In 2020, 162 people were first known to be infected with HIV in New Zealand. This represents a decrease from 2019 numbers, and the lowest figure since 2012.
The latest HIV numbers out of the University of Otago AIDS Epidemiology Group are encouraging, despite some uncertainties around COVID-19 impacts on testing volumes. We can also see a decline among cases acquired in New Zealand, so it appears we remain on a path to ending local HIV transmission.
A total of 162 cases were notified for 2020 – a decrease from the 212 reported in 2019 and 185 in 2018. Furthermore, the number of locally acquired infections, especially among men who have sex with men (MSM), has continued to decrease.
In 2020, 49 MSM were diagnosed with HIV and thought to have contracted the virus in New Zealand, a 15.5% decrease from 2019 numbers, and 50.5% decrease from the peak in 2016.
Among MSM, we have also seen a decline in the number of people diagnosed with high CD4 cell counts, indicating a recent infection. Seeing a reduction in this group of diagnoses gives us a good idea about the declining HIV incidence in Aotearoa.
We believe this means we are seeing the continued impact of local HIV prevention, like PrEP and condom use, and HIV testing efforts that allow for people to be diagnosed early and access medication to live healthy lives without the risk of passing HIV to their sexual partners (see U=U). This is great news.
We once again have a sign that we are starting to halt the epidemic.
With Kiwis’ heightened awareness of public health in light of COVID-19, it is now more important than ever for all New Zealanders to understand HIV prevention and the realities of HIV stigma for Aotearoa to continue to be a world leader in infectious disease response.
While we don’t know the exact number of people living with HIV in New Zealand, we know that, currently, 2839 people in New Zealand are receiving treatment for HIV.
Overall, New Zealand has a relatively low prevalence of HIV by international standards. This is largely due to the consistent promotion of condom and lube use for anal sex between men, since 1987. A robust legislative environment based on a strong human rights approach is also a key reason for this. However, the number of gay and bisexual men infected in New Zealand steadily rose between 2011 and 2016 and this means we know we cannot let our guard down.
Gay, Bisexual and Other Men Who Have Sex With Men
Of the 162 new HIV notifications in New Zealand in 2020, 106 were gay, bisexual and other men who have sex with men (GBM).
In 2020, 62 MSM were first diagnosed with HIV in New Zealand and 44 had previously been diagnosed overseas. The number of MSM who have acquired HIV locally has continued to decline after the peak in 2016 (n=98) with a sharp decrease to 69 in 2017, and then steadily to 63 in 2018, 58 in 2019, and 49 in 2020.
While gay and bisexual men account for only approximately 2.5% of New Zealand's population, they are consistently over-represented in HIV diagnoses. There are three clear reasons for this.
Heterosexual Men & Women
In 2020, there were 36 people found to be heterosexually infected with HIV.
Of these 36, 26 were first diagnosed in New Zealand which is a slight decrease from 27 of those heterosexually infected individuals diagnosed in New Zealand in 2019. Only 13 were thought to have acquired HIV in New Zealand.
Among the heterosexually infected individuals in New Zealand in 2020, over half had a low CD4 count at the time of diagnosis that was indicative of a relatively late-diagnosed infection.
While the number of heterosexual men and women infected in New Zealand in 2020 was basically the same as the previous year, the numbers each year are very small and therefore subject to year-by-year fluctuations.
People who inject drugs
Low numbers of people who inject drugs (PWID) and the successful operation of an effective national needle exchange programme since 1988 has meant that PWID account for very few HIV infections in New Zealand. There were no local infections in this group in 2020, and two infections were thought to have been acquired in people reporting injecting drugs overseas.
We are proud that blood to blood transmission is very rare New Zealand due to the work of the Needle Exchange Programme across the country. This is a great example of the effectiveness of rational, community-focused, and science-led public health policy.
It is widely acknowledged that there are very few sex workers living with HIV in New Zealand. In fact, the latest published data in 2006 recorded there were no HIV infections among the study sample of more than 300 workers.
This is due, in large, to the work of the New Zealand Prostitutes Collective (NZPC). In operation since 1987, the NZPC is a nationwide community-led advocacy group focused on providing equal rights and safe working conditions for sex workers.
Mother to Child
Between 1998-2020, there were 193 births to women known to be living with HIV in New Zealand. None of these children have been infected with HIV. However, the AIDS Epi-Group says, for children born in 2020 it is too soon to be sure about this as acquired HIV cannot be definitively ruled out until the child is slightly older.
In 2020, there were three women diagnosed with HIV through antenatal testing, the similar number as in 2019, which reinforces the need to continue the effective antenatal screening programme.
Widespread pregnancy screening and effective treatment for pregnant women means that the transmission of HIV from mothers to babies is at very low levels.
HIV Stigma in Aotearoa New Zealand
Effective treatment means that people living with HIV can live long healthy lives without the fear of transmission through sex or pregnancy. Unfortunately, people's attitudes toward HIV have not come quite as far as the treatments have.
This means, that HIV stigma is still prevalent and very harmful - often people living with HIV report this is the most harmful of living with the virus today.
Measuring HIV stigma isn't simple, but it is possible. Through interviews with people living with HIV and assessments of the general public's attitudes toward and understanding of HIV, a picture can be painted of what HIV stigma looks like in Aotearoa.
Landmark study the People Living with HIV Stigma Index Aotearoa New Zealand, is the first of its kind in Aotearoa. A study for people living with HIV, carried out by people living with HIV, this project focused on face-to-face interviews with people to capture their experiences of stigma.
The results of this study are able to be read in the two reports on the Stigma Index site.