Progress towards the UNAIDS 2030 HIV prevention target in New South Wales, Australia: a population-based study.

Background: The UNAIDS ending AIDS strategy includes a 2030 prevention target of a 90% reduction in new infections from 2010. We report progress towards this goal in gay, bisexual and other men who have sex with men (GBM) in New South Wales (NSW), Australia.

Methods: We report HIV notification data for people newly diagnosed by exposure category, with a focus on GBM who comprised more than three-quarters of diagnoses. We report HIV testing, pre-exposure prophylaxis, HIV treatment, and undetectable viral load based on surveys of community-based GBM and data from a sentinel surveillance network of 50 clinics. We report trends between 2010 and 2022, including by geography grouped by postcodes with high-, medium- and low-prevalence of gay residents. Trends were assessed using the chi-square test for linear trend.

Findings: Statewide, annual notifications declined by 56% in GBM, and declines were much greater in inner-Sydney postcodes with a high percentage of gay residents compared to postcodes with a low percentage (88% and 32%). Among community-recruited GBM, annual HIV testing and PrEP uptake increased over time and by 2022 were higher in the high- (91% and 82%) than low-gay prevalence postcodes (78% and 61%). In the clinic sample, HIV testing and PrEP use increased but there was no evidence that they differed by geography. In both samples, among GBM living with HIV, the percentages on HIV treatment and with undetectable viral load increased over time, and by 2022 were greater than 95%.

Interpretation: HIV notifications in GBM in NSW have dropped by more than half since 2010. In inner Sydney areas with a high prevalence of gay men, prevention uptake was highest, and the decline in notifications approached 90%. Declines in HIV notifications were more modest elsewhere, and prevention uptake lower. Currently available prevention interventions, if extended population-wide, can enable a 90% reduction in new HIV infections in GBM, consistent with the ending AIDS target.

Funding: This project was funded by the National Health and Medical Research Council and the NSW Ministry of Health.