AIDS – New Zealand
Issue 47 – February 2001
ISSN 1170-2656
AIDS and HIV infection in New Zealand to end of December 2000
In the second half of 2000, there were 10 notifications of AIDS (9 males and 1 transsexual) and 38 people (29 males and 9 females) were found to be infected with HIV. To the end of December 2000, a total of 729 people (687 males and 42 females) have been notified with AIDS, and 1,478 people (1,270 males, 189 females, and 19 sex not stated) have been found to be infected with HIV. This total reflects 18 deletions from the HIV database, found to be duplicates.
Update on HIV/AIDS in the Pacific
This year marks the 20th anniversary of the recognition of the AIDS epidemic. As the epidemic has grown to claim up to 3 million lives per year, relatively little attention has been paid globally to the spread of HIV in the Pacific Region, of which New Zealand is a part. This large and diverse region, comprising 22 independent states and dependencies in addition to Australia and New Zealand, can be overlooked in the face of the continued expansion of HIV through much of neighbouring Southeast Asia.
In recent years the incidence of AIDS has been declining in high-income countries of the region. The introduction of highly active antiretroviral therapy (HAART) and the relative success in controlling the spread of infection among men who have sex with men are largely responsible for this trend. Elsewhere in the Pacific Region HIV transmission has been limited, at least by world standards. But the region includes many developing nations that would be poorly equipped to control HIV on a large scale. These Pacific neighbours, whose people now number more than 7 million,
may not be able to escape the widening diffusion of the epidemic indefinitely. The spread of HIV in the Pacific also has serious implications for New Zealand, because of our close social, economic and cultural ties across the region.
Surveillance for HIV/AIDS in the Pacific
The table on the next page shows an uneven pattern of reported HIV infection in the Pacific Region to date. There is a very low cumulative incidence (< 15 per 100,000 for both HIV and AIDS) in 15 of the smaller countries; a more moderate cumulative incidence (15-20 per 100,000 for AIDS, 30-50 per 100,000 for HIV) in Kiribati, New Zealand, Northern Mariana Islands and Papua New Guinea; a higher cumulative incidence (>20 per 100,000 for AIDS, >80
per 100,000 for HIV) in Australia, French Polynesia, Guam and New Caledonia; and a very high cumulative incidence for AIDS in Hawaii (>200 per 100,000, similar to the average for all US states).
Differences between countries may reflect true differences in the incidence of HIV/AIDS, but they may be affected by access to diagnostic tests, the effectiveness of public health surveillance and travel patterns. The table also shows differences in the evolutionary stage of the epidemic among countries of the region. The proportion of new HIV infections noted since the beginning of 1996 in Australia and New Zealand is just 19.0%, while these cases account for 72.9% of new infections in the other countries of the region.
New reports of AIDS and HIV infection have been mounting most rapidly in Papua New Guinea, where the World Health Organisation now estimates that the actual number of people infected with HIV aged 15 to 49 has reached 14,000 – a number equal to that of Australia, where the population is 4 times greater. The epidemic in PNG stems
mainly from heterosexual contact. HIV prevalence among female sex workers in Port Moresby was estimated at 16% in 1998.
Reported Cases of AIDS and HIV Infection in the Independent States and Dependencies of the Pacific Regiona
Notes:
a. HIV totals include AIDS cases. No cases of HIV infection or AIDS have been reported from American Samoa,
Cook Islands, Niue, Tokelau or Vanuatu.
b. Cases reported to the World Health Organization, Regional Office for the Western Pacific, except for Hawaii
(where data were obtained from the Hawaii Department of Health) and Australia (where data were obtained from the
National Centre in HIV Epidemiology and Clinical Research). HIV data for Australia are cumulative to 31 October
2000.
c. Cumulative rates based on population estimates for 2000, US Census Bureau.
d. Actual value estimated at 17,900, after adjusting for multiple reports. Unadjusted value used here, for consistency.
e. Hawaii has no routine reporting of HIV infection. Hawaiian population is excluded from total HIV incidence rates.
f. Total rates include independent states and dependencies where no cases have been reported.
Challenges to Effective HIV Prevention
Poor understanding of potential HIV risks and a low level of social tolerance of HIVinfected people may hamper prevention efforts in some Pacific countries. In one study in the Solomon Islands in 1997, 54% of teenage girls and 45% of teenage boys who were sexually active said they had never used condoms [Burslem F et al. Naked wire and naked truths: reproductive health risks faced by teenage girls in Honiara, Solomon Islands. Pacific Health Dialog 1998; 5: 8-15]. In another study, one-third of medical lab technologists from Pacific countries were not aware that HIV-positive persons can be free of symptoms [Siebers R et al. HIV and AIDS knowledge among medical laboratory technologists in the Pacific. Pacific Health Dialog 1998; 5: 22-5]. More than one-third of respondents to a 1995-96 survey in the Cook Islands said that HIV-infected people should not be allowed to live in the community [Tamarua N et al. HIV/AIDS knowledge, attitudes and practices in the Cook Islands. Pacific Health Dialog 1998; 5: 16-21].
HIV in New Zealand Acquired in the Pacific
Since the start of enhanced surveillance of new HIV infections in New Zealand in 1996, at least 8 persons found to be infected here were thought to have acquired their infections in the Pacific, outside Australasia or Hawaii. Six of the 8 patients, including those with infections acquired in Tonga, Kiribati and Samoa, were found to be infected during the year 2000.
These six cases accounted for 9% of all new HIV infections detected in New Zealand for which a likely place of infection was known, and for 15% of new infections thought to be acquired outside New Zealand during 2000.
AIDS and HIV Infection in New Zealand
The AIDS Epidemiology Group received 10 notifications of people (9 males and 1 transsexual) with AIDS during the second half of 2000. Eight of the men were reported to have been infected through sex with men, and one, an immigrant from Southeast Asia, was reported to have been infected heterosexually. The mode of infection for
the transsexual is unknown.
The Group has been informed of 38 people (29 males and 9 females) found to be infected with HIV during the second half of 2000. So far information on the likely mode of infection has been obtained on 33. Of these 33, 18 were men who were reported to have had sex with men, 10 (4 men and 6 women) were reported to have been heterosexually infected, 1 was reported to have received a blood transfusion while living in a high-prevalence country, and 4 were infected by unknown means. Of those whose infections were said to have been acquired heterosexually, 7 (3 men and 4 women) had lived in sub-Saharan Africa, 1 woman had contact with a bisexual man in New Zealand, 1 woman was a commercial sex worker from a high-prevalence country in Southeast Asia, and 1 man had contact with a woman from the same country.
Exposure categories and ethnicity of people notified with AIDS and found to be infected with HIV
Information on the categories of risk, sex and ethnicity, of the 729 people notified as having AIDS and of the 1,478 people diagnosed with HIV in New Zealand to the end of December 2000 is shown in Tables 1 and 2 (overleaf).
Table 1 Exposure category by time of notification of people with AIDS, and by time of diagnosis for those found to be infected with HIV. A small number of transsexuals are included with the males
NS = Not stated
*Includes people who have developed AIDS
†Acquired overseas
Table 2 Ethnicity by time of notification for people with AIDS, and by time of diagnosis for those found to be infected with HIV. Information on ethnicity of people found to be infected with HIV is only available since 1996. A small number of transsexuals are included with the males
NS = Not stated
* Includes people who have developed AIDS
†Includes people who belong to Maori and another ethnic group
For further information about the occurrence of AIDS in New Zealand contact:
Dr Jason Eberhart-Phillips
AIDS Epidemiology Group
Department of Preventive and Social Medicine
University of Otago Medical School
PO Box 913
Dunedin
New Zealand
Tel: (03) 479 7201
Fax: (03) 479 7298
Email: jeberhart@gandalf.otago.ac.nz
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