Edwina Wright: HIV progress

AUSTRALIA has been on the world stage on several occasions during 2014. The world rightly hurled shoes at a couple of its performances, notably the current Australian Government’s policies on climate change and its treatment of asylum seekers.

However, the World AIDS 2014 conference, held in Melbourne earlier this year, was a widely lauded performance from Australia and our neighbouring countries in Asia and the Pacific.

World AIDS 2014 saw 14 000 people — scientists, social researchers, people living with HIV, politicians, lawmakers and others — visit Melbourne to spend more than 5 days attending and engaging in presentations and analyses on the current issues within HIV medicine.
    
A key legacy of this conference was a bipartisan agreement signed by all state and territory health ministers to achieve the end of HIV transmissions by 2020.

This legacy statement stands alongside Australia’s signing of the United Nations 2011 Declaration that included halving HIV transmissions globally by 2015 and Australia’s 2014‒2017 HIV National Strategy which, for the first time, provides HIV treatment and prevention targets.

Can Australia honour these commitments?

Australia has a number of strengths that favour us doing so: we are a democracy; health care and medications are publicly subsidised; we have excellent HIV researchers and research institutes; we have strong partnerships between the HIV and medical communities; our youth and older populations are highly internet literate; and we have access to most of the available HIV prevention tools including antiretrovirals which, for HIV+ people who choose to commence treatment, greatly reduce the risk of transmitting HIV infection to sexual and injecting partners.

Australia has approximately 26 000 people diagnosed with HIV infection and, alas, sees approximately 1300 people newly diagnosed annually.

Given our country’s strengths, what will stand in the way of us diminishing this annual statistic to zero by 2020?

One ancient villain that stalks humanity comes straight to mind. Stigma towards “others” deemed so because of their sexual orientation, race, skin colour, recreational practices and sex industry work makes it tough to front up and be tested for HIV.

Australia has approximately 10 000 people living with undiagnosed HIV infection who may unknowingly transmit it to others. Although factors including HIV risk perception, time and access to appropriate testing influence HIV testing rates, stigma has a hand in holding people back. To end HIV transmission, Australia must transmogrify to provide a permissive legal and social environment, free of stigma, that encourages people at risk to be tested regularly for and live openly with HIV.

In turn, medical professionals need to advocate to change laws and attitudes that stigmatise their patients. Influential community figures need to step up as leaders and own their sexuality, their drug use and any other human trait deemed as “other”.

Another factor that will impede our success is holding the view that our abovementioned strengths will suffice and prevail. Australia needs to increase its research funding for HIV and non-AIDS comorbidities such as cancers, diabetes, cardiovascular and liver disease that are common to both HIV+ and HIV- members of the community.

We need to change our regulatory environs to see the Therapeutic Goods Administration — like the US Food and Drug Administration — call for and then fast track evaluations of new HIV medications and testing devices (HIV pre-exposure antiretroviral prophylaxis (PrEP) is a current case in point). Further work with pharmaceutical companies and their boards and shareholders to balance social justice issues with corporate profits is required.

With rates of infection increasing in young people, young Australians urgently require robust education about HIV within their school curricula to make HIV more visible to them, paraphrasing the chilling words of Sean Robertson in the film, Transmission.

There are enough health and research dollars in Australia to end HIV transmission and many other long-term epidemics such as obesity, heart disease and cancer. Those dollars will come from the grassroots efforts of Australians and peak research, health and community groups aligning and informing our elected officials about our health priorities.

In turn, these broad alignments, dedicated to ending epidemics such as HIV, will collectively reflect and own their successes and failures when the time comes to evaluate whether their targets were met.

And no one will even think about throwing shoes at the end of their performance.

Associate Professor Edwina Wright is an infectious diseases physician and clinical researcher at the Department of Infectious Diseases, the Alfred Hospital and Monash University and at the Burnet Institute. She was President of the Australasian Society for HIV Medicine from 2011 to 2014 and currently co-chairs The HIV Working Group within the Victorian Department of Health. Dr Wright is currently a Visiting Scientist at The Doherty Institute.

COIs: Dr Wright receives a research grant from the National Institutes of Health, a career development fellowship from the NHMRC, research funding from the Victorian Department of Health and unrestricted research funds from Gilead, Abbott, Janssen Cilag and Boehringer Ingelheim. She has also received funding that has been used for research purposes only from ViiV, Merck, Gilead and Abbott for consultancy work, payment for lectures from ViiV and payment for developing educational resources for ViiV and Gilead. The drug for the VicPrEP study has been donated by Gilead Sciences.