Aussie Women With HIV Are Being Diagnosed Too Late
Half of all women diagnosed with HIV have never been tested for it before in their lives, meaning they're being tested late -- and it's a big public health concern.
A new study has found that women are testing positive for HIV much later than men, which can lead to more serious and complicated health issues.
Women tested positive for HIV at 32 years of age, on average, and the vast majority of these (85 percent) had the infection transmitted through heterosexual sex.
The most common reasons women got tested for HIV was recent risk behaviour or because they were already exhibiting symptoms of the disease.
The research, published in the Australian and New Zealand Journal of Public Health, looked at Victorian public health data from 1994 to 2016.
Carol El-Hayek, an epidemiologist from the Burnet Institute and senior author of the paper, told 10 daily women will often go to their doctors with a complaint -- like persistent thrush or a cold sore -- which shows their immune system is already being compromised by the virus.
Occasionally, women will even present with advanced symptoms of AIDS such as respiratory illness. Some even find out only at the beginning of pregnancy.
Women tend to be "opportunistically diagnosed" said El-Hayek, rather than testing positive for HIV during routine check-ups.
Late HIV diagnosis is still a big problem in Australian healthcare.
In 2017 over a third of new diagnoses of HIV were considered late -- this means that patients were often diagnosed with AIDS, developed symptoms of HIV, or a low white blood cell count when they first test positive.
What Is Actually Happening with HIV in Australia?
At the end of 2017, there were approximately 27,545 people living with HIV in Australia.
Men are disproportionately affected by HIV in Australia -- only 12 percent of people living with the diagnosis in Australia are women.
While HIV infections have been on a downwards trend in general, the number of straight people infected every year is not shifting as much as in the gay community.
This means that straight infections now take up a greater percentage of the HIV-positive population.
Why is this a problem for Aussie women?
The study notes clinicians are less likely to give Australian women risk screening because of the overwhelming focus on HIV as a disease that affects men who have sex with men.
GPs often assess women as being low-risk for HIV, so testing rates among women are low compared to gay men.
El-Hayek said that since the beginning of her career in HIV epidemiology, she's seen "20 to 40 women diagnosed every year in Victoria -- and probably about 100 diagnosed in Australia."
"Obviously there's something going on for women and nothing's changing," she said.
El-Hayek notes one of the biggest barriers for women to getting diagnosed with HIV is simply that they don't know they're at risk of getting infected.
"In the case of women they could potentially be having sex with somebody bisexual or who is injecting drugs or who had sex with somebody overseas in a a high prevalence country... and they don't really know who they're having sex with."
El-Hayek believes that this belief of low-risk is also associated with people being less likely to have a consistent GP these days and "doctor shopping", rather than staying with one physician who knows the patient's behaviour and history well.
"I've heard stories through positive women, women that I know who have HIV where they've had to ask the GP several times for an HIV test," she said.
"Some of them do really comprehensive sexual health tests, some of them discuss it with you and say 'I can include it if you want me to' and some of them just ask you to pee in a jar and test for gonorrhea and chlamydia."
UNAIDS, the United Nations public health program for HIV/AIDS globally has its '95-95-95' goal, to be achieved by 2030.
The goal is that 95 percent of people who positive for the virus will know it, 95 percent of people who test positive will be receiving antiretroviral treatment for it and 95 percent of people on treatment will have a suppressed viral load.
El-Hayek believes that in order to reach this ambitious target in Australia, public health programs need to acknowledge vulnerable populations of women, migrants, and indigenous people.
"We need to promote HIV testing for women without making it this big thing -- we need to normalise it in a way," she said.