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Mortality & Morbidity: Acquired immunodeficiency syndrome
HIV and AIDS in Australia
In 1995 an estimated 15 million people were infected with HIV worldwide4. Australia established early strategies to combat HIV and AIDS. As a result, the incidence of HIV infection is relatively low. Since the early 1980s to September 1996, figures compiled by the National Centre in HIV Epidemiology and Clinical Research show that nearly 16,000 people had been diagnosed with HIV, 7,033 had been diagnosed with AIDS and 5,116 had died from AIDS-related illnesses5.
A HIV positive person can live a healthy life for 10 or more years before developing AIDS. As a result of this time delay the number of new AIDS cases each year has increased despite a fall in the number of new HIV cases. This time lag between contracting HIV and developing AIDS is expected to increase even further as new and emerging treatments give some promise that HIV will become a chronic, manageable illness2.
Despite Australia's success in limiting the spread of HIV and AIDS, there are still areas of concern. For example, it appears that the rate of diagnosis among Indigenous people is increasing2. As a result, new policy directions for Indigenous people have been defined in the third National HIV/AIDS Strategy.
HIV AND AIDS IN AUSTRALIA(a)
(a) New cases each calendar year.
(b) The ABS Causes of Death collection has identified deaths attributed to HIV/AIDS since 1988.
Source: National Centre in HIV Epidemiology and Clinical Research, Australian HIV Surveillance Report, April 1996;
HIV cases diagnosed
There has been a marked decrease in the number of new HIV cases diagnosed annually over the past decade. The number of HIV cases diagnosed peaked at 2,773 in 1987. This dropped by 1,062 the following year, and continued to decline to 833 in 1995.
The peak in 1987 is related to many factors. The virus was identified in 1983 and testing became available in 1985. The high number of diagnoses in 1986 and 1987 reflects the testing of many people who had contracted the virus up to that time. This peak was followed by a large decrease in the number of cases diagnosed because much of the backlog in testing had been cleared. The decline is also due to Australia's early and proactive response to the HIV/AIDS epidemic.
Of people diagnosed with HIV in 1995, most (760) were males and 73 were females. Over one third of people diagnosed with HIV were aged 30-39 (37%) and a further 30% were aged 20-29. The mean age at diagnosis was 35 for males and 30 for females.
Most people who have contracted HIV were exposed through male homosexual contact. Sydney, which has a relatively large homosexual population, has had a substantially higher per capita rate of HIV diagnoses compared to other cities of Australia2. As a result over half of all HIV diagnoses in 1995 were in New South Wales (53%). However, this was down from 73% in 19865. People in capital cities have, in general, experienced higher per capita rates of HIV and AIDS than those in regional Australia2.
HIV CASES DIAGNOSED(a), 1995
(b) Includes age unknown.
Source: National Centre in HIV Epidemiology and Clinical Research, Australian HIV Surveillance Report, April 1996 and unpublished data.
AIDS cases diagnosed
The number of new AIDS cases diagnosed increased from 231 in 1986 to a peak of 909 in 1994. In 1995 this fell to 648 diagnosed cases5. The increase to 1994 is linked to the large number of people who contracted HIV in the mid to late 1980s. The decline in 1995 is due, in part, to the fall in HIV cases diagnosed from 1987. It may also reflect the increasing effectiveness of treatments for HIV, extending the time between infection and progression.
Of people diagnosed with AIDS in 1995, most (619) were males, 27 were females and two did not report their sex. Almost half (45%) of those diagnosed with AIDS were aged 30-39 and 27% were aged 40-49. Taking into account the time delay between contracting HIV and developing AIDS, this indicates that most of these people were in their late 20s or early 30s when they were infected with HIV. This is a similar pattern to those who have contracted HIV more recently.
AIDS CASES DIAGNOSED(a), 1995
(b) Includes sex not reported.
Source: National Centre in HIV Epidemiology and Clinical Research, Australian HIV Surveillance Report, April 1996.
Causes of death statistics compiled by the Australian Bureau of Statistics indicate that the number of AIDS-related deaths increased progressively each year from 231 in 1988 to 764 in 1994. These increases were due to deaths of people who acquired the illness during the 1980s. As such, they do not indicate more recent increases in the spread of AIDS.
The high rates of HIV diagnosis in the late 1980s and the subsequent large number of AIDS cases diagnosed over the last decade, suggest that the increases in numbers of people dying from AIDS might have continued for the rest of the century.
However, the number of deaths fell to 666 in 1995. This decrease is especially surprising because of the peak in AIDS cases diagnosed in 1994. However, there have been developments in AIDS treatments in the last year which are prolonging life expectancy for those infected. This may have helped to lower the rate, although it does not necessarily indicate the start of a long-term decline in AIDS-related deaths.
In 1995, most people dying from AIDS-related illnesses were males (94%). Among males, 42% of those who died were aged 30-39, and a further 31% were aged 40-49. Among females, 35% were aged 30-39 and 27% were aged 20-29. The majority of AIDS-related deaths were in New South Wales (56%), Victoria (23%) and Queensland (10%).
AIDS RELATED DEATHS, 1995
Because of the lag between contracting HIV and developing AIDS, only people who have recently been diagnosed with HIV are studied to determine current transmission modes.
In 1995, the majority of people diagnosed with HIV contracted it through male homosexual/bisexual contact only (566 cases). This was down from 1,097 cases in 1986. At the same time, the number of people who contracted HIV through receiving blood components or tissue has also decreased. This is linked to the introduction of blood and tissue screening for the virus. Similarly, the number of people who contracted the virus through injecting drug use has decreased since the late 1980s. This follows the introduction of needle and syringe exchange programs. The number of people contracting HIV through heterosexual contact has increased from 24 cases in 1986 to 131 cases in 1995.
There are sex differences in the exposure categories of people diagnosed with HIV. In 1995, among males, the most common exposure category was homosexual/bisexual contact (74%). Among females, it was heterosexual contact (81%).
PEOPLE DIAGNOSED WITH HIV
1 Department of Community Services and Health 1989, National HIV/AIDS Strategy: A Policy Information Paper, AGPS, Canberra.
2 Commonwealth Department of Health and Family Services 1996, Third National HIV/AIDS Strategy 1996-97 to 1998-99, AGPS, Canberra.
3 Duckett, M. 1986, Australia's Response to AIDS, Parliamentary Paper No. 424, AGPS, Canberra.
4 UNICEF 1995, The Progress of Nations, UNICEF, New York.
5 National Centre in HIV Epidemiology and Clinical Research, Australian HIV Surveillance Report, January 1997 and April 1996, AGPS, Canberra.