A new surveillance system for monitoring HIV infection in Victoria, Australia
Rebecca Guy A B F , Megan S. C. Lim A B , Yung-Hsuan J. Wang A , Nicholas Medland C , Jonathan Anderson D , Norman Roth E and Margaret E. Hellard AA Centre for Epidemiology and Population Health Research, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Vic. 3001, Australia.
B Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Vic. 3004, Australia.
C The Centre Clinics, St Kilda, Vic. 3182, Australia.
D Prahran Market Clinic, Prahran, Vic. 3181, Australia.
E Carlton Clinic, Carlton, Vic. 3053, Australia.
F Corresponding author. Email: Rebecca.Guy@burnet.edu.au
Sexual Health 4(3) 195-199 https://doi.org/10.1071/SH07011
Submitted: 19 February 2007 Accepted: 5 July 2007 Published: 23 August 2007
Abstract
Objectives: To establish a new mechanism for monitoring patterns of HIV infection, in the context of a sustained increase in HIV diagnosis among men who have sex with men (MSM) in Victoria. Methods: Between April 2004 and August 2005, a linked voluntary HIV sentinel surveillance system was implemented at five medical clinics with a high case load of MSM. Using a questionnaire, doctors collected HIV testing history, demographic and sexual risk behaviour information from all clients undergoing voluntary HIV testing. Questionnaires were linked with HIV test results. Logistic regression analysis was conducted to determine factors associated with HIV infection. Results: Of 3435 MSM tested for HIV at participating sites, 1.7%, (95% CI = 1.2–2.2) were newly diagnosed with HIV; between 2004 and 2005 the proportion increased from 1.3% (95% CI = 1.2–1.5) to 2.0% (95% CI = 1.8–2.2), P = 0.107. There was no significant change in the number of HIV tests conducted per month or in demographic characteristics, testing history and sexual behaviour characteristics between time periods. In multivariate analysis, reporting unprotected anal intercourse (UAI) with any partner, UAI with a HIV-positive partner/s and being aged 30–39 years or 40 years or greater were significantly associated with HIV infection. Conclusion: This new surveillance mechanism, based on linked testing at participating clinics, indicates that the increase in HIV notifications in 2005 was unrelated to changes in testing and data from a Melbourne sexual behavioural survey suggests the increase was more likely to be attributed to increases in transmission within the past few years. The sentinel system highlighted UAI, especially with HIV positive partner/s are important transmission factors.
Additional keywords: HIV, sentinel surveillance, voluntary testing.
Acknowledgements
We gratefully acknowledge the participating HIV sentinel surveillance sites (Centre Clinic, Prahran Market Clinic, Carlton Clinic, Geelong Sexual Health Clinic and Richmond Hill Medical Centre) for their contribution to the linked Voluntary HIV sentinel surveillance pilot study. We also acknowledge the support of the Victorian AIDS Council in partly funding the sentinel surveillance system to assist in an evaluation of the ‘Check-it-Out’ HIV/STI testing campaign. Burnet manages HIV surveillance on behalf of the Department of Human Services (DHS) and in collaboration with the Victorian Infectious Diseases Reference Laboratory and the Partner Notification Officers of DHS.
[1] Yohannes K. Sexually transmissable infections – human immunodeficiency virus (HIV) infection. Vic Infect Dis Bull 2006; 10 23–6.
[Accessed 6 November 2006]
[3] McDonald A, Donovan B, O’Connor C, Packham D, Patten J, Chuah J, et al. Time trends in HIV incidence among homosexually active men seen at sexual health clinics in Australia, 1993–1999. J Clin Virol 2001; 22 297–303.
| Crossref | GoogleScholarGoogle Scholar | PubMed | [accessed 6 November 2006].
[5]
[6]
[7] Crawford JM, Kippax SC, Mao L, Van de Ven PG, Prestage GP, Grulich AE, et al. Number of risk acts by relationship status and partner serostatus: findings from the HIM cohort of homosexually active men in Sydney, Australia. AIDS Behav 2006; 10 325–31.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[8] Read TR, Hocking J, Sinnott V, Hellard M. Risk factors for incident HIV infection in men having sex with men: a case–control study. Sex Health 2007; 4 35–9.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[9] Prestage G, Mao L, Fogarty A, Van de Ven P, Kippax S, Crawford J, et al. How has the sexual behaviour of gay men changed since the onset of AIDS: 1986–2003. Aust N Z J Public Health 2005; 29 530–5.
| PubMed |
[10] Wasserheit J. Epidemiological synergy: interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis 1992; 19 61–77.
| PubMed |
[11] Cohen M, Hoffman I, Royce R, Kazembe P, Dyer J, Costello Daly C, et al. Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. Lancet 1997; 349 1868–73.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[12] Atkins M, Carin E, Emery V, Griffiths P, Boag F. Fluctuations of HIV load in semen of HIV positive patients with newly acquired sexually transmitted diseases. BMJ 1996; 313 342–3.
| PubMed |
[13] Marrone J, Fairley CK, Chen M, Hocking JS. Comparisons of trends in antiretroviral use and HIV notification rates between three Australian states. Aust N Z J Public Health 2007; 31 131–4.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[14] Law MG, Prestage G, Grulich A, Van de Ven P, Kippax S. Modelling HIV incidence in gay men: increased treatment, unsafe sex and sexually transmissible infections. AIDS 2002; 16 499–501.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[15] Law MG, Prestage G, Grulich A, Van de Ven P, Kippax S. Modelling the effect of combination antiretroviral treatments on HIV incidence. AIDS 2001; 15 1287–94.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
