HIV prevalence, knowledge of HIV status and unrecognised infection among men who have sex with men in Australia
A. Pedrana1,2, M. Hellard1, K. Wilson3, R. Guy4, G. Prestage5, S. Best3, M. Stoové1
1Burnet Institute, Centre for Population Health, Melbourne, Australia, 2Monash University, Department of Epidemiology & Preventive Medicine, Melbourne, Australia, 3National Serology Reference Laboratory, Melbourne, Australia, 4National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sexual Health Program, Sydney, Australia, 5National Centre in HIV Epidemiology and Clinical Research (NCHECR), HIV Epidemiology and Prevention Program, Sydney, Australia
Background: Australia has seen a resurgence of HIV diagnoses among men who have sex with men (MSM) since 1999, following a decade of declining rates. Unrecognised infections are a risk for ongoing HIV transmission. An important prevention strategy to reduce HIV transmission among MSM is increasing the proportion of men who are aware of their HIV infection, allowing timely diagnoses and clinical care. To date, there have been no studies of HIV prevalence or examinations of unrecognised infections using a biological outcome in Australia.
Methods: In June 2008, we conducted a cross-sectional bio-behavioural study of men attending seven gay-community venues (bars/clubs and sex-on-premises venues) in Melbourne – the second largest city in Australia. Participants self-completed behavioural surveys and self-collected oral fluid specimens. Specimens that were repeatedly reactive for HIV antibodies in the GACELISA were confirmed by western blot.
Results: There were 639 men recruited with a median age of 35 years. The prevalence of HIV was 9.6%, of which 31.1% were unaware of their positive HIV status. Of the unrecognised infections, 68.4% of men reported ever being tested for HIV, with 61.5% reporting a test in the last year. Compared with HIV negative MSM, MSM with unrecognised HIV infection were more likely to report unprotected anal intercourse (OR: 2.05, 95%CI: 0.80-5.27), last HIV test more than 12 months ago (OR: 2.60, 95%CI: 0.85-7.92), and being unsure of their HIV status (OR: 4.4, 95%CI: 1.7-11.7).
Conclusions: These are the first estimates of unrecognised HIV infection among MSM in Australia. The findings highlight the urgent need for health promotion and clinical strategies to increase HIV testing frequency among MSM, particularly those highly sexually active. Timely HIV diagnosis will allow MSM to appropriately modify their sexual risk practices and reduce transmission risks.