A record high of more than 90% of HIV-positive gay and bisexual men are achieving an undetectable viral load thanks to antiretroviral treatment

UNSW researchers have recorded an “encouraging” major shift towards newer forms of prevention of HIV transmission, thanks to government-funded access programs.

The researchers, from the university’s Centre for Social Research in Health (CSRH) say 92% of HIV-positive gay and bisexual men are taking antiretroviral treatment and achieving an undetectable viral load.

The result is more than 90% of these men can no longer transmit HIV. This is a record high for the third year running.

The Annual Report of Trends in Behaviour 2018 was released by the CSRH at UNSW Sydney, alongside The Kirby Institute’s Annual Surveillance Report in HIV, viral hepatitis and sexually transmissible infections in Australia at the Australasian HIV/AIDS Conference in Sydney.

The report finds the proportion of gay men with casual partners who reported using the HIV prevention tool pre-exposure prophylaxis (PrEP) before sex increased from 1% in 2013 to 5% in 2016 and then to 16% in 2017.

Project leader of the Gay Community Periodic Surveys at CSRH, Professor Martin Holt, said this increase was mostly seen during 2016-2017.

He says this suggests that PrEP uptake was boosted by access to state-funded PrEP programs in NSW, Victoria and Queensland in 2016.

“PrEP and treatment as prevention (TasP) are becoming increasingly popular HIV prevention strategies used by gay and bisexual men, particularly those well connected to the urban gay community networks,” Professor Holt said.

“Now that PrEP is available through the Pharmaceutical Benefits Scheme, the challenge is to achieve greater prevention coverage of all people at risk of HIV, including those who are Medicare-ineligible, in order to achieve targets for the elimination of HIV transmission.”

Key findings from the Gay Community Periodic Surveys show that gay and bisexual men are taking a number of critical steps to negotiate relationships, sex and HIV risk in a changed prevention landscape.

These include:

  • Frequent HIV testing: In 2017, over 40% of non-HIV-positive gay men had at least three tests within the previous year (one HIV test every four months on average).
  • Comprehensive STI testing: In 2017, over half of gay and bisexual men reported comprehensive STI testing (a minimum of one blood sample, urine sample, throat swab and rectal swab each) in the previous year.
  • Regular HIV clinical monitoring: over 60% of HIV-positive gay men had quarterly HIV-related clinical visits in the previous year.
  • Increased STI diagnoses: close to one-in-four HIV-negative gay men and two-in-five HIV-positive gay men reported a STI diagnosis in the previous 12 months.

Lead author of the CSRH report, Associate Professor Limin Mao, says the report shows there is a continued improvement in the health of people living with HIV, which contributes significantly to eliminating HIV transmission.

“Increased reliance on effective biomedical prevention strategies by both HIV-positive and HIV-negative men have brought successes in driving HIV notifications down,” she says.

“This also brings challenges to our health system to take a more holistic approach to a range of priority populations across different settings.”

According to Associate Professor Christy Newman, also from CSRH, these changes provide an opportunity to expand and prioritise future efforts towards the needs of minority groups.

“Many populations have been less well engaged by existing approaches to HIV prevention, including straight-identified men who have sex with men, people from migrant or refugee backgrounds, women, and adolescents and young people,” Associate Professor Newman says.

“We now have an opportunity to think more creatively about overcoming the stigma and taking alternative approaches to better serve beyond urban communities of gay and bisexual men.”