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Late HIV Diagnoses in Australia and Delayed HIV Testing

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Drawing upon HIV surveillance data and the Seroconversion Study, this presentation explores reasons for late diagnosis of HIV and barriers to testing among gay men and other MSM in Australia. The presentation was given by Phillip Keen from the Kirby Institute at AFAO's National Gay Men's HIV Health Promotion Conference in April 2016.

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Late HIV Diagnoses in Australia and Delayed HIV Testing

  1. 1. Late HIV Diagnoses in Australia and Delayed HIV Testing Phillip Keen | 19 April 2016
  2. 2. Australian Definitions 2 Late HIV Diagnoses and Delayed HIV Testing Delayed HIV diagnoses (<350 cells/µl) – Late HIV diagnoses (200-349 cells/µl) – Advanced HIV infection (<200 cells/µl) – Excludes cases with evidence of primary HIV infection (<12 months)
  3. 3. Figure 38: The proportion of late diagnoses in people who report heterosexual sex as an exposure risk, 2010-2014, by sub-category (n=891) 3 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Tasmania Northern Territory South Australia Victoria Queensland New South Wales Western Australia Australian Capital Territory Major cities Inner regional Outer regional Remote and very remote Male Female 50+ 40-49 30-39 <30 Aboriginal and Torres Strait Islander Australian-born non-Indigenous South East Asia Sub-Saharan Africa Other Australia From high prevalence country Heterosexual sex not further specified Partner high prevalence country Partner HIV riskState/Territory Placeof residenceSex Agegroup (years) Aborig inal and Torres Strait Island er status Country/regi onofbirth Exposure male-to- malesex Source: State and Territory health authorities
  4. 4. 2015 Annual Surveillance Report Proportion of late and advanced HIV diagnoses in MSM, 2005-2014, by exposure category 26.4% 23.9% 25.3% 22.8% 21.4% 14.8% 12.3% 12.5% 13.1% 11.3% 0% 10% 20% 30% 40% 50% 60% 70% 2005-2006 2007-2008 2009-2010 2011-2012 2013-2014 Proportion(%) Year Late, MSM and MSMIDU Late, bisexual Advanced MSM and MSMIDU Advanced, bisexual Source: State and Territory health authorities
  5. 5. Figure 37: The proportion of late diagnoses in men who reported sex with men as an exposure risk, 2010-2014, by sub-category (n=3 159) 5 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Tasmania Northern Territory South Australia Victoria Queensland New South Wales Western Australia Australian Capital Territory Major cities Inner regional Outer regional Remote and very remote 50+ 40-49 30-39 <30 Aboriginal and Torres Strait Islander Australian-born non-Indigenous South East Asia Sub-Saharan Africa Other Australia Bisexual* Male-to-male sex and injecting drug use Male-to-male sex State/Territory Placeof residence Agegroup (years) Aborigi naland Torres Strait Islande rstatus Country/regio nofbirth Exposure male-to- malesex Source: State and Territory health authorities * Men who reported male-to-male sex and also sex with women
  6. 6. Contributions to total late diagnoses 6 Late HIV Diagnoses and Delayed HIV Testing • High rates of late HIV diagnosis among people in non-MSM exposure categories • Between 2010-2014, 56% of all late HIV diagnoses in Australia were among MSM • 81% of late HIV diagnoses among MSM were among men who lived in urban areas
  7. 7. 2015 Annual Surveillance Report Late diagnoses in MSM by exposure sub- category, 2010-2014 Source: The ACCESS project * Includes men who have sex with men and also sex with women 41% 26% 22% 32% 14% 5% 81% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Bisexual* Male-to-male sex and injecting drug use Male-to-male sex All MSM diagnoses Proportion late diagnoses Contribution to MSM late diagnoses
  8. 8. 2015 Annual Surveillance Report Late diagnoses in MSM by State/Territory, 2010-2014 Source: State and Territory health authorities 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% TAS NT SA VIC QLD NSW WA ACT Proportionlatediagnoses(%) State/Territory Proportion late diagnoses Contribution to MSM late diagnoses
  9. 9. 2015 Annual Surveillance Report Late diagnoses in MSM by location, 2010-2014 Source: State and Territory health authorities 23% 37% 39% 29% 82% 11% 5% 1% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Major cities Inner regional Outer regional Remote and very remote Proportionlatediagnoses(%) Region of residence Proportion late diagnoses Contribution to MSM late diagnoses
  10. 10. 2015 Annual Surveillance Report Late diagnoses in MSM by country/region of birth, 2010-2014 37% 33% 23% 22% 19% 2% 19% 61% 0% 10% 20% 30% 40% 50% 60% 70% South East Asia Sub-Saharan Africa Other Australia Proportionlatediagnoses(%) Country/region of birth Proportion late diagnoses Contribution to MSM late diagnoses Source: State and Territory health authorities
  11. 11. Contributions to total late diagnoses in MSM 11 Late HIV Diagnoses and Delayed HIV Testing • Higher rates of late HIV diagnosis among MSM who are: – Bisexual, MSM+IDU, non-urban, Tas, NT, SA, born in Sub-Saharan Africa or SE Asia • But most late HIV among MSM were among Australian born men who lived in urban areas
  12. 12. NSW HIV Strategy 2015 Annual data Report HIV Viral Load and Stage of Diagnosis 12 Late HIV Diagnoses and Delayed HIV Testing
  13. 13. NSW HIV Strategy 2015 Annual data Report Diagnosing Doctor/Service 13 Late HIV Diagnoses and Delayed HIV Testing
  14. 14. The Seroconversion Study • Among GBM, multiple reasons why avoided or delayed testing prior to diagnosis • Belief that not done anything ‘risky’ • Fear of being given a positive result • Structural barriers less commonly nominated as reasons for delaying testing than surveys of GBM • Less socially connected men more likely to avoid or delay testing Late HIV Diagnoses and Delayed HIV Testing
  15. 15. Experiences of HIV – The Seroconversion Study Final Report 2007-2015 SCS – Time since last negative test among GBM 15 Late HIV Diagnoses and Delayed HIV Testing
  16. 16. Experiences of HIV – The Seroconversion Study Final Report 2007-2015 SCS – Reasons for delayed testing among GBM 16 Late HIV Diagnoses and Delayed HIV Testing
  17. 17. Experiences of HIV – The Seroconversion Study Final Report 2007-2015 SCS – Reasons for delayed testing among GBM 17 Late HIV Diagnoses and Delayed HIV Testing
  18. 18. Overcoming fear of testing “I was always too scared to go for a test. And the … first couple of experiences with going for a test was through my family GP that I’d been seeing since I was a teenager, and they didn’t know much about HIV. And they were kind of, I can remember some of the things they’d say to me, like, ‘You're playing Russian roulette.’ I didn’t feel comfortable. And it wasn’t until … I actually did a test through M Clinic, when I actually felt more comfortable knowing the support would be there.”
  19. 19. ACON Ending HIV Testing Campaign 2016 Social marketing 19 Late HIV Diagnoses and Delayed HIV Testing
  20. 20. • Higher rates of late diagnoses among all other exposure categories, but around half of late diagnoses are among GBM (‘MSM’) who report homosexual contact only in urban areas. • Addressing psychological barriers to testing • Raising awareness of HIV testing among GPs in areas of high HIV prevalence Conclusions 20 Presentation Title // edit 'Header & Footer' to change or remove

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