Australia Is Closing The Gay-Straight HIV Gap

Recent Australian research revealed good news around HIV prevention. Gay and bisexual men are driving a sharp decline in new HIV transmissions in Australia — a 30 percent drop in just five years — according to the Kirby Institute’s 2018 HIV Surveillance Report.

“It’s the lowest number we’ve seen in 18 years,” said Rebecca Guy, head professor of the institute’s Surveillance, Evaluation and Research program, in a report in The Sydney Morning Herald. Guy attributed the drop to the increase of pre-exposure prophylaxis (PrEP) use, regular testing, and treatment efforts. PrEP is highly effective at making HIV transmission nearly impossible. 

However, the report did not reveal good news for straights folks Down Under.

HIV rates among straight men and women are holding steady in Australia, and account for roughly 200 new cases every year. Traditionally, heterosexuals have accounted for roughly one in five of all HIV diagnoses annually, but now — just as gay and bisexual men are curbing their HIV rates in the country — their rate has risen to one in four.

One issue is that testing rates are significantly lower among heterosexuals. Only an estimated one in three heterosexual people had been tested for HIV in their lifetime in Australia. This results in a large numbers of people living with HIV for years before they are diagnosed, raising the risk of unknowingly transmitting the virus to their sexual partners, according to Kirby’s data.

Guy adds that the dramatic decline was the result of the "incredible commitment" of government, healthcare workers, the community and researchers.

"More people are being tested for HIV than ever, people living with HIV are starting treatment earlier, and we’re seeing a very promising uptake of [PrEP] among gay and bisexual men," she said.

Head of the Kirby Institute’s HIV Epidemiology and Prevention Program Professor Andrew Grulich said the combination of these strategies “had turned the HIV epidemic in gay and bisexual men around in this country”.

Truvada, the only approved PrEP method in both Australia and the United States, is a daily pill taken by HIV-negative people to prevent transmission of HIV. Truvada has been available by prescription on the Pharmaceutical Benefits Scheme (PBS) since April 2018, and would have otherwise cost individuals $2496 a year. Roughly 41 percent of gay men at high risk of acquiring HIV in Australia were on PrEP. That number needs to rise to at least 75 percent to eliminate HIV transmission, according to Kirby’s modeling.

Among Indigenous Australians, there was no reduction in HIV, according to the report. Associate professor James Ward, head of the Infectious Diseases Research Program for Aboriginal Health at the South Australian Institute for Health and Medical Research, said more needed to be done to overcome the inequities in HIV prevention, detection, and treatment.

“We need targeted, culturally appropriate, community-focused campaigns to increase testing and treatment and PrEP, and we need to focus on increasing awareness, both within the community and among healthcare providers,” said Ward.

The Australian federal government also recently listed new medicines to treat HIV on PBS that would otherwise cost up to $10,800.