Recently released statistics say that HIV rates among gay Australian men have reached a record high. Why are HIV rates continuing to rise among gay men, and what can be done about it?
The Kirby Institute at the University of New South Wales’ Australia Annual Surveillance Report provides statistics that show HIV infections in Australia rose by 10% in the past 12 months. That’s the largest increase in 20 years.
To put that in real terms, last year 1,253 cases of HIV were diagnosed. To compare, in 1999 there were just 719 new diagnoses. Even accounting for better testing methods and better testing uptake, that’s still a troubling increase. The report also suggested that, based on predictors like past figures, researchers believe there may be a further 25% of undiagnosed HIV cases.
The most common method of transmission was unprotected sex among gay men, though there was also a worrying upward trend of HIV transmission in the wider population due to intravenous drug use.
It’s not just HIV infection rates that are worrying Australia’s health officials. The report also showed an increase in a number of sexually transmitted infections, including chlamydia and gonorrhoea.
The report does note, however, that the HPV vaccine appears to have dramatically reduced instances of genital warts among young women aged 21 years or younger, decreasing rates from 12.1% of women in 2007 to 1.1% in 2012. Given that the HPV vaccine can also prevent cervical cancer, this uptake is encouraging.
Yet HIV rates continue to rise, particularly among gay men — and not just in Australia, but among many gay populations in the UK, America and across Europe. Why is this?
Complacency About HIV
One of the main factors appears to be age. One of the main demographics presenting with rising HIV numbers, at least in Australia’s case, appears to be 20-something gay men for whom the AIDS crises of the 80s and early 90s fails to register. As such, they are unlikely to see HIV as lethal as it once was, mindful of how antiretroviral treatments have meant that those infected with HIV can live relatively normal — and, crucially, long — lives.
Professor David Wilson, who conducted the study, is quoted as saying:
“It’s very alarming what’s happening with HIV at the moment. We’ve had over 1,250 cases of HIV recorded, that’s those that have been diagnosed. HIV is no longer the death sentence it once was. With good, effective treatments, it can keep people alive to almost a full life expectancy. So I think it’s perhaps a little bit of complacency that’s set in.”
However, Wilson cautioned that this could be the seeds of another epidemic, with a particular fear that the young Aboriginal population, which was burdened with one of the biggest increases, is particularly at risk, especially because the population has a rising rate of drug use.
While not wanting to scaremonger and risk further stigmatizing those living with HIV, how can health services and governments better educate and help at risk groups when, apparently, the messaging that worked so well in the 80s and 90s has now lost some of its impact?
Condoms Aren’t Necessarily the Only Answer
Pre-Exposure Prophylaxis, or PrEP, is a relatively new HIV prevention method in the form of a daily pill for HIV negative people. It is intended for high risk populations and has shown remarkable effectiveness for reducing HIV infection risk among adult men and women who might contract HIV through sexual activity or intravenous drug use.
The pill is not intended as a sole prevention method and cannot completely cut HIV infection risk, but studies have shown that PrEP can provide 44% additional protection to men who have sex with men who were also receiving comprehensive sexual health care services like HIV testing, condom provision and support for dealing with sexually transmitted infections.
The level of protection offered by PrEP varies dramatically as it is dependent on how regularly subjects use the drug, but in those who have adhered to a daily regimen, the risk of HIV acquisition can be cut by 50% or more, with some studies finding rates in the 80-90% range.
PrEP will not be suitable for all at risk populations and individual circumstances will have to be evaluated, but making such treatments not just available but well publicized may now be key in convincing younger populations and the wider gay community to take preventative measures to help stop HIV infection and transmission because, for a complex set of reasons, they are no longer using condoms.
Also, and drawing a thread from above, improving access and knowledge of the availability of HIV screening and sexual health care are all recommended by health experts. Recognizing, then, that men who have sex with men are not a homogeneous group and instead span a wide variety of demographics, in terms of wealth, education, race and age, can all help to create programs that can specifically answer the needs of individual MSM populations.
Essentially, the key message to emerge here seems to be that a focus solely on condoms is no longer working. Encouraging wider education on HIV/AIDS, stressing the importance of regular HIV testing, and providing better access to cheap PrEP medications may now have to play a more prominent role while reinforcing that considering sexual health isn’t just important for individuals, but is vital for the health of entire communities.
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