The future face of HIV in Australia

The profile of people living with HIV in Australia is set to change significantly over the next decade. Among these changes are increases in new HIV infections; increases in the number of older men and women living with HIV; and a greater proportion of people with HIV living outside major metropolitan areas.

These changes are analysed in a new report “Mapping HIV outcomes: geographical and clinical forecasts of numbers of people living with HIV in Australia”, to be released during this week’s Australasian Sexual Health Medicine conference in Sydney.

The work was commissioned by the National Association of People Living with HIV (NAPWA), and compiled by a team of mathematical modelling researchers at the National Centre in HIV Epidemiology and Clinical Research (NCHECR), at the University of New South Wales. It has showed that the largest expected increase in HIV-positive populations will be in Queensland and Victoria. This reflects projected population movements and increases in new HIV infections in those states.

At present, the PLHIV population is mostly found in the central areas of the major capital cities and on the coast between Sydney and Brisbane.

Forecasts suggest that Australia needs to plan for a one-third increase in the total number of people living with HIV (PLHIV), from about 21,000 nationally now to about 28,000 in 2020; an ageing HIV-positive population, with 44% over the age of 55 compared to 26% currently; and increasing numbers of them living outside major metropolitan areas.

“The ageing of PLHIV is largely due to the life-prolonging impact of effective antiretroviral treatments but also a trend towards people being older when they become infected”, said A/Professor David Wilson, head of the NCHECR’s Surveillance and Epidemiology Program for Public Health. “Most PLHIV can now have life expectancies close to the uninfected population if they are regularly monitored by their doctors and take antiretroviral treatment as recommended.”

“The expected rise in the average age of Australians living with HIV will present challenges for health providers, as age-related medical issues such as cancer, frailty and other morbidities start to increase,” A/Professor Wilson said.

“Movement of people with HIV away from traditional population centres will also require the health system to focus more on the HIV care needs of people living in non-metropolitan settings.”

Commissioned by the National Association of People Living with HIV/AIDS (NAPWA), these forecasts are valuable to guide the planning of high quality treatment, care and support services for people living with HIV throughout metropolitan and regional Australia.

Key findings:

• The total number of people living with diagnosed HIV in Australia is estimated to be 20,956 in 2010. By 2020, the total number of people living with diagnosed HIV in Australia is predicted to be 28,422 (that is, a 36% increase). This does not account for the 10-20% of HIV infections that are thought to be undiagnosed.
• New South Wales is the state with the highest population of people living with HIV, with 9,924 people in 2010, estimated to increase to 11,721 by 2020.
• The population of people living with HIV is mostly found in the central areas of the major capital cities, on the coast between Sydney and Brisbane and in far North Queensland.
• Tasmania and Queensland have experienced the largest relative increases in HIV diagnoses over the past 10 years.
• The simulations predict that over the next decade, increasing numbers of people living with HIV will live outside major metropolitan areas.
• Statistical regions with the largest expected increase in HIV-positive populations are expected to be based mainly in Queensland and Victoria.
• In 2010, females make up an estimated 9% of the population living with HIV. By 2020, females are predicted to be 10.5% of the population living with HIV.
• Western Australia and the Northern Territory are jurisdictions which have the highest numbers of the female population as a percentage of the diagnosed HIV population, being 18.2 % and 17.5% respectively in 2010 and further increases are expected over the next 10 years. These figures reflect the more heterosexually driven epidemics in these states, particularly among new immigrants and indigenous populations respectively.
• The population of people living with HIV has aged significantly. In 1985 the proportion of the population aged over 55 years was 2.7%. By 2000 it was 11.2%. In 2010, it was 25.7% and by 2020 it is expected to be 44.3%.
• The total potential demand for antiretroviral therapy (eligible to consider treatment) in Australia is estimated to be 18,362 people in 2010 and 25,580 in 2020 (that is, a 39% increase); the estimated number of people eligible for second-line and subsequent lines of therapies is expected to increase from 7,050 and 5,489 in 2010 to approximately 8,355 (19% increase) and 11,385 (107% increase) in 2020.
• A lower-bound estimate suggests that 11,746 people in Australia are currently on HIV treatment.