Abstract
IntroductionWe conducted a detailed analysis of trends in new HIV diagnoses in Australia by country of birth, to understand any changes in epidemiology, relationship to migration patterns and implications for public health programs.MethodsPoisson regression analyses were performed, comparing the age-standardised HIV diagnosis rates per 100,000 estimated resident population between 2006–2010 and 2011–2015 by region of birth, with stratification by exposure (male-to-male sex, heterosexual sex–males and females). Correlation between the number of permanent and long-term arrivals was also explored using linear regression models.ResultsBetween 2006 and 2015, there were 6,741 new HIV diagnoses attributed to male-to-male sex and 2,093 attributed to heterosexual sex, with the proportion of diagnoses attributed to male-to-male sex who were Australian-born decreasing from 72.5% to 66.5%. Compared with 2006–2010, the average annual HIV diagnosis rate per 100,000 in 2011–15 attributed to male-to-male sex was significantly higher in men born in South-East Asia (summary rate ratio (SRR) = 1.37, p = 0.001), North-East Asia (SRR = 2.18, p<0.001) and the Americas (SRR = 1.37, p = 0.025), but significantly lower as a result of heterosexual sex in men born in South-East Asia (SRR = 0.49, p = 0.002), Southern and Central Asia (SRR = 0.50, p = 0.014) and Sub-Saharan Africa (SRR = 0.39, p<0.001) and women born in South-East Asia (SRR = 0.61, p = 0.002) and Sub-Saharan Africa (SRR = 0.61, p<0.001). Positive associations were observed between the number of permanent and long-term arrivals and HIV diagnoses particularly in relation to diagnoses associated with male-to-male sex in men from North Africa and the Middle East, North Asia, Southern and Central Asia and the Americas.ConclusionThe epidemiology of HIV in Australia is changing, with an increase in HIV diagnosis rates attributed to male-to-male sex amongst men born in Asia and the Americas. Tailored strategies must be developed to increase access to, and uptake of, prevention, testing and treatment in this group.
Highlights
We conducted a detailed analysis of trends in new HIV diagnoses in Australia by country of birth, to understand any changes in epidemiology, relationship to migration patterns and implications for public health programs
Compared with 2006–2010, the average annual HIV diagnosis rate per 100,000 in 2011–15 attributed to male-to-male sex was significantly higher in men born in South-East Asia (summary rate ratio (SRR) = 1.37, p = 0.001), North-East Asia (SRR = 2.18, p
Migrants from high prevalence countries such as in SubSaharan Africa have been the most affected, but emerging evidence from Europe suggests this is changing, with decreases in HIV diagnoses attributed to heterosexual exposure in African migrants and increases in new HIV diagnoses attributed to male-to-male sex in Latin American migrants [1, 2]
Summary
Poisson regression analyses were performed, comparing the age-standardised HIV diagnosis rates per 100,000 estimated resident population between 2006–2010 and 2011–2015 by region of birth, with stratification by exposure (male-to-male sex, heterosexual sex–males and females). Under procedures described previously [7], all new HIV diagnoses in Australia are first notified by laboratories and/or doctors to State and Territory health authorities, who analyse and report this data to the National HIV Registry, maintained by the Kirby Institute at UNSW Sydney on behalf of the Australian Government Department of Health [8]. Data extracted from the National HIV Registry for this analysis were year and age at diagnosis, sex, country of birth (routinely collected from 2002), mode of exposure to HIV (males who have sex with males (MSM); MSM with dual risk of injecting drug use (IDU); heterosexual sex; and other/undetermined exposure, including mother-to-child transmission, direct blood/tissue exposure, and iatrogenic exposure, likely place of acquisition (Australia or overseas) and year of arrival in Australia. The ABS has primary responsibility in Australia for collection of population data
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