Australia is known for its rich cultural and linguistic diversity, with 30% of its population born overseas and 22% speaking a language other than English at home. This diversity brings a unique set of challenges and opportunities, particularly in the realm of public health. One significant area of concern is the increasing contribution of people born overseas to HIV notifications.
All states and territories in Australia report HIV notification data to the National HIV Registry (NHR), managed by the Kirby Institute at UNSW Sydney. This registry collects crucial information such as country of birth, language spoken at home, and year of arrival, which helps define the CALD population. Impressively, the completeness of these variables is over 80% in NHR.
Over the past decade (2014-2023), there has been a 21.5% increase in HIV notifications among people from CALD backgrounds. In 2014, there were 306 notifications (28% of total notifications), which rose to 372 (51% of total notifications) in 2023. This significant rise highlights the growing impact of HIV within these communities.
During this period, the highest proportion of HIV notifications was among people born in Southeast Asia, accounting for 40% of the cases. The primary exposure risk category was men who have sex with men (MSM), which constituted 63% of the notifications. Alarmingly, 40% of the total notifications from CALD backgrounds were diagnosed late, defined as having a CD4+ count of less than 350 cells/µL at diagnosis, during the last decade. Of the 40% of HIV notifications diagnosed late, 80% were males, 44% were from Southeast Asia, and 55% reported having sex with males. Additionally, 28% of the total notifications among people from CALD backgrounds reported heterosexual sex as the exposure risk, out of which with 51% were diagnosed late. The proportion of late diagnoses increased in both MSM (from 26% in 2014 to 36% in 2023) and heterosexual exposure categories (ranging from 44% in 2014 to 54% in 2023).
By the end of 2022, an estimated 7,942 people from CALD backgrounds were living with HIV in Australia. Of these, 18% were undiagnosed, compared to 5% undiagnosed of the estimated people born in Australia living with HIV and 2% undiagnosed of those born in main English-speaking countries living with HIV. This disparity underscores the challenges faced by CALD populations in accessing timely HIV diagnosis and care.
Late diagnosis is particularly prevalent among those reporting heterosexual exposure, suggesting a significant gap in services targeting CALD communities. This trend indicates a need for more culturally appropriate strategies and interventions to raise awareness about HIV testing and reduce the barriers to accessing healthcare.
To address the rising HIV notifications and late diagnoses among CALD populations, Australia must implement more culturally sensitive and inclusive public health strategies. These could include working closely with community leaders and organisations to promote HIV awareness and testing within CALD communities, increasing PrEP and PEP awareness by developing educational materials and campaigns in multiple languages that resonate with the diverse cultural backgrounds of the population, ensuring that healthcare services and HIV testing are accessible and welcoming to people from all cultural backgrounds, with interpreters and culturally competent healthcare providers and focusing on high-risk groups, with tailored interventions to reduce the risk of HIV transmission and encourage early testing. By adopting these strategies, Australia can better support its CALD populations and work towards the target of eliminating HIV by 2030. The goal is to create an inclusive healthcare system that recognises and addresses the unique needs of its diverse population, ultimately leading to positive health outcomes for everyone.