The state of sexually transmissible and blood-borne infections in Australia: the 2010 Surveillance Reports

  • Findings contained in three national surveillance reports to be released this week.
  • Australia reports largest number of new HIV cases since early 1990s.
  • Rates of infectious syphilis, gonorrhoea and hepatitis B and C were stable or declining.
  • Urgent action needed to bring down rates of bacterial STIs in Aboriginal communities.

Australia last year reported its largest number of new HIV cases since the early 1990s but has seen a reduction in cases of hepatitis, infectious syphilis and gonorrhoea, new data contained in HIV, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2010 shows.

The report will be launched on Wednesday 20 October at the Australasian HIV/AIDS Conference 2010 by UNSW’s National Centre in HIV Epidemiology and Clinical Research, alongside two other national reports: the Bloodborne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander People: Surveillance and Evaluation Report 2010; and the Annual Report of Trends in Behaviour 2010.

HIV, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2010 indicates that exposure to HIV was attributed to sex with men in 66% of new HIV diagnoses in the five years from 2005–2009. But Australia is also experiencing a steady rise in heterosexually transmitted HIV, largely occurring in people from high-prevalence countries or among those whose sexual partners are from such countries. There were 1050 new HIV diagnoses overall in 2009. Nevertheless, HIV prevalence in Australia remains one of the lowest in the world, at about 0.1%.

In addition, the report indicates that the rate of diagnosis of newly acquired hepatitis B has declined substantially among young people over the past decade. Adolescent ‘catch up’ vaccination programs may have played a role in this reduction. Hepatitis C diagnoses also declined in all age groups, with a substantial drop of more than 80% over the past five years in the 15–19 year age group, probably due to reductions in the prevalence of injecting drug use. However, reported hepatitis C transmission continued to occur at high rates among young adults, primarily those with a history of injecting drug use.

Australia is experiencing a continuing epidemic of chlamydia, which remains the most frequently notified condition in Australia, with 62,613 newly diagnosed cases in 2009. Increasing rates of chlamydia diagnoses were reported in all States and Territories and were greatest in the 20–29 and 15–19 year age groups. After a rapid increase in diagnoses of gonorrhoea from 2000 to 2004, this notifiable disease has declined over the past five years by 10% in males and by 5% among females. Similarly, the national infectious syphilis epidemic of the past six years, which has largely affected men who have sex with men, appears to have started declining.

“We are starting to see the success of public health efforts to curtail the spread of some of these infectious diseases,” said UNSW Associate Professor David Wilson, head of the Surveillance and Evaluation Program for Public Health at the National Centre in HIV Epidemiology and Clinical Research. “However, rates of infection remain very high and controlling their spread requires renewed efforts.” Earlier this year the Australian Government endorsed five new national strategies for blood-borne viruses and sexually transmissible infections. “These strategies provide direction for targeting actions that will protect the health of Australians at risk of acquiring infection and potentially developing serious disease outcomes,” Professor Wilson said.

The second report to be released, Bloodborne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander People: Surveillance and Evaluation Report 2010, indicates that 196 Aboriginal and Torres Strait Islander people were newly diagnosed with HIV infection in Australia in the past ten years, 2000–2009. Rates of HIV diagnosis in the Aboriginal and Torres Strait Islander population remain about the same as that in the non-Indigenous population. Rates of sexually transmissible infections such as gonorrhoea and chlamydia are considerably higher in the Indigenous population, particularly among younger age groups and people living in remote areas, partly reflecting poor access to appropriate primary health care services for many Aboriginal people in regional and remote communities.

However, there are two areas where the report notes improvements: in rates of donovanosis and infectious syphilis. For the fourth year in a row, fewer than 10 cases of donovanosis were detected nationally among Aboriginal and Torres Strait Islander people, reflecting good practice in case detection and treatment of this infection. In the case of infectious syphilis among Indigenous people, there has been a steady decrease in rates since 2006, when 233 cases were diagnosed, down to 123 cases in 2009. “It’s the right time to plan for the elimination of infectious syphilis from remote Aboriginal communities – there is no reason for us to not to achieve this goal within the foreseeable future,” said James Ward, head of the National Centre’s Aboriginal and Torres Strait Islander Health Program.

Rates of hepatitis C continue to be much higher, and increasing, among Aboriginal and Torres Strait islander people, and a larger proportion of cases of HIV attributable to injecting drug use occur among Indigenous people, compared with the non-Indigenous population. “The message remains the same for Aboriginal Australia,” Mr Ward said. “We need to act urgently to bring down these rates and the unacceptably high rates of bacterial STIs in Aboriginal communities.”

The third report, the Annual Report of Trends in Behaviour 2010, released by UNSW’s National Centre in HIV Social Research, indicates that unprotected sex is common among many population groups. Across Australia, the proportion of gay men engaging in unprotected sex with casual partners has increased from 20 to 24% and unprotected sex.

“This suggests that continued vigilance is needed to ensure that HIV and STI prevention remains successful,” said Centre director, Professor John de Wit. However, across Australia, fewer gay men are having very large numbers of sexual partners and they are more commonly communicating about risk of infection with their partners. Over the last ten years there has been an increase in disclosure of HIV serostatus to sexual partners, from 35% to 46% among HIV-negative men and from 50% to 62% among HIV-positive men.

Illicit drug use remains common among young people attending music festivals, with 57% reporting use of any illicit drug. Marijuana remains the most commonly used drug, followed by ecstasy and meth/amphetamine. In 2009 there was a considerable and sharp increase in the use of cocaine (from 3.6% in 2008 to 16.6% in 2009) and LSD (from 4.2% in 2008 to 10.6% in 2009). “Sharing of injecting equipment remains relatively common among people who use pharmacies to obtain injecting equipment,” Professor de Wit said. “This underscores the continued need for scaling up the distribution of injecting equipment, including through novel strategies.”

The two National Centres in HIV Research are part of the University of New South Wales.

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