A new Burnet Institute-led study has identified significant gaps in the rates of HIV diagnosis and treatment in Australia among migrant populations and overseas-born gay and bisexual men, compared to non-migrants.
The research shows that while Australia is on track to meet UNAIDS global HIV testing, treatment, and viral suppression targets, the rates of testing and treatment of migrants reporting male-to-male HIV exposure, migrants from South-East Asia, and migrants who are Medicare ineligible is lagging.
When someone is receiving treatment and has their HIV suppressed they cannot pass the virus on to others, and current prevention strategies rely heavily on early diagnosis and treatment of people living with HIV.
Study lead author, Burnet researcher Dr Tafireyi Marukutira, said this inequality in diagnosis and treatment represents an important gap in Australia's HIV response.
"The data shows Australia meets the UNAIDS 90-90-90 targets in 2020 - with at least 90 percent of people estimated to be living with HIV knowing their HIV status, 90 percent of these people receiving treatment, and 90 percent of those on treatment experiencing viral suppression," Dr Marukutira said.
"That's the good news. The problem is that since 2012, we've had an average of 1000 new infections in Australia every year. While the trend is going down, it is not going down as fast as our progress towards the UNAIDS 90-90-90 targets. We asked ourselves, if we are reaching 90-90-90 that fast, shouldn't we be seeing a significant decline in new HIV infections already?
"So we took a closer look at these key sub-populations and what we found confirmed our thinking, that migrants had lower rates of testing, diagnosis and treatment, exposing a big gap in the HIV prevention cascade resulting in fewer migrants living with HIV who have suppressed virus."
One of the starkest differences is between migrant and non-migrant gay and bisexual men. In 2018, only 66 percent of migrants reporting male-to-male HIV exposure achieved viral suppression compared to 85 precent of non-migrants reporting male-to-male HIV exposure.
Dr Marukutira said the study underscores the need for targeted public health and awareness campaigns to:
- Encourage migrants, especially those who are gay and bisexual men and from Southeast Asia to get tested early and frequently
- Encourage GPs to think proactively about offering an HIV test for patients who may benefit
- Address stigma as a serious and ongoing barrier to testing, and
- Promote the availability of specialist community clinics, which provide free HIV testing and treatment
"The first question people need to ask themselves is, 'am I at risk?' Testing is the gateway to HIV prevention, so know your risk profile, and when and how to get an HIV test irrespective of who or where you are," Dr Marukutira said.
"Overseas students need to know what their health insurance covers. When it comes to HIV care, even in the absence of health insurance, health care facilities have access to compassionate programs, which may cover them.
"So if you feel you are at risk for a sexually transmitted infection including HIV, get tested anyway. If you're positive, the health care facilities will assist you wherever possible to access treatment."
Supervising co-author, Burnet Institute Head of Public Health, Professor Mark Stoové said that while migrants and foreign students have been slow to get tested, once on treatment their rates of viral suppression are very strong, which can prevent onward HIV transmission ('U=U'- undetectable means untransmissible).
"People need to know their HIV risk profile, get an HIV test and prioritise their health and wellbeing, knowing that with suppression of the virus, they can live long and fulfilling lives," Professor Stoové said.
"In the HIV epidemic response, it's about not leaving anyone behind."
This study, published in the journal PLOS Medicine, was conducted in collaboration with Monash University, the Kirby Institute, UNSW and University of Melbourne.
