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
Elizabeth Peach A H , Chris Lemoh B C , Mark Stoove A D , Paul Agius A D E , Carol El Hayek A D , Nasra Higgins F and Margaret Hellard A D G
+ Author Affiliations
- Author Affiliations
A Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia.
B Monash Infectious Diseases, Monash Health, 246 Clayton Road, Clayton, Melbourne, Vic. 3168, Australia.
C School of Clinical Sciences, Monash University, Scenic Boulevard and Wellington Road, Clayton, Melbourne, Vic. 3168, Australia.
D Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Vic. 3004, Australia.
E Judith Lumley Centre, La Trobe University, 215 Franklin St, Melbourne, Vic. 3000, Australia.
F Victorian Department of Health and Human Services, 50 Lonsdale Street, Melbourne, Vic. 3000, Australia.
G Infectious Diseases Unit, Alfred Hospital, 55 Commercial Road, Melbourne, Vic. 3004, Australia.
H Corresponding author. Email: liz.peach@burnet.edu.au
Sexual Health 15(5) 441-450 https://doi.org/10.1071/SH17192
Submitted: 20 October 2017 Accepted: 5 June 2018 Published: 15 October 2018
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.
Additional keywords: Epidemiology, heterosexual, travel, vulnerable populations.
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