% in the non‐Indigenous population between 2013 and 2016 . Despite the overall reduction among MSM in major cities, subpopulations such as bisexual men (who may be less likely to access HIV prevention and testing services than gay‐identified MSM) and Asian‐born MSM continue to be at high risk . The decrease in consistent condom use among gay and bisexual men since the introduction of pre‐exposure prophylaxis has led to an increase in the burden of bacterial STIs, particularly rectal chlamydia infections, and warrants attention .…”