BACKGROUND: We describe Australia’s overall progress towards achieving the UNAIDS 95-95-95 targets by analysing the trends in epidemiological metrics over 2004-2021.
METHODS: We used mathematical modelling and national HIV notification, cohort, and administration data to calculate annual estimates for the HIV cascade, the number of annual new HIV infections, and other HIV epidemic metrics during 2004–2021. We used piecewise negative binomial regression to determine changes in trends and annual rate ratios (ARRs) for each cascade step and metric.
RESULTS: We estimate there were 29,460 (range: 25,230?34,070) people living with HIV in Australia at the end of 2021. All 90-90-90 targets were achieved in 2020, with 91.1% of people living with HIV diagnosed, 91.6% of those diagnosed on Treatment and 97.8% of those on treatment being virally suppressed (achieving the final 95 target) at the end of 2021. There were reductions in each gap of the cascade and the number of people living and diagnosed with HIV is stabilising. However, the percentage diagnosed and receiving treatment has plateaued under 92% since 2015 after a large fall in the number untreated over 2011-2014. Changes in the cascade gaps coincided with a slow increase in HIV notifications from 2004 to 2014, followed by a slow decline to 2019, and then a rapid fall. Similar trends were found for the estimates of new HIV infections. Most metrics showed substantial improvement since 2004, particularly after the emergence of COVID-19 in 2020, with the incidence prevalence ratio falling below the UNAIDS global target of 0.03 in 2019.
CONCLUSIONS: While Australia saw substantial progress in the HIV cascade and achieved the 90-90-90 targets in 2020, reaching all 95-95-95 targets by 2025 is not guaranteed. Despite large falls in new infections, particularly since the start of the COVID-19 pandemic, gaps in the cascade related to diagnosis and treatment remain. Further efforts are needed to achieve the UNAIDS targets and end HIV as a public health threat in Australia.