New push to end HIV transmission as fifth decade of pandemic begins

Jolyon Attwooll

18/06/2021 4:01:49 PM

Exactly 40 years since the reality of the global AIDS pandemic emerged, there is new hope of ending HIV transmission in Australia.

HIV red ribbon.
The most at-risk group remains men who have sex with men, who account for around two-thirds of new HIV/AIDS diagnoses.

In June 1981, a seminal report was published by the US Centers for Disease Control and Prevention (CDC), detailing the cases of five men treated in Californian hospitals for pneumonia – two of whom died. The report is widely viewed as a harbinger of the global AIDS pandemic.
Forty years later, and more than 900 Australians are still being diagnosed on average with HIV every year. However, this month a ‘consensus statement’ was published outlining how to end transmission Australia within four years – a goal that has gained more and more momentum as awareness and prevention improve.
The Agenda 2025 document, backed by HIV clinicians, the Australian Federation of AIDS Organisations (AFAO), the Kirby Institute and the Doherty Institute among others, outlines how a $53 million funding injection could help make that a reality.
Dr Amy Moten, Chair of RACGP Specific Interests Sexual Health, told newsGP it has been frustrating to not see the number of transmissions fall further.
‘We have the means to prevent transmission now,’ she said.
‘What’s more lacking is the implementation in terms of people being aware of what they can access and people being aware of the need to access preventive measures.’
There has been a significant decrease in HIV transmission among Australian-born men who have sex with men (MSM). However, Dr Moten says around half of new diagnoses in the MSM group are among those born overseas.

‘Part of the problem may be that these people aren’t getting the messages because we don’t have culturally appropriate HIV education for these people.
‘They may be less likely to access health services, depending on their status and access to Medicare, and they may have poorer health literacy than Australian-born people who have grown up with HIV prevention messaging.’
The Agenda 2025 statement also highlights that the rate of HIV among Aboriginal and Torres Strait Islander people is higher than that of Australian born non-Indigenous people.
‘That just reflects how HIV, like all sexually transmitted infections, has socio-economic factors. People who have less access to health and are living in poverty are always going to be at higher risk,’ Dr Moten said.
The Agenda 2025 document outlines the four strands to the campaign: prevention, testing, treatment and reducing stigma. Reflecting Dr Moten’s emphasis on messaging, the most substantial tranche of suggested funding – a total of $20 million – would be for community-led campaigns and peer education.
An overall $10 million investment would also be required to extend HIV treatment and clinical care to everyone with HIV in the country, regardless of visa status.
The plan outlined in the statement, which was put to parliamentarians this month, could prevent more than 6000 infections by 2030 and save $1.4 billion in healthcare costs, its proponents believe.  
A snapshot of the current HIV/AIDS situation in Australia is issued by AFAO each year. The most recent data indicates the most at-risk group remains men who have sex with men, who account for around two-thirds of new diagnoses, compared to 23% associated with heterosexual sex, 3% with injection drug use, and 8% listed as ‘other/unspecified’.
A key step in HIV strategy took place in April 2018, when the pre-exposure prophylaxis (PrEP) pill – a highly effective method of preventing HIV infections – began to be subsidised through the PBS.
The Kirby Institute, which collates data for HIV, viral hepatitis, and sexually transmissible infections across the country, reported 901 new HIV diagnoses in 2019, the most recent year for which figures are available. Until that year, the trend had been consistently downwards since 2016.
‘GPs are a really important part of the whole picture,’ Dr Moten said. ‘We know that people are very happy to talk to their GPs about their sexual health issues if they feel the GP is willing and able to talk about that.’
Incorporating sexual health checks into annual check-ups is a good way to do that, she suggested.
‘GPs are also the primary providers of health education in everyday consultations and implementing testing is part of that,’ Dr Moten said.
From 1981–2012, there were 6845 deaths recorded from AIDS across Australia, according to data collected by the Kirby Institute , of which 6507 were men.
The United Nations estimates the numbers killed by AIDS-related illnesses as 34.7 million worldwide.
Dr Moten says data showed Australia is performing well on a global level, and with more than 90% of those living with HIV aware of their status, and 95% of those are receiving treatment.  
She also said it would be ‘fantastic’ to see no new diagnoses in the country, outside of people coming from overseas who are already HIV positive.
‘We would see anyone acquiring HIV in Australia as potentially a failure of the system, because it is completely preventable now,’ she said.
‘We don’t have far to go, we just need that extra help to get us over the line, and that means state and federal funding.’
Darryl O’Donnell, the CEO of AFAO, said: ‘This month we entered the fifth decade of the HIV epidemic. If parliamentarians adopt this plan, we can avoid entering a sixth.’
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