Significant drop in HIV diagnoses but no way to tell why

  • 📅20 June, 2018

A new report shows that for the first time since 2011, the number of annual HIV diagnoses in New Zealand has fallen. But without funding for a repeat of ongoing surveys to monitor changes in behaviour, testing and attitudes, health workers can’t be sure what’s driving the decrease.

In 2017, there were 197 people first diagnosed with HIV in New Zealand – almost a 20% decrease from 2016, which was the worst year on record with 243 diagnoses.

“This is wonderful news. Any fall in the number of new HIV diagnoses should be celebrated but it is also very important to note that one data point is not a trend. We saw a similar drop from 2010 to 2011, and infection rates consistently rose from then until 2016. We need to see a steady consistent decrease over the next few years before we can confidently say we are on the right track,” says NZAF’s Executive Director, Dr Jason Myers.

Early 2017 saw the launch of NZAF’s social marketing program Ending HIV, which has the ambitious goal of ending HIV transmissions by 2025. The program embraces a revolution in HIV prevention science, continuing to promote condoms as the mainstay of HIV and STI prevention in New Zealand but adding to this the daily HIV prevention pill PrEP and making the most of modern HIV treatments, which can prevent the virus from passing on through sex from people living with HIV who have achieved and maintained HIV viral suppression.

Countries like Australia and the UK have seen drops in HIV diagnoses since implementing combination HIV prevention responses similar to that of Ending HIV in New Zealand. “While we’d like to think that this approach has had a significant impact on the 2017 numbers in New Zealand, we unfortunately have no data to confirm our hunches,” says Dr Myers.

New Zealand has world-recognised ongoing surveys that monitor the knowledge, attitudes and behaviours of gay and bisexual men, the group disproportionately impacted by HIV in New Zealand. Alarmingly, these have not been funded for scheduled repeat since 2014, well before the prevention landscape significantly changed.

“It has never been more crucial to have surveillance updated. While HIV diagnoses may have fallen in 2017, growing STI epidemics are increasing cause for concern. Understanding changes in knowledge and behaviour since the introduction of treatment based prevention tools is critical if we are to ensure the most appropriate targeting of our behaviour change messaging,” says Dr Myers.

“It would also assist the government in assessing whether NZAF’s taxpayer-funded programs are having the desired impact.”

“New Zealand has shown true leadership in the past two years, removing all barriers to HIV treatment and funding the revolutionary HIV prevention pill, PrEP. We have all the tools we need to ensure that the 2017 data is the beginning of the end of new HIV infections in New Zealand. However, we will only realise this potential if we see strong follow-through on the government’s election promise to support our ambitious goal.”

 

Key data points:

  • A total of 197 people were diagnosed with HIV in NZ in 2017.
  • It’s useful to look at the numbers in terms of people who reported infection taking place within New Zealand (locally acquired infections). The total number of locally acquired infections for 2017 is 80, a 27% reduction from 110 in 2016.

Men who have sex with men (MSM)

  • 71 men MSM diagnosed in 2017 reported locally acquired infection. This is a 29% decrease on the 100 reported in 2016.
  • MSM made up 89% of locally acquired HIV infections in 2017.
  • 53% of MSM diagnosed in 2017 and reporting locally acquired infections had a CD4 count greater than 500, indicating they were diagnosed within 14 months of infection.
  • The proportion of MSM diagnosed and reporting infection in New Zealand has been decreasing in Auckland since 2013, and rising in Wellington. The 2017 figures show this trend has continued, with a larger shift than in previous years.

Heterosexual and Transgender

  • There was a 43% reduction in heterosexual diagnoses from 2016, with the lowest number (4) of locally acquired HIV among heterosexuals since 1996.
  • There were 4 diagnoses among transgender New Zealanders in 2017, the highest of any year on record. Since 1985, 18 diagnoses have been recorded within the transgender community in NZ. This increase is likely to be due to an improvement in recording gender options as of early 2017, rather than a true rise in incidence.

Treatment costs

  • In 2005, the total annual cost of subsidised ART treatments in New Zealand for people living with HIV was $8.9 million. In 2017, this was $35.6 million.