Universal HIV tests not needed in Oz

There is no need for all Australian adults to be tested for HIV, experts said this week in response to recommendations by the US government to screen almost the entire American population for the virus.

Under the new recommendations by the US Centers for Disease Control and Prevention (CDC), everyone aged between 13 and 64 would be screened for HIV.

The drastic measure was needed, the CDC said, because an estimated 250,000 Americans with HIV did not realise they had it. Current guidelines only called for people at high risk to get tested.

More than one million people in the US are currently living with HIV, with around 40,000 new infections each year.

But the situation in Australia was quite different, according to Ian Rankin, president of the Australian Federation of AIDS Organisations (AFAO).

There’s not evidence of a large population of undiagnosed HIV in the Australian community like the quarter of a million they’re talking about in the United States, Rankin said.

We have a very different epidemic in Australia. We have a concentrated epidemic amongst populations at risk and we certainly encourage people with multiple partners to continue testing for STIs, and we encourage gay men and injecting drug users to keep testing for HIV.

He said late diagnoses of HIV in Australia each year were numbered in the teens, not the hundreds or thousands.

John Kaldor, deputy director at the National Centre in HIV Epidemiology and Clinical Research, said Australians at high risk of HIV, such as men who had sex with men, had very high rates of self-referral for testing.

We’ve had a strategy that encouraged people to be aware of HIV and have sufficient awareness to be able to assess their own risk in a quite sophisticated manner, Kaldor said.

He said infection rates were too low to consider adopting the American approach, but acknowledged there would always be people in high-risk categories who could benefit from a better awareness of testing.

Last year the United Nations estimated 14,840 people in Australia were HIV-positive, with around 820 new infections each year.

Some HIV organisations in the US welcomed the CDC’s proposals while others urged caution. Of particular concern were recommendations to remove the lengthy pre- and post-test counselling to speed the process up.

Rankin said the counselling aspect was vital for prevention.

We’re worried that if this became a regular routine thing like cholesterol testing, we’d lose the really valuable intervention that pre- and post-test counselling give us, he said.

In Australia we chat about why you’re coming in for an HIV test, should you modify your behaviour, how would you cope with a positive diagnosis. Those sorts of things help change behaviour and help reduce the level of transmission in our community.