Register      Login
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
RESEARCH ARTICLE

Testing for HIV among men who have sex with men needs a paradigm shift in Australia, given the minimal increase between 2003 and 2013 in Melbourne, Australia

An-Chieh Lin A B , Christopher K. Fairley A C , Krishneel Dutt A B , Karen M. Klassen A D , Marcus Y. Chen A C , Glenda Fehler A , Matthew Law E , Catriona S. Bradshaw A C , Ian Denham A , Tim R. H. Read A C and Eric P. F. Chow A C F
+ Author Affiliations
- Author Affiliations

A Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia.

B Melbourne Medical School, The University of Melbourne, Level 2 West, Medical Building (181), Vic. 3010, Australia.

C Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 89 Commercial Road, Melbourne, Vic. 3004, Australia.

D Northwest Academic Centre, DX212695, The University of Melbourne, Sunshine Hospital, PO Box 294, 176 Furlong Road, St Albans, Vic. 3021, Australia.

E The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia.

F Corresponding author. Email: echow@mshc.org.au

Sexual Health 12(5) 373-382 https://doi.org/10.1071/SH14167
Submitted: 26 August 2014  Accepted: 5 May 2015   Published: 20 July 2015

Abstract

Background: Increasing the frequency of HIV testing in men who have sex with men (MSM) will reduce the incidence of HIV. Trends in HIV testing among MSM in Melbourne, Australia over the last 11 years have been investigated. Methods: A retrospective study was conducted using electronic medical records of the first presentation of MSM who attended the Melbourne Sexual Health Centre between 2003 and 2013. Factors associated with HIV testing (year, demographic characteristics and sexual practices) were examined in multivariable logistic regression analyses. Jonckheere–Terpstra tests were used to examine the significance of trends in the mean time since the last HIV test. Results: Of 17 578 MSM seen; 13 489 attended for the first time during the study period. The proportion of first attendances who had previously tested and reported a HIV test in the last 12 months increased from 43.6% in 2003 to 56.9% in 2013 (adjusted ptrend = 0.030), with a corresponding decrease in median time since the last HIV test from 19 months [interquartile range (IQR) 6–42] in 2003 to 10 months (IQR4–24) in 2013 (ptrend <0.001). The proportion of high-risk MSM (who reported unprotected anal intercourse and/or >20 partners in 12 months) who reported an HIV test in the last 12 months was unchanged (ptrend = 0.242). Conclusions: Despite HIV testing becoming more frequent, the magnitude of change over the last decade is insufficient to substantially reduce HIV incidence. A paradigm shift is required to remove barriers to testing through strategies such as point-of-care rapid testing or access to testing without seeing a clinician.

Additional keyword: HIV testing.


References

[1]  The Kirby Institute. HIV, viral hepatitis and sexually transmissable infections in Australia Annual Surveillance Report 2013. Sydney: The Kirby Institute, the University of New South Wales; 2013.

[2]  Department of Health and Ageing-Medicines Australia. Trends in and drivers of Pharmaceutical Benefits Scheme expenditure: report for the Access to Medicines Working Group. Canberra: Department of Health and Ageing-Medicines Australia; 2013.

[3]  Department of Health and Ageing Australian Government. Sixth national HIV strategy 2010–2013. Canberra: Department of Health and Ageing Australian Government; 2010.

[4]  Department of Health Australian Government. 2011 national HIV testing policy. Canberra: Department of Health Australian Government; 2011.

[5]  STI’s in Gay Men Action Group. Australian sexually transmitted infection & HIV testing guidelines 2014. Sydney, Australia: STI’s in Gay Men Action Group; 28 April 2014. Available online at: http://stipu.nsw.gov.au/wp-content/uploads/STIGMA_Testing_Guidelines_Final_v5.pdf [verified 30 April 2014].

[6]  Apoola A, Ahmad S, Radcliffe K. Primary HIV infection. Int J STD AIDS 2002; 13 71–8.
Primary HIV infection.Crossref | GoogleScholarGoogle Scholar | 11839160PubMed |

[7]  Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States - implications for HIV prevention programs. J Acquir Immune Defic Syndr 2005; 39 446–53.
Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States - implications for HIV prevention programs.Crossref | GoogleScholarGoogle Scholar | 16010168PubMed |

[8]  Wilson DP, Hoare A, Regan DG, Law MG. Importance of promoting HIV testing for preventing secondary transmissions: modelling the Australian HIV epidemic among men who have sex with men. Sex Health 2009; 6 19–33.
Importance of promoting HIV testing for preventing secondary transmissions: modelling the Australian HIV epidemic among men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 19254488PubMed |

[9]  Marks G, Crepaz N, Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS 2006; 20 1447–50.
Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA.Crossref | GoogleScholarGoogle Scholar | 16791020PubMed |

[10]  de Wit J, Mao L, Holt M, Treloar C. HIV/AIDS, hepatitis and sexually transmissible infections in Australia: annual report of trends in behaviour 2013. Sydney: Centre for Social Research in Health, The University of New South Wales; 2013.

[11]  Jin FY, Prestage G, Law MG, Kippax S, Van de Ven P, Rawsthorne P, Kaldor JM, Grulich AE. Predictors of recent HIV testing in homosexual men in Australia. HIV Med 2002; 3 271–6.
Predictors of recent HIV testing in homosexual men in Australia.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38noslymsA%3D%3D&md5=bc40b1ab9729915230393a9f1c813eb1CAS | 12444945PubMed |

[12]  Zablotska I, Holt M, de Wit J, McKechnie M, Mao L, Prestage G. Gay men who are not getting tested for HIV. AIDS Behav 2012; 16 1887–94.
Gay men who are not getting tested for HIV.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC38rosVyltA%3D%3D&md5=422309f4462162c97e42f6b7ac71e8efCAS | 22538372PubMed |

[13]  Tideman RL, Chen MY, Pitts MK, Ginige S, Slaney M, Fairley CK. A randomised controlled trial comparing computer-assisted with face-to-face sexual history taking in a clinical setting. Sex Transm Infect 2007; 83 52–6.
A randomised controlled trial comparing computer-assisted with face-to-face sexual history taking in a clinical setting.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2s%2FnvVKhsA%3D%3D&md5=7e69ae5c4fa4b46f4e32fab69ef0acc7CAS | 17098771PubMed |

[14]  Oster AM, Johnson CH, Le BC, Balaji AB, Finlayson TJ, Lansky A, Mermin J, Valleroy L, MacKellar D, Behel S, Paz-Bailey G. Trends in HIV prevalence and HIV testing among young MSM: five United States cities, 1994–2011. AIDS Behav 2014; 18 237–47.
Trends in HIV prevalence and HIV testing among young MSM: five United States cities, 1994–2011.Crossref | GoogleScholarGoogle Scholar |

[15]  Australian Bureau of Statistics. 2011 Census QuickStats. Canberra: Australian Bureau of Statistics; 2013 [updated 28 March 2013; cited 27 June 2014].

[16]  Grulich AE, De Visser RO, Smith AMA, Rissel CE, Richters J. Sex in Australia: homosexual experience and recent homosexual encounters. Aust N Z J Public Health 2003; 27 155–63.
Sex in Australia: homosexual experience and recent homosexual encounters.Crossref | GoogleScholarGoogle Scholar | 14696706PubMed |

[17]  Prestage G, Ferris J, Grierson J, Thorpe R, Zablotska I, Imrie J, Smith A, Grulich AE. Homosexual men in Australia: population, distribution and HIV prevalence. Sex Health 2008; 5 97–102.
Homosexual men in Australia: population, distribution and HIV prevalence.Crossref | GoogleScholarGoogle Scholar | 18588772PubMed |

[18]  Bavinton BR, Brown G, Hurley M, Bradley J, Keen P, Conway DP, et al Which gay men would increase their frequency of HIV testing with home self-testing? AIDS Behav 2013; 17 2084–92.
Which gay men would increase their frequency of HIV testing with home self-testing?Crossref | GoogleScholarGoogle Scholar | 23525790PubMed |

[19]  Chan DJ. Factors affecting sexual transmission of HIV-1: current evidence and implications for prevention. Curr HIV Res 2005; 3 223–41.
Factors affecting sexual transmission of HIV-1: current evidence and implications for prevention.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2MXmsVKls7w%3D&md5=3fc0d4b2e6037b80aa3ec0392de35873CAS | 16022655PubMed |

[20]  Prestage GMP, Hurley M, Bradley J, Down I, Brown G. Pleasure and sexual health: the PASH study, 2009. Sydney: National Centre in HIV Epidemiology and Clinical Research; 2010.

[21]  Pell C, Donohoe S, Conway D.. Health care services for men who have sex with men in different Australian states and territories since the emergence of HIV. Sex Health 2008; 5 161–8.
Health care services for men who have sex with men in different Australian states and territories since the emergence of HIV.Crossref | GoogleScholarGoogle Scholar | 18588781PubMed |

[22]  Barber B, Hellard M, Jenkinson R, Spelman T, Stoove M. Sexual history taking and sexually transmissible infection screening practices among men who have sex with men: a survey of Victorian general practitioners. Sex Health 2011; 8 349–54.
Sexual history taking and sexually transmissible infection screening practices among men who have sex with men: a survey of Victorian general practitioners.Crossref | GoogleScholarGoogle Scholar | 21851775PubMed |

[23]  Conway DP, Holt M, McNulty A, Couldwell DL, Smith DE, Davies SC, Cunningham P, Keen P, Guy R. Multi-centre evaluation of the Determine HIV combo assay when used for point of care testing in a high risk clinic-based population. PLoS One 2014; 9 e103399
Multi-centre evaluation of the Determine HIV combo assay when used for point of care testing in a high risk clinic-based population.Crossref | GoogleScholarGoogle Scholar |

[24]  Fox J, Dunn H, O’Shea S. Low rates of p24 antigen detection using a fourth-generation point of care HIV test. Sex Transm Infect 2011; 87 178–9.
Low rates of p24 antigen detection using a fourth-generation point of care HIV test.Crossref | GoogleScholarGoogle Scholar | 21084439PubMed |