Can Australia halve HIV transmission by 2015?

LAST year Australia was a signatory to a new United Nations Declaration on HIV and AIDS that commits our nation to reduce sexual transmission rates of HIV by 50% by 2015.

Each diagnosis of new HIV infection remains a tragedy for the infected person and their loved ones. It also adds to the financial burden on our nation’s health system.

It is 30 years since the start of the HIV epidemic. HIV has resulted in 30,000,000 deaths worldwide. In Australia, more than 30,000 people have been diagnosed, and the number of new HIV diagnoses in 2010 was just over 1000.

This rate of new diagnoses has remained constant over the past five years, and although the majority of new cases of HIV continue to be in gay men and other men who have sex with men, the pattern of Australia’s epidemic is seeing increased heterosexual transmission and increasing diagnoses in people who are from, or who have travelled to, high prevalence countries.

The rate of HIV transmission in Australia has not risen dramatically, as in many other countries, because of successful interventions including public education, targeted prevention campaigns, early adoption and continuing support for needle and syringe exchange, and other initiatives carried out through a sustained partnership of affected people, clinicians, researchers, advocates and governments.

But the rate of HIV transmission could rise swiftly if these interventions do not continue.

At the same time, HIV has become a chronic condition for many people, managed by the use of antiretroviral medications. And so the number of people living with HIV in Australia continues to rise.

Part of the success of Australia’s response to the HIV epidemic has been the strength of our system of primary health care, delivered through general practice and sexual health services, and available to all people in Australia.

This has involved GPs counselling our patients about prevention, testing people at risk of infection and supporting appropriate referral for people diagnosed with HIV. It has also involved individual GPs taking on responsibility for anti­retroviral medication prescribing and ongoing treatment and support of people with HIV in their communities.

In order to achieve the United Nations target, Australia will need to scale up our prevention and education programs, especially for populations at higher risk; widely promote HIV testing; ensure continuing wide availability of condoms and sterile injecting equipment; and utilise new technologies for public sharing of information.

At the same time, recent research findings have reinforced the effectiveness of HIV biomedical prevention, including the use of antiretroviral treatments that, particularly when introduced early, can reduce the risk of HIV transmission.

In order to be effective, this means scaling up HIV testing so that people infected are diagnosed soon after infection. It also means encouraging people with HIV to consider commencing treatment early to reduce their potential infectivity to others.

This change in the science of HIV prevention and treatment recently led the United States secretary of state, Hilary Clinton, to declare that the world can “change the course of this pandemic and usher in an AIDS-free generation”.

The move towards a marked reduction in HIV transmission in Australia poses particular challenges for general practice.

Can we increase our efforts to counsel our patients at risk of HIV about prevention? Do we have the capacity to support increased and more frequent testing of those at risk of HIV? Will we refer people diagnosed with HIV for earlier consideration of commencement of treatment? Do we have the capacity to assist people diagnosed with HIV to consider starting treatment early, which research is showing is likely to provide increased health benefits for the individual and reduced risk of HIV transmission?

And do we have the capacity to monitor and support an increased population of people with HIV on antiretroviral treatments who, at the moment, will need to make a lifelong commitment to treatment?
Professor Michael Kidd, AM
GP, Executive Dean, Faculty of Health Sciences, Flinders University