Associations between country of birth, migration status and engagement in HIV care among gay and bisexual men living with HIV in Australia, 2019-2022.

Abstract

Background: In the last decade, while HIV diagnoses have declined among Australian-born gay and bisexual men (GBM), they have declined much less among migrant GBM, with recently arrived GBM facing particular challenges, such as access to HIV treatment. This study assessed HIV care cascade (treatment) outcomes among GBM living with HIV in Australia by migration status.

Methods: Data were collected in national cross-sectional behavioural surveillance surveys during 2019-2022. HIV cascade outcomes were stratified by country of birth and length of residency in Australia, examining HIV clinical appointments in the previous year, being on antiretroviral treatment (ART) and achieving an undetectable viral load. Percentages were calculated with the previous cascade step as the corresponding denominator.

Results: Between 2019 and 2022, 32 236 GBM completed surveys, including 2533 (7.9%) people living with HIV (PLWH). Among 2188 PLWH reporting migration/residency status, 72.2% were Australian-born, 13.3% were from high-income English-speaking countries, 13.0% were non-recently arrived migrant GBM from other countries and 1.5% were recently arrived in Australia (<2 years). Median ages for the four groups were 50, 51, 41 and 34 years, respectively. Recently arrived PLWH were the most likely to be recently diagnosed (<2 years, 15.2% vs. <5% in the other groups). The HIV cascade of care, treatment, and viral suppression differed by migration status (p < 0.001): Australian-born, 92.5%, 96.9% and 94.6%, respectively; born in high-income-English-speaking countries, 91.8%, 97.4%,9 8.9%; non-recently arrived, 93.7%, 95.1%, 96.8%; and recently-arrived, 90.9%, 90.0%, 100%. Recently-arrived PLWH were less likely to be on treatment, but all those on treatment achieved viral suppression.

Conclusions: Engaging and supporting recently arrived PLWH in Australia to access ART and relinking PLWH disengaged from care remains crucial.