HIV risks increased by trend towards late diagnosis, researcher warns

FEBRUARY 24 2019

An alarming and unneccesary number of late-term diagnoses stands in the way of Australia eliminating transmission of HIV, according to a leading researcher.

Key points:

• More than a third of HIV diagnoses in Australia in 2017 were classed as late
• A leading researcher and people with HIV are concerned about the trend
• Home testing kits are being touted as a potential solution

Professor Steve Wesselingh from the South Australian Health and Medical Research Institute (SAHMRI) said a persistent number of HIV patients were being diagnosed late.

The trend is illustrated by the latest set of figures profiling HIV in Australia, which show 937 new HIV diagnoses in 2017, down from 1,013 in 2016.

Of those new cases, 36 per cent were classed as late, which can result in patient health being unnecessary compromised.

In a few rare instances, doctors have seen new cases of the opportunistic infections that once killed people prior to the advent of effective HIV treatments.

“That is a real pity, because in modern HIV management we can prevent that from happening with someone who comes to us early,” Professor Wesselingh said.

“Someone who comes to us early never has to experience what people experienced in the 1980s and ’90s.

“Your health is going to be a little bit worse off if you get treated late.”

PHOTO: Professor Wesselingh says late diagnoses pose a public health risk. (ABC News: Simon Royal)

Professor Wesselingh said late diagnoses could also pose a potential public health risk.

“The big problem with not knowing you are HIV positive is that you can then put other people at risk,” he said.

“We now know if we get you on treatment, get your viral load down to undetectable, then you don’t pose a transmission risk and that is one of the great public health outcomes of HIV treatment.”

Overall success in treating and containing the spread of the virus has helped to mask the problem, Professor Wesselingh said.

“I actually think it’s been bubbling away for a while,” he said.

“Because we’ve become so successful at early testing and early outpatient treatment [of HIV] this particular group of patients have become much more obvious.”

Service cuts could make problem worse

South Australia has the highest rate of late HIV diagnoses among men who have sex with men — a situation that angers Adelaide resident Hayden Patterson.

Mr Patterson found out he was HIV positive in 2006 and expects to live a long and full life, thanks to the medication he takes every day.

“It’s one tablet and it’s the size of a horse tablet, but it works,” Mr Patterson said.

“I take better care of my health now, and I expect to live until my 70s or 80s.”T

Eve van Grafhorst was almost three when she was diagnosed with HIV in 1985. Then she was banned from childcare, and eventually her family was hounded to New Zealand where they started a new life.

Mr Patterson noted that both Labor and Liberal state governments had cut budgets for specialist HIV services, and said he believed that helped explain the state’s rate of late diagnoses amongst gay men.

“I didn’t come out until I was 26, I grew up a Mormon so there are a lot of issues with that … you don’t necessarily want to go and sit in the waiting room with people of mixed sexual orientations,” he said.

“Because all of those services have now been mainstreamed, if you are a young kid, or even someone in their late 30s and coming out, you might be less likely to go somewhere you are going to be outed.”

Professor Wesselingh believes demographic and social factors are at play.

“I think there are some groups that are perhaps a little more common in South Australia and they are people who are from countries where there is a lot of HIV who are coming to South Australia but who are not getting the education around early testing,” he said.

“I also think there are people in South Australia, particularly men who have sex with men, who are a little bit isolated from the general gay community and therefore don’t get that education about testing.”

Home testing could help ‘eliminate’ transmissionP

It is not, however, just a small cohort of isolated gay men who are adversely affected by late diagnoses.

Tasmanian man Robert Mitchell, from the National Association of People Living with HIV, is concerned about the number of women, culturally and linguistically diverse people and Aboriginal Australians who show higher rates of late-term diagnosis.

“All this is about people’s access to treatment and their awareness of HIV,” Mr Mitchell said.

One problem is that people who do not see themselves at risk of HIV do not embrace early testing, or any of the medications that prevent HIV infection.

Mr Mitchell said there was no single solution to that.

He would like to see new public awareness campaign, but both Mr Mitchell and Professor Wesselingh want authorities to move quickly and register the use of HIV home testing kits.

Professor Wesselingh said slashing rates of late HIV detection would help put Australia on track for an historic achievement.

“We actually believe if we do all of this right, if we find all of the people who are positive … that we can virtually eliminate HIV transmission in Australia. It’s incredibly exciting.”

https://www.abc.net.au/news/2019-02-24/hiv-risks-increased-by-trend-towards-late-diagnosis/10843160