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.
Highlights
We 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 preexposure prophylaxis in 2016
This study aims to examine whether there is any difference in the incidence of HIV infection between newly-arrived Asian-born and the other MSM and if this has changed since the introduction of of treat-all antiretroviral therapy (ART) guidelines in 2015 and the widespread availability of pre-exposure prophylaxis (PrEP) in 2016
We included 2781 HIV tests in 1047 newly-arrived Asian-born men who have sex with men (MSM) and 32,962 HIV tests in 11,133 other MSM performed between 1 July 2013 and 30 June 2017 after excluding first tests in 825 newly-arrived Asian born MSM and 2051 other MSM with no record of prior testing
Summary
We 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 preexposure prophylaxis in 2016. The effectiveness of HIV pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) in interrupting HIV transmission is well established [1, 2]. In Australia, antiretroviral therapy (ART) is publicly funded and has been available to all patients regardless of CD4 cell count or clinical stage since 2015 [8]. Eligibility for Medicare, Australia’s national universal health insurance scheme, is required to access antiretroviral therapy nationally and to access PrEP in Melbourne. Melbourne is a so-called fast-track city and reports progress against the 90–90-90 goals of 90%, 94% and 93% of people living with HIV diagnosed, on ART and with virological suppression respectively [11, 12]
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