Urgent action needed to increase HIV testing rates

The AMA Position Statement on Sexual and Reproductive Health 2014, released today, stresses the need to improve policy coordination, overcome gaps in service provision, and increase investment in prevention and treatment.

AMA President, A/Prof Owler, said today that Australia’s response to HIV is at a crossroads, with the rate of new infections at the highest level in 20 years.

“In the face of increasing rates of HIV infection, a business-as-usual approach is not enough.

“Testing rates have declined, rates of unprotected sex and high-risk sexual behaviour have increased, and a significant number of those infected with HIV are not receiving treatment.

“Despite Australia’s earlier gains in combatting the spread of HIV, governments have been slow to adapt to new challenges and changing demographics.

“There are persisting and growing gaps in testing, and access to affordable treatments and clinical care.

“There is a growing gap between the demand for clinical HIV services and their supply, with too many people missing out on essential treatment.

“The Federal Government can address this by increasing the Medicare rebates for services provided by Sexual Health Medicine Specialists, as recommended by its Medical Services Advisory Committee.”

A/Prof Owler said the AMA welcomes the release of new national strategies on HIV, sexually transmissible infections, and blood-borne viruses, which have been endorsed by the Commonwealth and all State and Territory Health Ministers.

“For the first time, the national strategies include targets that provide an impetus for action and a framework for accountability,” A/Prof Owler said.

“The AMA commends the Government’s commitment to halving new HIV infections by 2015, and ending new infections by 2020.

“But to reach these goals, we must act now.

“We urgently need an implementation action plan and government investment if we are to turn aspirational targets into a reality.

“This must include a focus on reducing inequities and engaging with communities experiencing higher infection rates and poorer health outcomes.

“These include men who have sex with other men, Aboriginal people and Torres Strait Islanders, and people living in rural and remote areas.

“Targets can only be met if public and private sector Sexual Health Medicine specialist services are properly resourced by governments.”

The AMA Position Statement on Sexual and Reproductive Health 2014 is available at https://ama.com.au/position-statement/sexual-and-reproductive-health

Background

• Over the past decade, annual notification rates of HIV and other sexually transmissible infections (STIs) have steadily increased in Australia, with the rate of new HIV infections reaching the highest level in 20 years; new diagnoses of HIV have increased by 70 per cent since 1999.
• The majority (75 per cent) of new HIV cases in Australia occur among men who have sex with men. Of new HIV infections attributed to heterosexual contact, around half were in people born in Sub-Saharan Africa and South-East Asia.
• There has been a decline in testing rates among those at risk of HIV infection. Between 14 and 30 per cent of individuals (up to 10,000 Australians) with HIV remain undiagnosed, and a significant proportion of those who are at high risk of infection are not regularly tested.
• A disproportionate number of new HIV infections are transmitted from people who are undiagnosed.
• The average time between HIV infection and diagnosis is too long: the Kirby Institute estimates the median time is four years. Between 2008 and 2012, 39.3 per cent of people diagnosed with HIV in Australia were classed as late diagnoses, and 15 per cent were diagnosed with advanced HIV disease.
• An estimated 30 to 50 per cent of people who know they are living with HIV are not receiving antiretroviral treatment. A proportion of these people are either not linked to HIV care or are not retained in care (NB Australia has committed to achieving 90 per cent treatment uptake by 2015).
• Starting treatment early can play an important role not only in improving long term health outcomes for individuals, but also in reducing the risk of HIV transmission by dropping the carrier’s viral load.
• Aboriginal people and Torres Strait Islanders experience poorer sexual and reproductive health outcomes than other Australians, including substantially higher rates of STIs (esp. chlamydia, gonorrhoea, syphilis and hepatitis B).
• Although HIV prevalence is similar to the wider population, the number of new infections is at the highest level since 1992, and Indigenous people are regarded as being at particular risk of HIV infection due to higher rates of STIs, limited access to health care, patterns of risk-taking behavior (e.g. higher rates of injecting drug use), and over-representation in prisons and juvenile detention.
• Traditional safe sex messages are losing traction, as reflected in increased rates of unprotected casual sex, particularly among men who have sex with other men, and those aged under 25.

18 July 2014

CONTACT:        John Flannery                     02 6270 5477 / 0419 494 761

                            Sanja Novakovic                 02 6270 5478