Testing for HIV among men who have sex with men needs a paradigm shift in Australia, given the minimal increase between 2003 and 2013 in Melbourne, Australia
An-Chieh Lin A B , Christopher K. Fairley A C , Krishneel Dutt A B , Karen M. Klassen A D , Marcus Y. Chen A C , Glenda Fehler A , Matthew Law E , Catriona S. Bradshaw A C , Ian Denham A , Tim R. H. Read A C and Eric P. F. Chow A C FA Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia.
B Melbourne Medical School, The University of Melbourne, Level 2 West, Medical Building (181), Vic. 3010, Australia.
C Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 89 Commercial Road, Melbourne, Vic. 3004, Australia.
D Northwest Academic Centre, DX212695, The University of Melbourne, Sunshine Hospital, PO Box 294, 176 Furlong Road, St Albans, Vic. 3021, Australia.
E The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia.
F Corresponding author. Email: echow@mshc.org.au
Sexual Health 12(5) 373-382 https://doi.org/10.1071/SH14167
Submitted: 26 August 2014 Accepted: 5 May 2015 Published: 20 July 2015
Abstract
Background: Increasing the frequency of HIV testing in men who have sex with men (MSM) will reduce the incidence of HIV. Trends in HIV testing among MSM in Melbourne, Australia over the last 11 years have been investigated. Methods: A retrospective study was conducted using electronic medical records of the first presentation of MSM who attended the Melbourne Sexual Health Centre between 2003 and 2013. Factors associated with HIV testing (year, demographic characteristics and sexual practices) were examined in multivariable logistic regression analyses. Jonckheere–Terpstra tests were used to examine the significance of trends in the mean time since the last HIV test. Results: Of 17 578 MSM seen; 13 489 attended for the first time during the study period. The proportion of first attendances who had previously tested and reported a HIV test in the last 12 months increased from 43.6% in 2003 to 56.9% in 2013 (adjusted ptrend = 0.030), with a corresponding decrease in median time since the last HIV test from 19 months [interquartile range (IQR) 6–42] in 2003 to 10 months (IQR4–24) in 2013 (ptrend <0.001). The proportion of high-risk MSM (who reported unprotected anal intercourse and/or >20 partners in 12 months) who reported an HIV test in the last 12 months was unchanged (ptrend = 0.242). Conclusions: Despite HIV testing becoming more frequent, the magnitude of change over the last decade is insufficient to substantially reduce HIV incidence. A paradigm shift is required to remove barriers to testing through strategies such as point-of-care rapid testing or access to testing without seeing a clinician.
Additional keyword: HIV testing.
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