Delayed HIV diagnoses among gay and bisexual men in Australia
The majority of HIV diagnoses including delayed diagnoses in Australia occur among men who report homosexual contact – hereafter called gay and bisexual men (GBM). Delayed diagnosis is strongly associated with increased HIV-related mortality and morbidity. People who are unaware of their HIV-positive status may also be unwittingly transmitting HIV. We assessed trends in delayed HIV diagnoses among GBM in Australia.
Method: National surveillance data on new HIV diagnoses among GBM in the years 2002-11 were analysed. The number and proportion of diagnoses defined as late (a CD4+ cell count of 200 to 349 cells/μl at diagnosis), and advanced (<200 CD4+ cells/μl at diagnosis) is reported. A Chi-square test was used to assess trends in these two categories.
Results: A total of 6,725 HIV diagnoses in GBM were notified in the 10-years 2002-11. The number of diagnoses in GBM increased over time, from 592 in 2002 to 675 in 2006 and 801 in 2011. Of all diagnoses in GBM, 11.9% were defined as advanced, remaining steady over-time at 11.7% in 2002, to 12.7% in 2006 and 11.1% in 2011, with no significant trend (ptrend=0.593). A lower proportion of diagnoses in GBM were defined as late (9.8%), but diagnoses in this category increased steadily from 8.4% in 2002 to 11.3% in 2006 and 13.1% in 2010, with a decline in 2011 to 6.9%. There was a significant increasing trend in the proportion of HIV diagnoses defined as late over the period 2002-11 (ptrend=0.038).
Conclusion: An increasing proportion of HIV diagnoses among GBM were late diagnoses. The pattern of late diagnosis may be affected by patterns of antibody testing. A CD4+ count of 200-350 generally reflects an average time of around 4-7 years since initial infection. Services that offer more convenient and acceptable options for HIV testing may be needed to reduce delayed diagnoses among GBM.
