Australia

Among gay men, the group principally affected by HIV in Australia, testing is generally considered to be far more common than among gay men in the UK. However this understanding comes from surveys conducted at gay community events and gay venues.

For example, in the 2009 Gay Community Periodic Surveys, 87% had ever been tested and 60% had done so in the past year.

Such surveys under-represent younger men, non-gay identified men and men living in rural or remote areas. Online surveys such as the 2008 e-male survey tend to recruit more of these men and find that testing rates are lower. In this sample, 72% of the participants had ever been tested for HIV and 28% had never been tested. Around half the men (48%) had tested in the last twelve months.¹

Australia’s 2011 testing policy² has eight key principles:

• Testing is demonstrably of the highest possible standard and timely.
• Testing should be voluntary and performed with informed consent.
• Test results will remain confidential (i.e. only the person being tested and the person providing the results will be entitled to information necessary to identify the individual result). Exceptions to this principle are identified in the policy.
• Testing must be accessible to all those at risk of HIV infection.
• Testing is critical to the interruption of transmission on a population level.
• Testing is of benefit to the person being tested and a critical trigger to initiating interventions including treatment.
• Testing is critical to understanding the epidemiology of HIV infection in the community.
• Anonymous testing should be available to individuals, subject to the need to obtain sufficient demographic information from those being tested to allow accurate aggregate information to contribute to surveillance.

HIV testing is recommended when there is clinical suspicion of HIV infection (e.g. opportunistic infection, clinical indicator disease); diagnosis of an STI or viral hepatitis; high-risk sexual behaviour or re-use of injecting equipment; during pregnancy; or because the individual belongs to a group at higher risk of infection.

First-line diagnostic tests are often third-generation tests.

In terms of rapid testing, rigorous quality control and quality-assurance procedures are described. Rapid testing may be considered for community-based testing interventions for high-risk (gay men) or hard-to-reach populations and individuals (who are resistant to conventional testing). The guidelines draw attention to problems managing the post-test discussion after a reactive result and the need for a community testing intervention to be able to take a venous blood sample for confirmatory testing. Rapid testing is not recommended in remote Aboriginal or Torres Strait Islander communities because of the low prevalence of HIV and hence high risk of false positive results.

Home testing is rejected.