By Associate Professor Edwina Wright, President of the Australasian Society for HIV Medicine (ASHM)
ASHM is the local scientific partner for AIDS 2014 and is very much looking forward to the synergistic outcomes that typically arise when science-meets-society at these wonderful World AIDS meetings. ASHM is a peak organisation of health professionals in Australia and New Zealand who work in HIV, viral hepatitis and sexually transmissible infections. In the blog below ASHM’s president, A/Prof Edwina Wright, looks over the key new HIV health messages for Australia.
The embrace of a society- its land, people, cultures, religions, laws and economic and scientific progress- may be cordial or disarmingly cold when it comes to the issue of HIV and other stigmatizing infections that are transmitted from human to human. Australia has a complex past characterized by a brutal period of British colonization and repression of its First People. Following this, waves of migration have brought people from the UK and countries of Europe, Asia and Africa to Australia, which can now boast that over 25% of its current population was born overseas. This is what has made our society marvelously rich and diverse.
Australia is a democracy with a universal health care system, Medicare, which subsidises the costs of laboratory tests, medical care and prescription medications. Through Medicare, all of Australia’s residents and citizens have the opportunity to receive equal access to the health prevention messages, medical treatment and scientific advances that are critical to reducing HIV infection and improving the health and longevity of people living with HIV.
Key, new HIV health messages for Australia and other societies include the finding that HIV pre-exposure prophylaxis (PrEP), a daily antiretroviral tablet taken by HIV negative people at risk of HIV, can reduce HIV transmission by 44%-76% and even up to 99% if people adhere strictly to the medication. In Australia PrEP is available in Victoria and will soon be available in New South Wales and Queensland though open access demonstration projects. Recently two other HIV prevention studies - the HPTN 052 and the PARTNER studies - have shown that the risk of sexual transmission of HIV from a virologically suppressed HIV+ person to their HIV negative partner is extremely low, including within couples practising condomless sex as shown in the PARTNER study. The implications of these findings are important in terms of HIV prevention, but also because they afford HIV serodifferent partners more accurate information to help navigate their HIV transmission risk during sexual intimacy.
A major treatment advance and an important message for people living with HIV, especially those newly diagnosed with HIV and those who shun antiretroviral treatment because of residual concerns about its toxicity is the availability of modern HIV antiretroviral medications with their relatively low pill burden and toxicity.
In Asia and The Pacific region approximately 4.8 million people live with HIV and of those, 25,000 people with known HIV infection live in Australia. The majority of new HIV diagnoses in Australia occur in gay men (64%), followed by heterosexuals (25%) and injecting drug users (2%). Overall the per capita rates of HIV infection in our Aboriginal and Torres Strait Islander and non-indigenous people are very similar, at around 4.5 per 100,000. Reflecting Australia’s diverse makeup, approximately 40% of all new heterosexual diagnoses between 2008-2012 occurred in people who acquired HIV from high prevalence countries such as Sub-Saharan Africa and South-East Asia.
In 2012 Australia had 1,253 new HIV diagnoses, certainly a modest number compared to other countries in our region, however this was the highest number we had witnessed for two decades and it spawned the 2012 Melbourne Declaration-Action on HIV! This Declaration brought together a number of peak HIV bodies to call for action in four areas: improving access to and uptake of (i) HIV testing and (ii) HIV treatment, (iii) making HIV PrEP available and (iv) strengthening our partnership response and enabling environment including changing laws that criminalise sex work and injecting drug use. The Australasian Society of Medicine (ASHM) was a key partner in the 2012 Melbourne Declaration and in 2013 ASHM led a major submission to Australia’s Pharmaceutical Benefits Advisory Committee (PBAC) in conjunction with our community partners, NAPWHA and AFAO. The submission sought to remove a restriction that only allowed HIV+ people with CD4+ counts less than 500/mm3, to have access to subsidised HIV antiretroviral treatment. The PBAC submission was successful so now all Australian residents and citizens can commence HIV treatment at a time that is right for them.