Publications & Reports

Aiming for 90-90-90 - the importance of understanding the risk factors for HIV exposure and advanced HIV infection in migrant populations and other groups who do not report male-to-male sex.

Peach E, Lemoh C, Stoove M, Agius P, El Hayek C, Higgins N, Hellard M

Abstract

Background: In Australia, new HIV diagnoses increasingly occur among people who do not report male-to-male sex. Among migrants, it is not clear what proportion acquired infection before migration. Similarly, among Australian-born people, it is not clear what proportion acquired infection in-country. There is a need to better understand the epidemiology of HIV in people who do not report male-to-male sex. Methods: Victorian public health surveillance data were used to classify migrants as having likely acquired HIV before or after arrival to Australia using a CD4 cell count decline method to estimate date of infection. Place of exposure for Australian-born people was estimated based on self-report. Factors associated with place of HIV acquisition, advanced infection and newly acquired infection were explored among migrants and among Australian-born people. Results: Between July 1996 and June 2014, there were 821 new non-MSM HIV diagnoses. Most (58%) were migrants, and of these, half (54%) were estimated to have acquired HIV before migration. Among Australian-born people, 27% reported exposure likely occurring abroad; the majority of these were men who reported exposure in South-East Asia. Advanced infection was common in migrants (45%) and Australian-born people (35%). Among migrants, birth in South-East Asia was associated with increased odds of advanced infection. Conclusion: These results highlight the potential vulnerability of migrants after arrival in Australia, especially those from South-East Asia and Sub-Saharan Africa, and that of Australian-born men travelling to these regions. Public health practice must be strengthened to meet prevention needs of these populations in line with Australian policy.

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