Since the early 1980s to September 1996, around 16,000 people had been diagnosed with HIV, 7,000 had been diagnosed with AIDS and over 5,100 people had died from AIDS-related illnesses.

Acquired immunodeficiency syndrome (AIDS) is caused by a virus known as HIV (human immunodeficiency virus). Infection with the virus leads to damage to the body's immune system, with consequent susceptibility to a variety of infections and some unusual forms of cancer. It is these associated illnesses that kill people with AIDS3.

AIDS is a world wide public health problem which raises many medical, social and legal issues. These issues include concerns regarding the transmission of the virus, the disclosure of HIV infection to health professionals, preventing discrimination, guaranteeing confidentiality and ensuring continued quality of life for those infected.

The two main risk behaviours involved in the spread of HIV are unprotected sexual intercourse between men and sharing needles among injecting drug users. There is no vaccine against, nor cure for, HIV infection. Consequently, prevention strategies focus on education to encourage behaviour change.

The Federal Budget allocated $51 million in 1996-97 to maintain an effective national response to HIV/AIDS, with a commitment to further funding over the next three years2.

HIV and AIDS

The human immunodeficiency virus (HIV) is a virus that selectively infects and destroys a particular group of white blood cells, T4+ lymphocytes. These cells are an integral part of the human immune system. When the number or effectiveness of these cells declines, the body becomes susceptible to various other infections.

HIV is a relatively new virus. It was identified in 1983 and testing began in 1985. It is transmitted from one person to another through the exchange of blood and bodily fluids. There is generally a long period between infection with HIV and the onset of severe HIV-related illnesses, including AIDS. After infection, most people enter a stage in which they have no signs or symptoms of HIV infection1.

Acquired immunodeficiency syndrome (AIDS) occurs when serious infections, neoplasms or other life-threatening conditions develop as a result of a progressively degenerating immune system caused by HIV2.

AIDS-related deaths are deaths where HIV or AIDS was the underlying cause or where HIV/AIDS was a condition mentioned on the death certificate.

HIV and AIDS in AustraliaIn 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 diagnosedThere 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

Males

Females

All people

Age group (years)

no.

no.

no.

0-12

2

5

7

13-19

5

10

15

20-29

233

20

253

30-39

283

26

309

40-49

146

8

154

50-59

49

3

52

60 and over

23

0

23

Total(b)

760

73

833

(a) Refers to new cases diagnosed between 1 January and 30 December 1995. (b) Includes age unknown.

Source: National Centre in HIV Epidemiology and Clinical Research, Australian HIV Surveillance Report, April 1996 and unpublished data.

The Third National HIV/AIDS Strategy2

The Third National HIV/AIDS Strategy, 1996-97 to 1998-99, was released in December 1996. It aims to:

eliminate the transmission of HIV; and

minimise the personal and social impact of HIV infection

There are five priority areas in this strategy. They are:

education and prevention;

treatment and care;

research;

international assistance and cooperation; and

legal and social justice matters

The strategy presents HIV/AIDS as one among a number of communicable diseases that pose serious public health risks. As such, it attempts to integrate HIV/AIDS into efforts to combat related diseases.

An evaluation of the second National HIV/AIDS Strategy concluded that HIV infections among homosexually active young men had plateaued at an unsatisfactorily high level and that there was almost certainly an epidemic of HIV in its early stages among Indigenous people. As a result, this third strategy will target these two groups by providing the context for two other important strategies - the Gay Men's Education Strategy and the Indigenous Sexual Health Strategy.

AIDS cases diagnosedThe 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

Males

Females

All people(b)

Age group (years)

no.

no.

no.

0-12

0

3

3

13-19

3

0

3

20-29

86

4

90

30-39

279

13

292

40-49

171

6

177

50-59

62

1

63

60 and over

18

0

18

Total

619

27

648

(a) Refers to new cases diagnosed between 1 January and 30 December 1995.(b) Includes sex not reported.

Source: National Centre in HIV Epidemiology and Clinical Research, Australian HIV Surveillance Report, April 1996.

AIDS-related deathsCauses 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

Age group (years)

Males

Females

All people

no.

no.

no.

0-19

2

1

3

20-29

51

10

61

30-39

264

13

277

40-49

197

8

205

50-59

87

4

91

60 and over

28

1

29

Total

629

37

666

Source: Causes of Death (unpublished data).

Transmission modeBecause 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

1986

1989

1992

1995

Self reported exposure category

no.

no.

no.

no.

Male homosexual/bisexual contact

1,097

965

746

566

Heterosexual contact

24

79

136

131

Male homosexual/bisexual contact and injecting drug use

35

35

38

35

Injecting drug use (female and heterosexual male)

60

78

55

33

Mother with/at risk for HIV infection

1

5

4

7

Receipt of blood components/tissue

76

22

16

2

Health care setting

0

0

3

0

Other/undetermined

857

379

144

59

Total

2,150

1,563

1,142

833

Source: National Centre in HIV Epidemiology and Clinical Research, Australian HIV Surveillance Report, April 1996 and unpublished data.

International comparison

The rates of AIDS cases reported varies greatly between different countries of the world. In 1994 Zimbabwe, for example, had 95 per 100,000 new AIDS cases reported. For Australia the rate was 5 per 100,000 which is similar to that recorded for Canada but substantially less than the rate recorded in the United States of America.

However, care should be taken in comparing these rates. They are affected by a number of factors such as the length of time AIDS has been in each country, as well as differences in reporting practices and testing procedures. For example the World Health Organisation estimates that there are nearly six million cases of AIDS in Africa, yet only 499,037 cases have ever been reported.

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