Ban’s announcement reflects the current optimism among communities and policy makers that an ‘end to HIV’ is a not too distant reality. Australian state and territory health ministers have signed an agreement to achieve the virtual elimination of HIV transmission by 2020.
In Australia, over 26,000 people live with HIV and there are around 1000 new cases diagnosed each year. The health ministers’ are aiming to significantly reduce this figure, so the number of new HIV cases diagnosed in Australia is close to zero by 2020.
So is this possible? Can we ‘stop HIV’ in Australia?
In theory, yes.
Initiatives to reduce HIV transmission focus heavily on the use of anti-retroviral (ART) medication – a strategy known as ‘Treatment as Prevention’ or TasP. There are two aspects to TasP.
ART is the great success story of HIV treatment. Access to ART means a person with HIV can expect to live a long, healthy life and that they will be much less likely to transmit HIV to others.
If most Australians living with HIV are using ART, and there is a continued emphasis on safe sex and safe drug use, then Australia is in a good position to achieve the 2020 goals.
However, the social reality is more complicated.
TasP means that prevention initiatives place emphasise the actions of people living with HIV. This potentially detracts from the sense of ‘shared responsibility’ for HIV prevention that characterised safe-sex campaigns.
Around 80% of people living with HIV in Australia today are using ART, but there are many who do not. There are likely to be multiple reasons for this. Recent evidence suggests that some people living with HIV have concerns about committing to a lifelong drug regimen and fear long term side-effects.
The increasing policy focus on TasP has potential to put pressure on people to move quickly into treatment despite these fears. People who chose not to use ART may also be seen as selfish or irresponsible, potentially adding another layer of stigma within the community to what is already a highly stigmatised illness.
A significant reduction in HIV transmission won’t happen here if we lose touch of the social and individual perspectives facing those who live with HIV.
HIV Futures is the most comprehensive national survey of people living with HIV in Australia. This study aims to put the social and human experience of living with HIV front and centre of political, medical and community responses to HIV, including prevention efforts.
The survey, by La Trobe University researchers from the Australian Research Centre in Sex, Health and Society, has been conducted periodically for nearly two decades. It is used widely to help shape policy development and service delivery.
The study documents dramatic changes that have occurred for people living with HIV over this time. In 1997, when the first survey was released, highly effective combination ART had only been available for a few years. People living with HIV often had poor health outcomes, much less capacity to work and many were dependent on disability support.
Today – thankfully – it is a very different story. For most people in Australia, an HIV diagnosis is not a fast track to a diminished work and personal life and certainly not a death sentence.
But findings from HIV Futures over this time also show entrenched attitudes and emotions around HIV remain. People are just as concerned about disclosing their HIV status to potential partners or transmitting HIV to partners, even though treatment technology means the risk of this is significantly lower than in 1997. But we still lack a complex understanding of the ways this shame or anxiety can affect the lives of people living with HIV in 2015.
Data is currently being collected for HIV Futures 8. The survey will explore the experience of living with HIV in Australia, including perspectives on ART and TasP among those most affected. This is a significant piece of social research given that, more than ever, the future course of the HIV epidemic in Australia is intertwined with the social and personal experiences of people living with HIV today.
If you are living with HIV and would like to take part in the HIV Futures 8 survey please go to www.hivfutures.org.au or contact the Australian Research Centre in Sex, Health and Society at La Trobe University via email to email@example.com.
Media;Catherine Garrett 9479 6565
Image ; Healthy CD4+ T-cell. Photo credit: National Institute of Allergy and Infectious Diseases (NIAID)