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Quarterly Surveillance Report 
Vol. 2, No. 2, October 1996

Contents

The Surveillance System for HIV infection in South Australia

Incident Cases of HIV Infection in Males in South Australia

HIV Infection in South Australia

Hepatitis C Surveillance in South Australia

Hepatitis B Surveillance in South Australia

Genital Chlamydial Infection in South Australia

Gonococcal Infection in South Australia

List of Tables

Table 1.1 Incident cases of HIV infection detected in Men in South Australia, 01/01/92 - 30/06/96 by age group and risk marker
Table 1.2 Incident cases of HIV infection detected in Men in South Australia, 01/01/92 - 30/06/96 by risk marker and knowledge of sexual partners
Table 2.1 HIV infection detected in South Australia in 1996. New diagnosis of HIV infection by sex and exposure category, cumulative to 30/06/96 and for the period 01/04/96 - 30/06/96
Table 2.2 HIV infection detected in South Australia in 1996. Testing history by age at diagnosis of HIV infection, cumulative to 30/6/96 and for the period 01/04/96 - 30/06/96.
Table 2.3 Number of HIV antibody tests performed in 1996 by laboratory and sex, cumulative to 30/06/96 and for the period 01/04/96 - 30/06/96
Table 3.1 Medical notifications for individuals who tested hepatitis C antibody positive for the first time in 1996, for the period 01/04/96 - 30/06/96 and cumulative to 30/06/96. Exposure category by sex
Table 3.2 Individuals who tested positive for hepatitis C infection for the first time in 1996 for the period 01/04/96 - 30/06/96 and cumulative to 30/06/96. Age group by sex
Table 3.3 Individuals who tested positive for hepatitis C infection for the first time in 1996 for the period 01/04/96 - 30/06/96 and cumulative to 30/06/96. Reported race and sex
Table 3.4 Newly acquired infections diagnosed in 1996, exposure category by sex for the period 01/04/96 - 30/06/96 and cumulative to 30/06/96
Table 3.5 Number of HCV antibody tests performed in 1996 by laboratory and sex, cumulative to 30/06/96 and for the period 01/04/96 - 30/06/96
Table 4.1 Acute cases of hepatitis B infection for 1996, cumulative to 30/06/96 and for the period 01/04/96 - 30/06/96. Risk category by sex
Table 4.2 Acute cases of hepatitis B infection for 1996, cumulative to 30/06/96 and for the period 01/04/96 - 30/06/96. Age group by sex
Table 4.3 Individuals who tested hepatitis B surface antigen positive for the first time during the period 01/01/96 - 31/03/96. Race by sex
Table 4.4 Laboratory screening for hepatitis B surface antigen by sex. 01/04/96 - 30/06/96
Table 5.1 Genital chlamydial infection in South Australia for 1996, cumulative to 30/06/96 and for the period 01/04/96 - 30/06/96. Age group by sex
Table 5.2 Laboratory testing for genital chlamydia in South Australia for 1996, cumulative to 30/06/96 and for the period 01/04/96 - 30/06/96
Table 6.1 Gonococcal infection in South Australia for 1996, cumulative to 30/06/96 and for the period 01/04/96 - 30/06/96. Age group by sex

THE SURVEILLANCE SYSTEM FOR HIV INFECTION IN SOUTH AUSTRALIA

AIDS has been a controlled notifiable disease in South Australia since 1983. Cases of AIDS were reported to the Communicable disease Control Unit until November 1995 when responsibility for AIDS surveillance was transferred to the STD Control Branch (STDCB). AIDS represents the late stage of HIV infection and consequently surveillance of AIDS does not provide information on the current epidemiology of HIV infection.

A more complete surveillance of HIV infection was possible in June 1985 when laboratory testing became available at the IMVS. The IMVS became the reference laboratory for South Australia and was able to perform screening EIA and confirmatory Western Blot assays. Statistics on the number of tests performed and presumed new diagnoses of HIV infection were compiled by the Virology Department of the IMVS with assistance from STD Services. However, The laboratory data had limited information about risk markers for infection.

HIV infection was proclaimed a controlled notifiable infection in September 1991 with a legal requirement on medical practitioners to notifiy cases of HIV infection. HIV infection is now reported directly to the STDCB by the State Reference Laboratory for HIV (IMVS) and a clinical notification is made by the attending medical practitioner. This notification system uses a name code and seeks information on demographics, testing history, risk factors and client preference for follow up procedures. The attending doctor may investigate to determine the likely risk factors and undertake contact tracing; alternatively the client may be referred to the STDCB. When the clinical notification indicates the latter option the HIV epidemiologist contacts the attending doctor to ensure the client is aware of the referral to the STDCB. The surveillance data from the laboratory and clinical notifications are supplemented with information obtained from client interviews for contact tracing conducted by the HIV epidemiologist.

The objectives of HIV surveillance in South Australia are as follows;

  • to define the epidemiology of HIV infection in relation to risk behaviour
  • to facilitate contact tracing/partner notification.

A sound knowledge of the local epidemiology of HIV provides important information for education, prevention and treatment programmes. Understanding current transmission dynamics is especially important for education and prevention programmes and depends on identifying incident cases and the risk behaviours involved. An incident case is defined by the following;

  • Evidence of a prior negative HIV antibody test in the 12 months prior to diagnosis of infection,
    or
  • Diagnosed seroconversion illness within 12 months of diagnosis of HIV infection

.Notification forms and reply paid envelopes are sent to the attending medical practitioner and additional forms may be obtained from:

Therese Davey
STD Control Branch
275 North Terrace
Adelaide 5000

Telephone: (08) 8226 6025
Fax: (08) 8226 6560

INCIDENT CASES OF HIV INFECTION IN MALES IN SOUTH AUSTRALIA

Incident cases of HIV infection in Males in South Australia for the period 01/01/92 - 30/06/96

There have been 175 individuals diagnosed with HIV infection between January 1992 and June 1996, 163 (93%) males 12 (7%) females (Table 1.1). Of the 175 reported cases, 53 were classified as incident infections (50 males, 3 females). The STDCB were able to interview 67% (117/175) of cases including 49/50 of the incident cases in males. Incident cases represented 31% (50/163) of reported infections in males and represents the minimum estimate of incident cases. Some incident cases will not be detected because of the lack of a sero-conversion illness or prior negative testing. The median age of incident male cases is 30 years compared to a median age for all new diagnoses in men of 33.9 years. The majority (86%) of incident cases were aged between 20 -39 years (Table 1.1).

A high proportion (41/50) of men who were incident cases reported male to male sexual contact as their risk factor, 4 men reported sex with both male and female sexual contacts, 2 men reported heterosexual contact in a country where HIV infection is primarily heterosexually transmitted, 2 men reported male to male sexual contact and injecting drug use as their risk factors. One male moved interstate shortly after diagnosis and could not be interviewed to determine his risk exposure.

Incident cases are interviewed to determine risk markers for infection and to identify other potentially infected individuals. The interview is not designed to determine whether individuals identify as gay. However, during the interview knowledge of the gay scene and association with other gay men is assessed. It is apparent from the interviews that the majority of incident cases are in gay identifying males. Information is collected on the knowledge of their partners' HIV status and where they meet sexual partners. Knowledge of sexual partners is assessed and recorded in a hierarchical fashion. Those who know their partners or their partners' HIV status are recorded as having sex with known partners, even though they may on occasions engage in sexual activity with anonymous partners. Those classified as having anonymous sex reported no sexual activity with known partners during the time period in which they were likely to have been infected.

Twenty men (40%) reported anonymous sexual activity following attendance at a gay venue and/or the beats. Of those who knew their sexual partners, 10 reported sexual contact with a known HIV antibody positive partner and 17 did not know their partners HIV status (Table 1.2).

Table 1.1 Incident cases of HIV infection detected in Men in South Australia, 01/01/92 - 30/06/96 by age group and risk marker.

EXPOSURE CATEGORY AGE GROUP
15-19 20-29 30-39 >40 Total
Homosexual contact 1 19 18 3 41
Homosexual contact / IDU 0 2 0 0 2
Bisexual contact 0 2 2 1 4
Heterosexual contact 0 0 0 1 2
Unknown / Other 0 0 0 1 1
TOTAL 1 23 20 6 50

 

Table 1.2 Incident cases of HIV infection detected in Men in South Australia, 01/01/92 - 30/06/96 by risk marker and knowledge of sexual partners.

  ANONYMOUS SEXUAL PARTNERS  
NO YES
EXPOSURE CATEGORY HIV Positive
Partner
HIV Status
Unknown
Gay Venues
+/- Beats
Beats Only TOTAL
Homosexual 10 16 8 7 41
Bisexual 0 1 1 2 4
Homosexual/IDU 0 0 0 2 2
Heterosexual 0 2 0 0 2
TOTAL 10 20 9 11 *50

* Total includes one notification not interviewed

HIV INFECTION IN SOUTH AUSTRALIA

HIV Infection 1985 - 30/06/96

There have been 620 individuals diagnosed with HIV infection, 576 (93%) in males and 44 (7%) in females. Of the males diagnosed, 75% (433) reported male to male sexual contact, 10% (52) reported injecting drug use and 5% (27) reported both risk factors. Injecting drug use was reported by 51% (22) of the women diagnosed with HIV infection and 37% (17) reported heterosexual transmission

HIV Infection 01/04/96 - 30/06/96

During the first six months of 1996 no infections in females were reported. Seven men have been reported with HIV infection during the second quarter of this year, and all reported male to male sexual contact as their risk factor (Table 2.1). Between 01/01/96 and 30/06/96 six men (reporting male to male sexual contact) had acquired their infection in the preceding 12 months (Table 2.2)

Laboratory Screening For HIV Infection 01/04/96 - 30/06/96

During the second quarter of 1996 there have been 18,818 screening tests performed, 8,154 (43%) on males, 10,515 (56%) on females and 149 tests were performed on individuals whose sex was unknown (Table 2.3).

Table 2.1 HIV infection detected in South Australia in 1996. New diagnosis of HIV infection by sex and exposure category, cumulative to 30/06/96 and for the period 01/04/96 - 30/06/96

EXPOSURE CATEGORY 2nd Quarter:
01/04/96 - 30/06/96
Cumulative
to 30/06/96
MALE
No(%)
MALE
No(%)
Homosexual contact

7

15

Heterosexual contact

0

2

Unknown

0

1

TOTAL

7

18


Table 2.2 HIV infection detected in South Australia in 1996. Testing history by age at diagnosis of HIV infection, cumulative to 30/06/96 and for the period 01/04/96 - 30/06/96.

TESTING HISTORY 2nd Quarter:
01/04/96 - 30/06/96
Cumulative
to 30/06/96
 TOTAL
AGE AGE
<25 25 - 39 40+ <25 25 - 39 40+
No previous test 0 1 3 0 4 4 8
Previous 12 months 1 0 0 2 4 0 6
12 - 24 months 0 1 1 1 2 1 4
TOTAL 1 2 4 3 10 5 18

 

Table 2.3 Number of HIV antibody tests performed in 1996 by laboratory and sex, cumulative to 30/06/96 and for the period 01/04/96 - 30/06/96.

  2nd Quarter:
01/04/96 - 30/06/96
Cumulative
to 30/06/96
 
LAB MALE FEMALE Unknown MALE FEMALE Unknown TOTAL
  No No No No No No No
IMVS 5629 6123 149 11789 12962 419 25170
Private 1850 3118 0 3782 6338 0 10120
Hospital 675 1274 0 1365 2520 0 3885
TOTAL 8154 10515 149 16936 21820 419 39175

HEPATITIS C SURVEILLANCE IN SOUTH AUSTRALIA

Hepatitis C Medical Notification 1 April 1996 - 30 June 1996

Laboratories reported 530 individuals who tested positive for Hepatitis C infection in the second quarter of 1996, 423 (80%) individuals were notified by medical practitioners. Of the 423 medical notifications received, 139 (32%) individuals reported never having a test, 174 (41%) had previously tested positive for Hepatitis C antibody, 19 (5%) individuals reported a previous negative test result and information on testing history was unavailable for 91 (22%) individuals. Of the 19 individuals with a previous negative test 6 were incident cases (defined by a negative test or acute clinical illness in the preceding 12 months).

Of the 249 individuals who tested positive for Hepatitis C infection for the first time in 1996, 157 individuals (63%) reported past and present history of injecting drug use, 20 (8%) reported blood transfusion/blood products as their only risk factor, tattoos accounted for 2% (4) and unknown exposure category accounted for 20% (50) of the infections reported (Table 3.1).

A high proportion of individuals were aged between 30 - 39 years (48% of men, 42% of women) (Table 3.2).

Table 3.3 shows the reported race of individuals who tested positive for hepatitis C infection for the first time in 1996.

There have been 6 individuals who acquired the infection in the preceding 12 months (defined by a negative hepatitis C antibody test in the 12 months prior to diagnosis or diagnosed acute illness) (Table 3.4). None of the incident cases reported an acute illness involving jaundice within the last 12 months.

During the second quarter of 1996 there were 13,859 screening tests performed, 6,763 (49%) on males, 7,008 (50%) on females and 88 tests were performed on individuals whose sex was not documented (Table 3.5).

Table 3.1 Medical notifications for individuals who tested hepatitis C antibody positive for the first time in 1996, for the period 01/04/96 - 30/06/96 and cumulative to 30/06/96. Exposure category by sex.

EXPOSURE CATEGORY 2nd Quarter:
01/04/96 - 30/06/96
Cumulative to 30/06/96 TOTAL
MALE

No(%)

FEMALE

No(%)

MALE

No(%)

FEMALE

No(%)

IDU* 108 (66) 49 (58) 264 (64) 98 (55) 362
Blood transfusion/blood products 15 ( 9) 5 (6) 34 (8) 18 (10) 52
Tattoos 4 (2) 0 23 (6) 3 (2) 26
Other** 7 (4) 11 (13) 12 (3) 17 (9) 29
Unknown 30 (19) 20 (23) 80 (19) 43 (24) 123
TOTAL 164 85 413 179 592

* includes those individuals whose exposure category is IDU, IDU/tattoos, IDU/tattoos/blood transfusion and IDU/blood transfusion.
** includes
those individuals whose reported exposure category is body piercing, residence in a high prevalence country, household contact, a positive sexual partner or perinatal.

 

Table 3.2 Individuals who tested positive for hepatitis C infection for the first time in 1996 for the period 01/04/96 - 30/06/96 and cumulative to 30/06/96. Age group by sex.

  2nd Quarter:
01/04/96 - 30/06/96
Cumulative
to 30/06/96
 
AGE GROUP MALE FEMALE MALE FEMALE TOTAL
  No(%) No(%) No(%) No(%) No
Under 10 0 3 (4) 0 4 (2) 4
10 - 19 6 (9) 3 (4) 9 (2) 7 (4) 16
20 - 29 37 (9) 19 (22) 105 (26) 41 (23) 146
30 - 39 79 (2) 36 (42) 191 (46) 74 (41) 265
40 - 49 27 (4) 13 (15) 77 (19) 26 (15) 103
50+ 15 (19) 11 (13) 30 (7) 27 (15) 57
TOTAL 164 85 413* 179 592*

* includes 1 male whose DOB is unknown

 

Table 3.3: Individuals who tested positive for hepatitis C infection for the first time in 1996 for the period 01/04/96 - 30/06/96 and cumulative to 30/06/96. Reported race and sex.

Race 2nd Quarter:
01/04/96 - 30/06/96
Cumulative
to 30/06/96
TOTAL
MALE FEMALE MALE FEMALE
No No No No No
Caucasian 126 62 309 131 440
Asian 10 5 23 8 31
Aboriginal 6 7 24 16 40
Unknown 22 11 57 24 81
TOTAL 164 85 413 179 592

 

Table 3.4: Newly acquired infections diagnosed in 1996, exposure category by sex for the period 01/04/96 - 30/06/96 and cumulative to 30/06/96**.

EXPOSURE CATEGORY

2nd Quarter:
01/04/96 - 30/06/96

Cumulative
to 30/06/96

TOTAL

MALE

FEMALE

MALE

FEMALE

 

No

No

No

No

No

IDU

5

0

6

0

6

IDU/tattoos

1

0

2

0

2

Needle stick injury

0

0

0

1

1

Unknown

0

0

1

0

1

TOTAL

6

0

9

1

10

** Newly acquired infections are defined by a negative test or diagnosed sero-conversion in the last 12 months as reported on notification form

 

Table 3.5: Number of HCV antibody tests performed in 1996 by laboratory and sex, cumulative to 30/06/96 and for the period 01/04/96 - 30/06/96.

  2nd Quarter:
01/04/96 - 30/06/96
Cumulative
to 30/06/95
 
LABORATORY MALE FEMALE Unknown MALE FEMALE Unknown TOTAL
  No No No No No No No
IMVS 3679 2993 88 7478 6194 187 13859
Private 2284 3265 0 4558 6919 0 11477
Hospital 800 750 0 1643 1572 0 3215
TOTAL 6763 7008 88 13679 14685 187 28551

 

HEPATITIS B SURVEILLANCE IN SOUTH AUSTRALIA

Hepatitis B medical notification 01/04/96 - 30/06/96

During the second quarter of 1996, 90 Hepatitis B medical notifications were received. Of these, 6 were acute cases of Hepatitis B infection (Tables 4.1, 4.2).

18 were carriers of greater than twelve months duration who had been previously diagnosed but not notified. There were 66 individuals who tested surface antigen positive for the first time in this quarter.

Of the 66 individuals who tested surface antigen positive for the first time but were not acute cases, the racial origin of a high proportion (46%) was reported as being Asian (Table 4.3).

Table 4.4 shows the number of Hepatitis B surface antigen tests performed by laboratories for this quarter.

Table 4.1: Acute cases of hepatitis B infection for 1996, cumulative to 30/06/96 and for the period 01/04/96 - 30/06/96. Risk category by sex.

  2nd Quarter:
01/04/96 - 30/06/96
Cumulative
to 30/06/96
 
RISK CATEGORY MALE FEMALE MALE FEMALE TOTAL
  No No No No No
IDU/Tattoos 0 1 1 1 2
Sexual 1 2 1 2 3
Social/Family 0 1 0 1 1
Unknown 0 1 1 2 3
TOTAL 1 5 3 6 9

 

Table 4.2: Acute cases of hepatitis B infection for 1996, cumulative to 30/06/96 and for the period 01/04/96 - 30/06/96. Age group by sex.

  2nd Quarter 01/04/96 - 30/06/96 Cumulative to 30/06/96  
AGE GROUP MALE FEMALE MALE FEMALE TOTAL
  No No No No No
10 - 19 0 0 0 1 1
20 - 29 1 2 1 2 3
30 - 39 0 1 1 1 2
50+ 0 2 1 2 3
TOTAL 1 5 3 6 9

 

Table 4.3: Individuals who tested hepatitis B surface antigen positive for the first time during the period 01/04/96 - 30/06/96. Race by sex.

  2nd Quarter:
01/04/96-30/06/96
Cumulative
to 30/06/96
 
Racial Origin MALE FEMALE MALE FEMALE TOTAL
  No % No % No % No % No %
Aboriginal 10 26 2 7 11 15 4 8 15 12
Asian 16 41 14 52 36 48 31 63 67 54
Caucasian 12 31 7 26 24 32 9 19 33 27
Other/Unknown 1 2 4 15 4 5 5 10 9 7
TOTAL 39   27   75   49   124  

 

Table 4.4: Laboratory screening for hepatitis B surface antigen by sex. 01/04/96 - 30/06/96

  2nd Quarter 01/04/96 - 30/06/96 Cumulative to 30/06/96  
LABORATORY MALE FEMALE Unknown MALE FEMALE Unknown TOTAL
  No No No No No No No
IMVS 3709 4180 0 7633 8735 0 16368
Private 828 1838 5334 1728 3922 10886 16536
Hospital 706 2004 0 1493 4292 0 5782
TOTAL 5243 8022 5334 10854 16949 10886 38686

 

GENITAL CHLAMYDIAL INFECTION IN SOUTH AUSTRALIA

Genital Chlamydial Infection 01/01/96 - 30/06/96

There were 536 cases of genital chlamydial infection notified between 1 January 1996 and 30 June 1996 (Table 5.1).

Genital Chlamydial Infection 01/04/96 - 30/06/96

Between 1 April 1996 and 30 June 1996, 281 cases of genital chlamydia were notified. Of these 281 cases, 106/281 (38%) occurred in males and 175/281 (62%) occurred in females (Table 5.1).

79% (84/106) of genital chlamydia occurred in males aged under 30 and 90% (158/175) occurred in females aged under 34 between 1 April 1996 and 30 June 1996 (Table 5.1).

1665 chlamydia tests were performed on men and 5481 on women between 1 April and 30 June 1996 (Table 5.2).

Table 5.1 Genital chlamydial infection in South Australia for 1996, cumulative to 30/06/96 and for the period 01/04/96 - 30/06/96. Age group by sex.

AGE GROUP 2nd Quarter
01/04/96 - 30/06/96
Cumulative
to 30/06/96
 
  MALE FEMALE MALE FEMALE TOTAL
15 - 19 18 51 23 91 114
20 - 24 47 63 82 141 223
25 - 29 19 25 44 51 95
30 - 34 8 19 11 33 44
35 - 39 10 9 16 16 32
40+ 4 7 9 17 26
TOTAL 106 175 185 351 536*

*total includes 2 females <15 years of age

Table 5.2 Laboratory testing for genital chlamydia in South Australia for 1996, cumulative to 30/06/96 and for the period 01/04/96 - 30/06/96.

  2nd Quarter
01/04/96 - 30/06/96
Cumulative
to 30/06/96
 
LAB MALE FEMALE MALE FEMALE TOTAL
  No No No No No
IMVS 987 2353 2094 4853 6947
Private 657 2643 1355 5541 6896
Hospital 21 485 40 1024 1064
TOTAL 1665 5481 3489 11418 14907

 

GONOCOCCAL INFECTION IN SOUTH AUSTRALIA

Gonococcal Infection 01/01/96 - 30/06/96

There were 184 cases of gonococcal infection notified between 1 January 1996 and 30 June 1996 (Table 6.1).

Gonococcal Infection 01/04/96 - 30/06/96

There were 144 cases of gonococcal infection notified between 1 April 1996 and 30 June 1996. Of these 144 cases, 79/144 (55%) occurred in males and 65/144 (45%) occurred in females (Table 6.1)

Table 6.1 Gonococcal infection in South Australia for 1996, cumulative to 30/06/96 and for the period 01/04/96 - 30/06/96. Age group by sex

AGE GROUP 2nd Quarter
01/04/96 - 30/06/96

Cumulative to 30/06/96

 
  MALE FEMALE MALE FEMALE TOTAL
< 15 3 3 3 4 7
15 - 19 25 23 27 31 58
20 - 24 19 18 28 20 48
25 - 29 11 7 16 8 24
30 - 34 9 6 11 9 20
35 - 39 4 4 10 3 13
40+ 8 4 7 7 14
TOTAL 79 65 102 82 184

All data in this report are provisional and subject to future revision.

The STD Control Branch Quarterly Surveillance Report is produced by the STD Control Branch, Public and Environmental Health Service, South Australian Health Commission.

Postal address:

STD Control Branch
PO Box 6
Rundle Mall SA 5000
Australia

Telephone: +61 (8) 8226 6025

Facsimile: +61 (8) 82266560

Email: STD.Services at health.sa.gov.au
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Contributors:

Dr Russell Waddell
Ms Tess Davey
Ms Julie Silvers
Ms Monica Winter

Desktop publishing: Ms Tammy Wilson

Conversion to HTML: Dr Christopher Miller

 

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