Dogma disputed: potential endemic heterosexual transmission of human immunodeficiency virus in Australia

A profile of HIV testing in Victoria to the end of 1993. Victorian Collaborative Group on HIV and AIDS Surveillance (VCGHAS)

Examination of testing patterns for human immunodeficiency virus (HIV) in a population is important because it affects interpretation of surveillance data on new HIV diagnoses and can guide the targeting and evaluation of campaigns to encourage appropriate antibody testing. This report describes a relatively inexpensive mechanism of collecting information on who is being tested for HIV in Victoria (other than at the Blood Bank). The annual number of HIV tests performed in Victoria increased steadily throughout the 1980s but the rate of increase slowed in the early 1990s. By 1993, women accounted for almost half of HIV tests, although they made up only 8 per cent of positive tests. There were marked differences in the volume of testing and testing profiles of different laboratories. The information available on personal risk category and the reasons for HIV tests show that many people of low risk are tested, although conclusions are limited by inadequate information elicited or provided by many requesting doctors. For better information on what is occurring with respect to HIV testing, the fundamental requirement is better compliance from requesting doctors in supplying basic information on who they test and why.

'Doing the right thing': the symbolic meanings and experiences of having an HIV antibody test

Very few studies have been undertaken to explore in depth the reasons why individuals seek HIV antibody testing. This paper discusses the socio-cultural meanings surrounding the HIV antibody test, using the findings from a qualitative study directed at understanding why 'low risk' individuals make the decision to have an HIV test, their experiences of testing and their use of the result, especially in negotiating sexual relationships. It is concluded that the less obvious reasons for taking the test include pressure from parents or lovers, as a symbolic closure or commencement of a sexual relationship, the discourse of mutuality, the privileging of 'knowledge' and notions of responsibility and purity. Implications for AIDS education programs and policy are addressed.

Heterosexual behaviour and HIV risk in New Zealand: data from a national survey

The pattern of any future major heterosexual epidemic of acquired immunodeficiency syndrome (AIDS) will depend partly on sexual behaviour and condom use among heterosexuals. This survey was designed to provide information on patterns of sexual behaviour in New Zealand. A national sample aged 18 to 54 was selected using a random method and telephone interviews were administered to 2361 people, using a questionnaire based on the protocol developed by the Global Program on AIDS of the World Health Organization. The reported mean lifetime number of partners increased with age up to 25 to 29 years for women and 30 to 34 years for men, and declined at older ages. Fifteen or more lifetime partners were reported by 17 per cent of men and 4 per cent of women. Multiple partnerships in the previous 12 months were commonest in those aged 20 to 24. In this age group, 32 per cent of men and 20 per cent of women reported two or more partners. Recent condom use for contraception was reported by 23 per cent of men and 19 per cent of women. Use was highest amongst those aged 18 to 24, and decreased sharply with age. The true proportion of the population with many sexual partners may be higher than reported. These data will be useful in modelling approaches to estimate the likelihood of future heterosexual spread of AIDS. The data on lifetime numbers of partners suggest that sexual decisions depend not just on age and sex but also on the era, and thus on changing social values about sexual behaviour.

Assessment of self-report in HIV surveillance: a pilot study

The basis of HIV exposure category classification was investigated among selected cases of newly diagnosed HIV infection. Questionnaires seeking specific information on patient-reported exposure to HIV were forwarded to doctors who had requested the HIV antibody test for patients who met the study sample criteria. The cases of interest were those newly diagnosed between 1 January and 31 October 1991 and notified to state and territory health authorities as having been attributed to exposures to HIV other than male homosexual contact or receipt of blood, blood products or tissue. A total of 158 questionnaires was forwarded and 59 per cent were returned. Among the returned questionnaires included in the study sample, exposure to HIV on the original notification to the health authority was given as injecting drug use (8 per cent, 3 of 37), heterosexual contact (46 per cent, 17 of 37), or unavailable (46 per cent, 17 of 37). A clear basis for HIV exposure category classification was provided on the questionnaires for 70 per cent (7 of 10) of cases among women, whereas among men whose infection was attributed to heterosexual contact, a basis for exposure category classification was specified for only 43 per cent (10 of 23) of cases. Although the study was limited by the low response rate, use of the questionnaire provided a relatively simple means for assessing self-reported HIV exposure history.

Assessing the extent of the Australian HIV epidemic from AIDS surveillance data

Current knowledge about human immunodeficiency virus (HIV) disease is used to assess past and future trends in Australian HIV/AIDS (acquired immune deficiency syndrome) incidence, focusing on the precision with which such assessments can be made. The statistical method of back-projection is applied to reconstruct the past pattern of HIV incidence from surveillance data on AIDS incidence to June 1992. The results indicate that HIV incidence rose rapidly in the early 1980s to peak in 1983-1984, followed by a sharp decline. This finding is insensitive to plausible variations from the assumptions made, and is consistent with both success in preventive strategies and high levels of infection in a subgroup having a high probability of exposure. Cumulative HIV incidence to the end of 1987 is estimated with a 90 per cent confidence interval from 9,350 to 10,350. Estimation of the cumulative HIV incidence to June 1992 is less precise, with a 90 per cent confidence interval of 12,900 to 17,800. After adjustment for underreporting the incidence could be as high as 22,000, but only if recent infection rates, which cannot be quantified accurately, were very high. Based on data to June 1992, the estimated trend in AIDS incidence indicates 680 new cases in 1993, rising gradually to 695 in 1995. The estimated rate of increase in AIDS incidence over the recent past and near future is significantly less than that observed earlier in the epidemic. This is a consequence of both the earlier peak in HIV incidence and the effect of therapy.

Adolescents, sexual behaviour and implications for an epidemic of HIV/AIDS among the young

OBJECTIVE

To determine the patterns of sexual behaviour, condom use and sexually transmitted diseases among young New Zealanders, and the characteristics of those with many sexual partners.

SUBJECTS

A cohort of young people enrolled in a longitudinal cohort study, and followed up since age three.

METHODS

Subjects were interviewed at age 18 years as part of a multidisciplinary health and development study. Questions about sexual behaviour were presented by computer.

RESULTS

Overall 862/1027 (83.9%) surviving in the cohort was interviewed. Only 1.4% declined to answer the section on sexual behaviour. Sexual intercourse in the previous 12 months was reported by 57.6% of the young men and 67.9% of the young women. Amongst those who were sexually active more of the young men reported multiple partners than the young women (59.8% v 46.5% p < 0.001). There was a trend for increasing number of partners with indices of lower school achievement but no significant association with socio-economic status. Condom use decreased with increasing number of partners for the young women, and for the young men there was no association. Sexually transmitted diseases were reported more commonly with increasing number of sexual partners for both men and women. The rates of sexual activity were substantially higher than reported in a comparable survey 20 years ago.

CONCLUSIONS

The pattern of sexual behaviour and condom use, and the occurrence of sexually transmitted diseases in this sample give cause for concern about the spread of sexually transmitted diseases including the possibility of an epidemic of HIV among heterosexual young people in New Zealand. The findings should help in targeting health promotional activities within this age group.