Evaluating the impact of COVID-19 on the HIV epidemic among men who have sex with men in Australia: A modelling study
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Introduction
The initial phase of the coronavirus disease 2019 (COVID-19) pandemic caused significant interruptions to human immunodeficiency virus (HIV) prevention and healthcare services. In Australia, these interruptions coincided with a large reduction in HIV diagnoses but it is unknown if this reflects a reduction in incidence or barriers to testing. We aimed to understand the changes in HIV transmission among men who have sex with men in Australia and the impact of disruptions to HIV prevention, testing and treatment services due to the COVID-19 pandemic and the public health response by incorporating time-sensitive factors in real-world situations.
Methods
We developed a mathematical model to estimate monthly HIV incidence between January 2020 and August 2022. We obtained aggregated monthly data for sexual partners, condom use, HIV testing, pre-exposure prophylaxis (PrEP) use, and migration. Three scenarios were simulated: 1) a COVID scenario with all changes in place; 2) a no COVID-19 scenario where input parameters remained at pre-COVID-19 values, and 3) a no COVID-19 scenario with continued PrEP scale-up.
Results
In the absence of the COVID-19 pandemic, the estimated number of cumulative infections from January 2020 to August 2022 would have been 1,266 [95% Percentile Interval (PI): 1,100–1,466] compared to 915 [95% PI: 729–1,181] for the COVID-19 scenario (a 27.7% reduction). The largest reduction in infections (44.3%) occurred in 2020 with 273 (95% PI: 221– 344) infections versus 490 (95% PI: 435–552) in the no-COVID scenario. There was a rebound with 387 infections (95% PI: 307–502) in 2021, followed by a reduction to a stable level by August 2022. Our model identified reductions in sexual partners as the leading factor contributing to the change in HIV infections and diagnoses (−24.8% and −10.5%, respectively).
Conclusions
A substantial reduction in new HIV infections and diagnoses in Australia occurred during the early stages of the COVID-19 pandemic, which was largely due to reduced HIV transmission. A rebound in infections as sexual partnerships increased between 2021-2022, highlights the imperative to maintain vigorous response efforts and take advantage of the gains made to virtually eliminate HIV transmission in Australia.
