5% of the Māori MSM and 37.5% of the Pacific MSM. A difference in HIV testing CH5424802 research buy by ethnicity, particularly lower rates among Pacific MSM, has also been seen in community surveys. In the 2006 Gay Auckland Periodic Sex Survey (GAPSS) [16], the respective proportions for these ethnic groups were 77, 75 and 40%, and in the 2008 GAPSS, 80, 77 and 60% [17]. The use of agreed definitions for late presentation allows international comparisons. The proportion of ‘late presentations’ among people diagnosed with HIV infection in the European Union (EU) in 2009 has recently been reported [18]. Among the 28 EU countries that report on HIV diagnoses, 18 countries monitored initial CD4 cell counts, 11 of which obtained

this information on more than half of the cases. The 2009 data for these countries (Table 6)

show that the proportion of cases for which we had this information in New Zealand for 2005–2010 (80%) was only surpassed by two of these countries. The proportion of ‘late presentations’ among MSM in New Zealand was similar to that in the UK, France and Spain but higher than that in six other countries. Among heterosexually infected people, the proportion of ‘late presentations’ was again similar to that in the UK and also to that in the Netherlands, but higher than that in seven other countries, Rapamycin although our exclusion of people diagnosed through immigration might have affected this comparison. These comparisons show that in recent years New Zealand has a very similar pattern of late presentation to that found SPTLC1 in the UK and several other Northern European countries. In Australia, initial CD4 cell counts were also available for about 80% of people diagnosed with HIV infection over the period 2005–2008 [19]. The initial CD4 count was <200 cells/μL for about 20% of all patients for whom this was available; and <350 cells/μL for about 40%, somewhat lower than our comparable proportions of 31 and 50%. The median CD4 count among all MSM diagnosed with HIV infection in Australia in the

period 2005–2009 was 460 cells/μL, slightly higher than for MSM in New Zealand for 2005–2010, for whom it was 404 cells/μL. As both Australia and New Zealand have had recent increases in the number of new infections of HIV among MSM, this suggests less testing in New Zealand. This is supported by gay community periodic surveys in Australia which in 2008 found rates of HIV testing in the previous 12 months of between 52 and 62% [20], compared with 45% in a similar survey in Auckland in that year. The major implication of these findings is that more efforts should be made to diagnose HIV infection early. Delayed testing has an impact not only on the well-being of individuals but also on the future spread of the epidemic in populations and groups. Mathematical modelling in Australia suggests that those with undiagnosed chronic HIV infection are likely to be responsible for a disproportionate number of new infections [21].