DAY 2 AIDS WORLD - SATURDAY 1 DECEMBER - Australian Federation of AIDS Organisations
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2018
WORLD
AIDS
DAY
SATURDAY
1 DECEMBER
Contents
Progress among people who are Medicare 2 Adj A/Prof Darryl O’Donnell
Adj A/Prof Darryl O’Donnell ineligible and Aboriginal and Torres Strait
Islander communities is urgently needed. 4 Senator Dean Smith and Senator the Hon Lisa Singh
Chief Executive Officer,
5 Senator the Hon Marise Payne
Australian Federation of We can reach these people with tools
AIDS Organisations and messages of HIV prevention and 6 The Hon Greg Hunt MP
treatment. However, it requires additional 8 Senator the Hon Penny Wong and the Hon Catherine King MP
HIV feeds on the very worst human investment in nationally coordinated
behaviour, encouraging prejudice, health and education programs, approval 10 Senator Richard Di Natale
discrimination and isolation. But our of a HIV self-test, and a boost to the skills 11 Professor Brendan Murphy
response to HIV also showcases humanity of the HIV workforce. With a relentless
at its best, emphasising determination, focus on access to health, we can ensure 12 Queensland Positive People’s Peer Navigation
empathy and co-operation. no one is left behind. 14 HIV in Australia 2017
On World AIDS Day 2018, we remember We must also maintain focus on the 15 The Hon Michael Kirby AC CMG
those lost and those living with HIV. awesome challenge that confronts us
16 Mr Peter Sands
We also reaffirm our commitment to in our region. Approximately 5.2 million
translate our best values into action. adults and children are living with HIV in 17 Professor Sharon Lewin
Asia and the Pacific, with 280,000 new 18 Professor Andrew Grulich
The past year demonstrates our capability.
infections in 2017. Only a little over half
Working together, we made access to 19 Professor Brendan Crabb AC
of these people are receiving treatment.
PrEP equitable and affordable. Minister
Even fewer have a suppressed a viral 20 Professor Carla Treloar
Hunt’s historic decision to approve this
load. Just as concerning, an estimated 1.4
medication for the Pharmaceutical 21 Alexis Apostolellis
million people in Asia are HIV positive but
Benefits Scheme puts it in reach of almost 22 Stigma – a persistent barrier to effective health care
are not aware of their status. Too many
40,000 people who will benefit from this
people are still dying from AIDS in the 24 Dr Graham Brown
highly effective HIV prevention strategy.
region, with 170,000 AIDS-related deaths
Already we are seeing the benefit of a in 2017. 25 Mr Bill Bowtell AO
sharp decline in HIV transmission. There 26 Mr Cipri Martinez
The challenge of fighting stigma,
will also be a powerful financial dividend,
encouraging testing and making treatment 27 Ms Jules Kim
as each averted HIV transmission saves
available in Asia and the Pacific should 28 Ms Melanie Walker
the Commonwealth approximately
occupy the effort and intellect of everyone
$1 million in lifetime costs. 29 Ms Michelle Tobin
interested in a healthy prosperous region.
While these advances are welcome there 30 Mr Eamonn Murphy
The community-led HIV response in
is no neutral gear with HIV – if we take our
Australia and in our region is delicately 31 Ms Amelia Christie
foot off the accelerator we will surely go
poised. A combination of scientific advance,
into reverse. 32 Indonesian AIDS Coalition
political will and growing public momentum
This insight informs AFAO’s HIV Blueprint, for our mission puts us in a promising 33 Ms Joselyn Pang
a costed plan to avert more than 2,000 HIV position. The challenge is turning the
34 Dr Bridget Haire
transmissions by the end of the decade. opportunity we have before us into action.
We must capitalise on early reductions in edits
transmission among gay and bisexual men.
Cover photo: Both Mr. and Mrs. Nilar are HIV-positive and receive antiretroviral treatment
with support from a peer outreach worker, who visits them at their farm in Shan State,
Myanmar. Mrs. Nilar received treatment to protect her baby from HIV during her pregnancy.
Photo credit: The Global Fund/John Rae
2 3 3
While Australia should be proud of its ambition to reduce the number of new
Senator Dean Smith and achievements, now is not the time to be Senator the Hon HIV cases and support early diagnosis
Senator the Hon Lisa Singh complacent. Marise Payne and treatment for those living with HIV/
AIDS in our region. The Framework is
Chair and Deputy Chair of the Education and awareness of HIV Minister for Foreign Affairs complemented by Australia’s work as a
Parliamentary Liaison Group for prevention is vital, and we must member of the governing body of UNAIDS,
HIV/AIDS, Blood Bone Viruses and continue to work together to support World AIDS Day is an opportunity to take through which Australia advocates
and encourage people to access testing, stock of achievements, and the work for action against this epidemic while
Sexually Transmitted Infections treatment and care. still ahead if we are to end the HIV/AIDS bringing focus to the Indo-Pacific region.
World AIDS Day is an opportunity to epidemic by 2030.
In addition, more work is needed in Scaling up HIV prevention work in our
commemorate those we have lost and a addressing the everyday stigma and region is critical to reverse the current
time for us to be mindful that those in our discrimination that can still limit
Our progress in the fight trend in new infection rates. In recognition
community living with HIV and AIDS still opportunities and prevent those with HIV
against HIV/AIDS is clear. HIV/ of this, Australia has supported UNAIDS
face real challenges. and AIDS from living full and happy lives. to address gaps in the HIV prevention
AIDS no longer features in the response in Papua New Guinea, Lao
With our scientific advances and decades Parliamentarians have a prominent
of experience, Australia has much to be World Health Organization’s PDR, Cambodia, and Indonesia, and
role in addressing these issues – by
proud of in the treatment and prevention showing national leadership and leading top ten list of leading causes to support broader regional health
of HIV and AIDS. by example by calling out stigma and of death, and global efforts security. UNAIDS is working to increase
discrimination whenever it raises its head. have resulted in progress engagement of key populations and civil
toward internationally agreed society; expand outreach to those at risk;
Photos from The Parliamentary Liaison Group for HIV/ and increase availability of prevention
the top: Senator One of the most significant AIDS, Blood Bone Viruses and Sexually targets. In 2017, UNAIDS
methods. Similarly, HIV/AIDS prevention,
Dean Smith and advancements in recent times Transmitted Infections continues to be a reports three out of four diagnostic and treatment services must
Senator the Hon strong bipartisan advocate for a scientific people living with HIV knew
Lisa Singh
is the listing of pre-exposure be accessible to all without stigma or
prophylaxis (PrEP) on the approach to treatment and support and their status; four out of five discrimination.
remains committed to continuing our were accessing treatment;
Pharmaceutical Benefits work in the Australian Parliament and to Australia also works with longstanding
Schedule (PBS) earlier this keep listening and working together for
and among those, four out of partners in the fight against HIV/AIDS,
year. This is a major step those living with HIV and AIDS in Australia. five were virally supressed. including through our pledge to the
forward and puts Australia Global Fund to Fight AIDS, Tuberculosis
in reach of being one of the and Malaria. In Papua New Guinea, the
Despite recent achievements, the
Global Fund supports HIV programs and
first countries in the world to HIV/AIDS epidemic remains a threat.
is currently assisting 25,700 people to
end the transmission of HIV. According to the World Health
access antiretroviral therapy.
Organization, in 2017 there were
36.9 million people globally living with Australian aid works to build strong and
Importantly, the listing of PrEP on the PBS HIV. Additionally, the decline in new HIV resilient health systems to strengthen
will not only benefit gay and bisexual men infections has stalled, with our region regional health security and support
but will importantly help to drive down rates experiencing rising incidences, and nine productive societies and economic growth,
of HIV in Aboriginal and Torres Strait Islander countries accounting for 96 per cent of in keeping with the 2017 Foreign Policy
Peoples and other population groups total new infections in Asia and the Pacific. White Paper. Combatting infectious diseases
which have, unfortunately, seen increased such as HIV/AIDS is key to a productive
transmission rates over recent years. Australia continues to contribute to
and prosperous Indo-Pacific region.
and advance efforts in the global fight
against HIV/AIDS. Australia’s Strategic
Partnership Framework with UNAIDS
commits funding and sets out our shared
4 5 5
In 2017, Australia recorded its lowest level
The Hon Greg Hunt MP of new HIV diagnoses (963) since 2010, Estimated HIV prevalence in selected countries, 2017
Minister for Health with fewer diagnoses among gay and
bisexual men. Chinaa 0.03
Australia has made great progress in Researchers at the Kirby Institute have New Zealandb 0.08
recent years to reduce new HIV infections, attributed the decline to the success
and World AIDS Day – 1 December 2018 – Philippines 0.1
of Australia’s testing and treatment
is a time for us recommit to doing all we initiatives, and the increased use of PrEP 0.1
Australia
can to eliminate transmission of the virus. among gay and bisexual men.
India 0.2
Of concern, however, is that there has
not been a corresponding decline in HIV United Kingdomc 0.22
Over the past year, the diagnoses in people who acquired HIV
Viet Nam 0.3
Australian Government has from heterosexual sex – with instances
taken a very important step increasing by 14 per cent between 2016
Country
Malaysia 0.4
to help end HIV transmission and 2017. This is a trend that needs to be
0.4
by listing tenofovir with carefully monitored. Indonesia
emtricitabine on the These individuals are also more United Statesd 0.42
Pharmaceutical Benefits likely to be diagnosed late, indicating 0.5
Cambodia
Schedule (PBS) for use as a the importance of initiatives to raise
awareness about HIV prevention, testing 0.6
preventative medicine, known Brazil
and treatment.
as Pre-Exposure Prophylaxis Papua New Guinea 0.9
(PrEP), for people at medium Another area of major concern is that
HIV notifications increased by 41 per Ethiopiae 0.9
to high risk of HIV infection.
cent among Aboriginal and Torres Strait 1.1
Thailand
Islander people between 2013 and 2016
The $180 million listing of PrEP on the compared to a 12 per cent decline in 0.0 0.2 0.4 0.6 0.8 1.0 1.2
PBS will benefit up to 32,000 patients each Australian-born non-Indigenous people
Prevalence (%)
year and puts Australia in reach of being – and in 2017 remained 1.6 times higher
one of the first countries in the world to than the broader Australian population. a 2013
b 2017 (AIDS Epidemiology Group (AEG), 2017)
end transmission of HIV. c 2016 (Public Health England, 2017)
In other population groups – for instance d 2015 (Center for Disease Control (CDC), 2015)
e 2015
Although PrEP is a real game-changer, among female sex workers – harm
Australia had already been making great reduction strategies to minimise HIV
inroads in the fight against HIV infection. transmission have been highly successful
and must be maintained.
This is reflected in the fact that in 2017, Globally, in 2017 there were:
for the first time, Australia met the 2020 Australia’s continued fight against HIV
UNAIDS global treatment target – with and AIDS has involved the hard work of
74 per cent of people living with HIV in countless dedicated Australians. I thank
Australia having an undetectable viral load
(target 73 per cent).
everyone involved for their determination
to win this fight. We have a way to go yet,
36.9 million 21.7 million 1.8 million
but I am confident we can win the battle. people living people with HIV people were
with HIV had access to newly diagnosed
treatment with HIV
6 7 7
organisations, including the Australian The fight to halt the transmission of HIV We are proud of the role played by the
Senator the Hon Penny Federation of AIDS Organisations, the has been impacted by the massive cuts Australian Labor Party in tackling HIV,
Wong and the Hon National Association of People with to Australia’s international development which has helped bring Australia to the
HIV, Scarlet Alliance and the Australian assistance budget over the last five years. brink of ending transmission.
Catherine King MP Injecting and Illicit Drug Users League.
A Shorten Labor Government will contribute We now have it within our grasp to make
Leader of the Opposition in the Senate Labor’s investment in these groups and
more to international development HIV history, and we must redouble our
Shadow Minister for Foreign Affairs; the National Aboriginal Community
assistance than the current Government. efforts to achieve this goal, not just for
Controlled Health Organisation will
Shadow Minister for Health And we will ensure more of it gets to the our fellow Australians, but for the world.
allow them to undertake critical
and Medicare people who it is meant to be assisting.
engagement and communications
activity with at-risk populations.
For nearly 40 years Australia has led the
world in tackling HIV. • $3 million a year to target ‘hidden
populations’ – including people who
As a result of the great work of aren’t diagnosed with or treated
governments and health professionals for HIV, Aboriginal and Torres Strait
working together with LGBTIQ community, Islanders, and people from culturally
sex workers, injecting drug users and and linguistically diverse backgrounds.
others, we are now living in an age when Labor’s investment will improve
HIV is no longer a death sentence, and prevention, testing and treatment
we can dare to hope that it will soon be for these groups through new health
Photos from the eliminated. promotion campaigns, expanding
top: Senator Hon We have the knowledge to make HIV access to testing, and partnering
Penny Wong and with primary health care providers to
Hon Catherine
history – now we need the resources.
ensure that people who are diagnosed
King MP Labor strongly welcomes the listing of with HIV are treated.
HIV Pre-Exposure Prophylaxis on the
Pharmaceutical Benefits Scheme, which Sadly, of course, the magnificent steps
will enable affordable access to this we have taken here in Australia are not
potentially life-saving treatment for any replicated across the world, or even in
Australian at risk of HIV acquisition. some parts of our own community.
But there is still much more to be done. More than 1,000 Australians are still
That is why a Shorten Labor Government diagnosed with HIV every year, and in
will renew the effort to end HIV some areas we are going backwards.
transmissions in Australia with a major Aboriginal and Torres Strait Islander
commitment to step up the fight against Australians are still diagnosed with HIV at
the condition. a rate 1.6 times that of the non-Indigenous
Labor will invest in protecting at-risk Australian-born population.
groups from HIV, and supporting experts In our own region, the Asia-Pacific, there
and community groups to reach hidden are over 5 million people living today
at-risk populations. with HIV and AIDS and 300 000 new
Labor’s commitment includes: notifications every year. Photo: For a mother living in this poverty-stricken neighbourhood of Phnom Penh,
Cambodia, paying for antiretroviral treatment would be impossible. Thanks to support
• $10 million a year to renew Australia’s Our nearest neighbour, Papua New through the Global Fund, not only does she, and other community members in need, have
HIV response by restoring the Guinea has the highest prevalence of AIDS access to free HIV medicine that allows her to remain in good health; she also received
funding and capacity that the current in the Pacific and AIDS-related deaths are treatment to prevent transmission of the virus to her one-year-old daughter.
government have cut from national HIV increasing. Photo credit: The Global Fund/John Rae
8 9
supporting research and its translation
Senator Richard Di Natale Australia has a responsibility Professor Brendan Murphy into clinical settings. New HIV medications
to get to the global target and treatments are being developed at a
Leader, Australian Greens Chief Medical Officer,
of zero new transmissions rapid pace; we must capitalise on these
Department of Health and maintain momentum.
Each year, World AIDS Day offers an both at home and in the
opportunity to come together, put political region. Our contributions to For three decades Australia has been at
differences aside, and redouble our the Global Fund are a critical the forefront of the global response to In December 2017, the
commitment of progress against HIV. element in our arsenal against HIV/AIDS, and our domestic actions are
generally regarded as a world-leading
government announced the
This year we celebrate the listing of PrEP HIV in our region and it is model of best practice. single largest investment in HIV
on the Pharmaceutical Benefits Scheme essential they continue. research, ultimately leading to
(PBS), a decision for which we commend This World AIDS Day, while we
significant clinical benefits for
the Government, and one for which we acknowledge the progress we have made
have long campaigned. This is a really At home, it is our Indigenous in fighting HIV/AIDS, we also reaffirm people with HIV and people at
exciting breakthrough that will have a communities in northern Australia our commitment to work towards the risk of infection. The support
tangible impact preventing HIV. With that demand close attention and local elimination of HIV transmission in we provide to Australia’s health
infections sitting stubbornly around 1000 solutions. HIV transmission in these Australia. and medical researchers will
per year, this is essential. The next step of communities is unacceptably high and
The ongoing developments in HIV help us find the next major
course, is ensuring that all those at risk rising. It is time we committed to working
together with communities to stop this treatments have been critical to improving medical breakthrough.
know they can now get affordable access
impending crisis in its tracks. That will the lives of people with HIV. As more
to PrEP. and more people with HIV are initiating
require engagement and collaboration, To support such advancements, our
Getting PrEP on the PBS is the latest and it will require genuine investment. the lifelong treatment, it is important
attention also needs to focus on
breakthrough in a string of measures that every new generation of treatment
Having been a GP and worked in HIV community care to ensure people with
that have been pivotal in driving down HIV therapies provides people with HIV
prevention overseas, I take this issue HIV receive the attention they need. A
in Australia over the last 30 years. It is simpler regimens with fewer side effects.
personally. While I am always pleased to well-trained HIV workforce is vital, as they
essential that we recommit to our work in The importance of Treatment as are uniquely placed to guide individuals on
education, health promotion, law reform have the opportunity to raise the profile of
this issue each year on World AIDS Day, Prevention for HIV is also well understood, prevention, testing and treatment options,
and treatment, in close partnership with and will continue to be critical to efforts and provide the ongoing, on-the-ground
the challenge for policy makers and for
affected communities. We have been a to eliminate transmission. For the first support needed to achieve and maintain
all of us, is to maintain focus throughout
world leader in these efforts and to have time, Australia has met the 2020 UNAIDS viral suppression. Reaching priority
the year. I want to take the opportunity
success in ending HIV transmission we global treatment target in 2017, with populations with HIV will take a combined
to congratulate and acknowledge the
must ensure they continue. 74% of Australians with HIV successfully effort between governments, community
tireless work of the Australian Federation
Stigma and discrimination have always of AIDS Organisations (AFAO), the Pacific achieving an undetectable viral load. organisations and clinicians.
played a part in this challenge. A key Friends of the Global Fund and the Innovative preventative therapies are also Australia has adopted the target of virtually
objective in this fight against HIV is ending National Association of People With HIV making an impact on the HIV epidemic. eliminating HIV transmissions by 2020, and,
this stigma. These days, fewer people Australia (NAPWHA), and other partner As of 1 April 2018, eligible Australians by ensuring we have a strong workforce,
are aware of HIV. In turn, this creates organisations, who carry on this fight can access PrEP (HIV pre-exposure easily accessible prevention methods
an opportunity for stigma and fear to year-round. prophylaxis) through the Pharmaceutical and testing options, effective treatments,
intensify, and infections to creep up. With continued support and attention, Benefits Scheme. This important ongoing community-based care and a
We must not allow this to happen. we can ensure we stay on the path to public health measure should see HIV robust research environment, we are within
elimination. transmission rates decrease significantly. reach of this ambitious target.
Advances in biomedical technology benefit
both individuals and the community, and
we need to foster such advancements by
10 1111
Queensland Positive culturally and linguistically diverse, Peer navigators are also trained to work link them with other services that Photo: Queensland
and Aboriginal and Torres Strait Islander alongside people living with HIV who could address barriers to care and
People’s Peer Navigation communities. A common request from are ineligible for Medicare. Arriving in treatment. 100% of people ineligible
Positive People’s Peer
Navigation Team.
For 30 years, people living with HIV have people newly diagnosed is to speak with Australia with a new or existing HIV for Medicare commenced HIV Photo Credit: Cleo Gardiner,
worked alongside affected communities, someone else living with HIV. diagnosis can be extremely stressful, medications within three months. Queensland Positive People
clinicians, researchers and policy makers and expensive with the cost of medicine
to support treatment, care and prevention. Peer navigators share their lived • Drawing on peer navigation’s
in the thousands of dollars. Peer
experience of HIV with clients and provide experience with self-stigma and
navigators explore more affordable
Queensland Positive People’s Peer both HIV education and support. This combined with compassionate based
options for accessing treatment.
Navigation program draws on this history includes practical support during medical approach to stigma, Queensland
to support HIV treatment, develop self- appointments, guidance navigating the Achievements of peer navigation include: Positive People was successfully
management skills and support improved health system such as pharmacies for • From July 2016 to June 2018, funded by ViiV Healthcare to
quality of life. HIV medications, education to understand the peer navigation program has deliver peer-led stigma reduction
pathology markers, treatment options received referrals for 151 people workshops. The workshop assists
Funded by Queensland Health, Peer
and side effects, and tips on disclosure living with HIV who were either newly participants to identify different
Navigation provides education, emotional
and sharing strategies to cope with a new diagnosed or wanted to re-engage types of stigma, coping strategies,
and social support for people newly
diagnosis. with care. and teaches skills to alleviate self-
diagnosed with HIV and those re-engaging
stigma. The collaboration in this
or at risk of falling out of care. Sharing the HIV experience alleviates • In the same period, peer navigation workshop encourages the sharing
stress. Peer navigators also provide the most supported people living with HIV
Peer navigators come from diverse of lived experience and supports the
up-to-date information and inform clients but ineligible for Medicare to access
backgrounds, such as LGBTI communities, development of resilience.
of their legal rights and responsibilities. HIV treatment in Australia and
heterosexual people living with HIV,
12 13
1313
2017
963 New diagnoses
of HIV in Australia.
Late diagnoses in men
reporting sex with both men
and women have fluctuated • A meeting of LGBTIQ leaders from
Decline compared to
in the last ten year period, The Hon Michael many countries, summoned by
7% the average of the last
but remain high, at Kirby AC CMG UNDP, examined what could be done
to secure reform of laws and social
four years.
49% in 2017 The Global AIDS Conference of the
International AIDS Society (IAS) met in
policies;
Amsterdam, The Netherlands, in July 2018. • A session of the conference offered
HIV notification rates were It is a unique opportunity for experts in sobering insights into the acute
The proportion has been
1.6 higher in Aboriginal and
Torres Strait Islander relatively stable among
people with a partner from a
biological sciences to rub shoulders with
experts in social sciences, leaders of civil
difficulties presented in Russia, Arab
countries, parts of Africa and the
people than that of society and occasional lawyers. I attended Caribbean;
Australian born non- high prevalence country many of the earlier conferences. The 2018 • A moving session at the close paid
Indigenous people.
46% to 40% conference was an opportunity to catch up
on worldwide developments.
tribute to Australian’s own hero of HIV
science, Professor David Cooper AC.
He had been President of the IAS and
87% 95% The opening ceremony afforded a memory
was universally loved and admired. His
of people of people on as well as people reporting only of the tragedy that had accompanied the
leadership of the Kirby Institute has
diagnosed with HIV treatment have male to male sex, or male to conference in Melbourne in 2014. So many
been instrumental in Australia’s own
were on treatment an undetectable male sex and injecting drug use delegates had perished in the downing
response to HIV and AIDS.
in Australia in 2017 viral load in 2017 of MH17, many of them leaders in the
26% of people with HIV including people 24% to 20% struggle against HIV in The Netherlands.
Scientists gave rapid briefings on the
Gradually, brilliant scientists like
living with undiganosed HIV do not have an David Cooper are pushing forward the
undetectable viral load latest advances in medical therapies treatments that will one day conquer
and vaccines. Social scientists told of HIV. Their work has contributed to the
the challenges in securing outreach to optimistic objectives of the United Nations’
vulnerable groups on every continent. Sustainable Development Goals 2015.
Number of new HIV diagnoses classified as newly acquired, 2008–2017,
International organisations described Everyone, everywhere, should have
by exposure risk category
new perils such as the cut back in funding access to essential medicines.
400 of antiretrovirals desperately needed to
keep people in poorer countries in receipt
350 of life-giving therapies. Amsterdam was Wealthier countries, like
300 teaming with delegates. There was the
usual mixture of good and bad news. Australia, must stay the
250 course. They must continue
My own engagements were typical of a financial support to neighbours
200
delegate coming from civil society, working
on the frontline:
and to the world. A message
150
of World AIDS Day 2018
100 • A conference session reviving the UNDP
Global Commission on HIV and the Law.
remains. AIDS cannot be
50 Tackling ongoing obstacles to healthcare conquered in a single country.
0 from outdated, moralistic laws; Solidarity is our watchword.
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 • A session with organisations A mixture of science, civil
representing people who use drugs. society and activists is unique.
Male-to-male sex and injecting drug use Male-to-male sex
At last they were putting a face to their But it carries messages
Injecting drug use Heterosexual sex Other/undetermined experience of the epidemic. Eloquent for the future strategies in
advocates demanded that governments healthcare. Everywhere.
get off their back in disproportionate
laws against adult drug use;
14 1515
The current state of the fight against HIV continue to lead and increase investment
Mr Peter Sands calls us to focus on those left behind. Professor Sharon Lewin to HIV programming, domestically and
If we stay the current course, we are internationally.
Executive Director, Global Fund to not likely to reach the goal of reducing
Director, The Peter Doherty Institute
Fight AIDS, Tuberculosis and Malaria new infections to 500,000 globally by for Infection and Immunity The Amsterdam conference was
2020. We need to double down on our bittersweet. The vibrancy of an AIDS
Australia has always been a strong Last year saw the first decrease in new conference in a beautiful, progressive
commitments to reach the unreached,
supporter of global health and the fight HIV diagnoses in Australia. Together with and inclusive city such as Amsterdam,
even though this urgent need comes at a
against AIDS, tuberculosis and malaria, high rates of testing, uptake of treatment was coupled with the memory of the six
time when global investments in health
contributing a total $A695 million to the and care, I am immensely proud of delegates we lost on their way to AIDS
are dropping. To defeat HIV, we need to
Global Fund to date. Together, we have Australia’s response to HIV. However, not 2014 in Melbourne, along with many other
find a way to increase investments in
made tremendous progress, delivering HIV all Australians are enjoying this progress, lives tragically lost on MH17. Sadly, this
the response against the virus, and to
treatment to more than 21 million people with increasing diagnoses in heterosexuals year we also lost Professor David Cooper,
invest more purposefully among people and Asian born men who have sex
globally and cutting the number of deaths one of Australia and the world’s leading
disproportionately affected by the disease. with men, and continuing high rates of
from AIDS in half since the peak in 2005 – HIV researchers.
from 1.9 million to under 1 million in 2017. The Global Fund is doing more in this diagnosis and low uptake of HIV testing
Across the three diseases, Australia has regard, increasing allocations in prevention and treatment in Indigenous Australians. Along with global financing for the
supported the Global Fund partnership to for key and vulnerable populations by We must ensure no-one is left behind. prevention, treatment and care of HIV,
save more than 27 million lives. nearly 30 percent for 2017-2019 over the investment in science and its effective
At the International AIDS Conference in implementation, must remain a top
previous funding period. We are investing Amsterdam in July this year, President
The fight against HIV has now reached a priority. The evidence undetectable
in partnerships that bring together Clinton declared there will be no Brexit
critical moment. Having reduced sharply equals untransmissible (U=U) is clear and
communities, schools, law enforcement for the HIV response. It was welcome
over the last several years, global HIV transformational for people living with HIV.
agencies, the private sector, health reassurance many leaders remain
infection rates are now rising in certain Our public health campaigns and laws
care workers, public health planners committed to an effective, equitable
communities in some countries. For must be strongly aligned with this evidence.
and technical partners to implement and global HIV response. However,
instance, China recently reported 14 In 2018, we saw evidence that for some
comprehensive strategies, which offer nationalism and human rights violations
percent surge in new HIV cases. New people, two antivirals for HIV is just as good
more protection to the vulnerable. are on the rise. The HIV response is
HIV infections in Papua New Guinea also as three. This has major implications for
increased by four percent between 2014 We are investing in community systems not immune, and there are clear signs
life long tolerability of antiretroviral therapy
and 2016. The spike in new infections has that deliver HIV prevention to hard-to- the response is not on track. Globally,
the annual number of new infections as well as cost. Injectable antivirals and
also been noted among key populations reach populations and bring diverse
remains stable at 1.8 million, with one even implants are likely to be a reality for
including sex workers, people who inject stakeholders directly into planning and
million AIDS-related deaths each year. either treatment or prevention.
drugs, transgender people, prisoners and decision making. For instance in the
gay men and other men who have sex current funding period, US$105 million International HIV assistance is declining Five major preventative vaccine studies
with men. To end the HIV epidemic and to of US$200 million in catalytic funding has and domestic spending on HIV is lagging. were launched this past year in sub
deliver greater health security across Asia been allocated for prevention, including I had the privilege to co-author a joint Saharan Africa. There are high hopes for
Pacific, we must do more to turn off the matching funds for key populations and International AIDS Society (IAS) Lancet the role of super powerful antibodies in
tap of new HIV infections. adolescent girls and young women. US$55 Commission with 40 HIV experts. We delivering a successful vaccine. These
million in matching funds for prevention called for rejuvenating the HIV response antibodies, together with stimulation of
The Asia Pacific region has the second
programs focusing on adolescent girls as an urgent global priority, and also to the immune system, also look promising
highest number of people living with HIV
and young women will leverage more than change the way we worked. Immediate as a strategy to cure HIV infection, at least
in the world – an estimated 5.1 million
US$150 million to be invested in 13 high- action is needed to link, integrate and in monkey models. These approaches will
in 2015. Key populations in the region
burden countries. synergize HIV services with other health soon move into clinical trials in people.
continue to be the most affected by HIV.
HIV prevention efforts undermined by As we strive to end HIV, TB, and malaria as services. Closer integration meets 35 years after the discovery of HIV, there
criminalisation, violence and discrimination epidemics, the global health community will the diverse health needs of an aging is still great sadness in remembering
in some countries continue to fuel the continue to count on Australia’s leadership population of people living with HIV. It the millions lost, pride in what has been
spread of HIV. To end HIV, we must break in the effort to reach the most marginalized offers a “win-win” scenario, benefitting achieved, but I hope no complacency, as
this cycle of stigma and discrimination. and most affected communities. both the HIV response and the broader there remains much work to be done.
16 global health agenda. Australia must 1717
David’s loss is felt immensely by people of HIV transmissions in Australia. Self-tests
Professor Andrew Grulich from all facets of his life and work, but we Professor Brendan can increase coverage, reduce barriers
Head, HIV Epidemiology and
will continue his legacy with pride, ever Crabb AC to testing and facilitate diagnosis, yet no
inspired by his intellectual brilliance, and self-tests are approved for use in Australia.
Prevention Program, Kirby striving to emulate his collaborative and Director and CEO, Burnet Institute Following the responsiveness of government
Institute, UNSW Sydney. compassionate approach to improving and regulatory agencies that delivered
the lives of people living with HIV around In 2018, UNAIDS released an interim report PrEP to tens of thousands of Australians, it
As we approach the end of 2018, it is a the world. on global progress towards the 2020 target is now crucial that similar leadership and
time to reflect upon the significant gains, aimed at achieving virtual elimination of innovation be applied to driving convenient
and significant losses, in the HIV space The day after David’s memorial, the HIV as a public health threat by 2030. While and equitable access to HIV testing.
during the past year. In March this year, Australian Government listed PrEP on the the Miles to Go report highlighted many
the world lost a great leader in the fight PBS, and Minister Hunt acknowledged successes, it also provided, as the title HIV PrEP and test and treat are prevention
against HIV, Professor David Cooper, David’s significant contributions to this suggests, a sallow picture of populations tools that require ongoing interaction with
Director of the Kirby Institute. momentous achievement in Australian HIV still not reached by new prevention tools, the healthcare system. With increases
prevention. In 2017, we began to reveal and quality treatment in the context of global in HIV being seen among people born
the exciting results of the EPIC-NSW trial, reductions in funding which threaten our overseas, it is imperative that our
which indicated the success of widespread HIV elimination goals. In Australia and our efforts to scale up these highly effective
David was a brilliant scientist access to PrEP, evidenced by significant prevention tools reach all Australians,
region, we have seen many success stories
and the story of how he came reductions in HIV transmissions. Now but like much of the world, we too have miles including people who are not eligible for
to be the first to recognise HIV that it is available nationally, we hope to to go and must ensure we continue to invest Medicare. Compassionate access schemes,
seroconversion illness is a see continued reductions, and for access and innovate to ensure we take long-term assistance navigating self-importation, and
great tale of medical discovery. to HIV prevention, testing and treatment advantage of the gains we are making. free HIV testing regardless of Medicare
to continue to improve for those who are eligibility are needed to provide equitable
It has been acknowledged many most at risk. This vision seems to be a Australia has made many impressive access to HIV prevention in Australia.
times over that David was reality in Australia, and we must continue steps towards HIV elimination. The listing
involved in the development of to work towards it becoming a global of HIV pre-exposure prophylaxis (PrEP) The Asia and the Pacific recorded a 14%
every HIV treatment, playing reality too. on the PBS in April 2018 builds upon the decline in new HIV infections over the
significant state-funded jurisdictional level past eight years; sustained investment is
an integral role in what is David often commented how remarkable trials. The impact of PrEP can already be needed to continue this trend. Biomedical
now a life-saving combination it was that in just over 30 years, HIV in seen, with New South Wales reporting prevention is hampered by limited funding
treatment of HIV. He created the Australia has evolved to a point where significant declines in HIV incidence and overburdened health systems. Papua
Kirby Institute in 1986 with only medical research is bringing it under following the large roll out of PrEP in that New Guinea recently experienced a
a handful of staff, in response control. But he always knew that more state, and similar reductions more recently stockout of ART, drug resistance is rising,
needed to be done, and in his honour, we being observed elsewhere. and PrEP is not widely available. With
to an appalling crisis that hit
must continue to work collaboratively at stagnated or reduced funding there is little
St Vincent’s hospital, where a local, national and global scale to build Australia is on track to achieve UNAIDS advancement in primary prevention and
he was a young immunologist capacity, improve access to treatment, targets of 90-90-90; 90% of people living community systems that engender strong
at the time. and ultimately find a way to prevent and with HIV knowing their status, 90% of people community response to HIV. The most
cure HIV. who are diagnosed on treatment and 90% vulnerable, including the young, are being
of people on treatment virally suppressed. left behind and evidence suggests that a
Researchers at Burnet Institute have resurgence of transmission is likely.
recently shown that despite Melbourne
exceeding targets for treatment and viral As we commend ourselves for our efforts
suppression, over the past five years to increase access to HIV prevention locally
there has been no gains made in reducing and the gains we have made in reducing
undiagnosed HIV and little change in HIV transmission, we must ensure that these
testing frequency among gay men. Increased successes are equitably distributed within
testing is needed to see shifts in diagnosis, Australia and the region. We have come a
which is now recognised as the key driver long way but still have miles to go to end HIV.
18 1919The Australian National HIV Strategy has created instability for individuals,
Professor Carla Treloar emphasised the importance of stigma Alexis Apostolellis organisations, programs and the national
in each iteration. Unlike surveillance of HIV agenda. The rapid rollout of cuts
Director, Centre for Social Chief Executive Officer, Australasian
indicators such as number of HIV tests compromised patient welfare and placed
Research in Health provided, and number of treatments Society for HIV, Viral Hepatitis and immense burdens on remaining systems
prescribed, we have not until recently Sexual Health Medicine (ASHM) to service increased patient loads. Unless
Australia has led the way in its response
to HIV and we are the envy of many been able to track the experience of future budget amendments to Australia’s
Each year, World AIDS Day presents an
countries. We benefit from many stigma among people living with HIV. aid programme are implemented
opportunity to reflect on the achievements of
important societal investments. The strategically and with planning, the risk
Australia has invested in a world- the global HIV response, as well as examine
Australian response to HIV has been to individual and community health,
first national program to monitor the challenges and our next steps. It is an
guided by successive national strategies especially for women and girls, will once
experience of stigma among people living opportunity to take the time to look further
which draw on best available evidence to again be significant.
with HIV. In the first wave of data collection than simply our own sector and community,
prioritise action. participants were asked to reflect on and speak to a broader audience about Despite these setbacks, there is also hope.
the previous 12-month period. Close to the challenges faced in responding to the For example, the recent Undetectable =
three quarters (74%) of people living with HIV epidemic both here in Australia and Untransmittable (or U=U) movement is a
HIV reported stigma related to their HIV throughout the Asia-Pacific region. major advance in HIV management, based
Prevention services, like needle status. More than half of respondents on findings from three key studies that
and syringe programs, are Earlier this year, ASHM testified to the
reported experiencing negative or demonstrate how effectively anti-retroviral
provided in the community for Commonwealth’s Inquiry into the strategic
different treatment by health workers therapy prevents sexual transmission
effectiveness and outcomes of Australia’s
no or low cost by government. (52%). Three out of five participants of HIV. Support for the U=U approach by
aid program in the Indo-Pacific and our role
Highly active treatments and reported that people did not want to Australia’s aid program has the potential
in supporting Australia’s regional interests.
Pre-exposure Prophylaxis are have sex or an intimate relationship with to improve the health, wellbeing and
As technical experts in clinical workforce
them (60%), with 29% stating this had productivity of people living with HIV,
available as publicly funded development for HIV, viral hepatitis and
‘often’ or ‘always’ occurred. In a sample and to increase biomedical prevention
medicines. And we enjoy a of the Australian general population,
sexual health within the region, we are in
of HIV transmission within the region.
legal framework that makes a position to understand what a difference
approximately half (52%) indicated that
it illegal to discriminate on Australia’s investment in aid makes to the
they would behave negatively toward
millions in our region at risk of or living
the grounds of a person’s HIV people because of their HIV status.
with HIV. We work closely with local health
This World AIDS Day, we
positive status. However, we systems and personnel to strengthen their should take the opportunity to
know that the experience of capacity to respond to the epidemic. harness our position within the
stigma makes it less likely region as committed leaders
While the history of HIV and AIDS in
that these societal investments Australia is filled with trauma and loss, in the response to the HIV
will achieve optimal results. working in the region reminds us that in epidemic. Embracing the spirit
Experiencing stigma directly many ways we have also been extremely of respectful collaboration
affects physical and mental lucky. Over the 35 years of Australia’s HIV that has characterised our
health and acts as a barrier to epidemic we have seen the power of a movement in Australia
coordinated response from community, from the beginning, we can
seeking health and social care.
clinicians, researchers and government to
help bring us to where we are today. make a real difference to
the lives of our regional
But there is still much work to be done neighbours also grappling
in the Indo-Pacific region to achieve the
with the challenges of HIV.
UNAIDS 90-90-90 targets. The withdrawal
of government funding from HIV programs
in Papua New Guinea during 2016–2017
20 2121Stigma – a persistent barrier Discrimination lingers for people living with HIV
to effective health care The survey was completed by 181 people living with HIV, and 74 per cent reported some stigma.
This did not happen regularly, however, with participants more likely to report experiencing it ‘rarely’
or ‘sometimes’ (56 per cent).
The vast majority of respondents were male (88 per cent) and acquired HIV from having sex with a
Advances in medicine, technology and health promotion have powered man (86 per cent). 99 per cent were on HIV treatment and 94 per cent had an undetectable viral load.
strong progress against HIV. While stigma surrounding HIV has eased, it still
generates misunderstanding, hindering the treatment and prevention effort. Inthe
In thelast
last12
12months,
months,have
to what
youextent do you any
experienced agree that the
stigma following occurred?
or discrimination in relation to your HIV status?
Health workers treated me negatively 2 14 24 19 62 37 12 11 8 73
or different to other people
Australian health strategy explicitly aims to “eliminate the negative impact of stigma, 0 20 40 60 80 100
discrimination, and legal and human rights issues on people’s health” regarding HIV,
Never Rarely Sometimes Often Always
blood-borne viruses and sexually transmitted infections, gay and bisexual men, people who
inject drugs, people living with HIV, people living with viral hepatitis (B and C) and sex workers.
Health workers and sexual partners compound stigma
More than half the respondents living with HIV reported negative or different treatment by health
Injecting drug users bear the brunt of stigma workers (52 per cent). Most indicated this happened ‘rarely’ or ‘sometimes’ (44 per cent). Three
in five participants reported people did not want to have sex or an intimate relationship with them
A survey of 1001 people indicated that (60 per cent), with 29 per cent stating this had ‘often’ or ‘always’ occurred.
86% would behave 28% indicating this In the last 12 months, to what extent do you agree that the following occurred?
negatively towards
injecting drug use
86% 28% would often or always
be the case.
Health workers treated me negatively
or different
In the last 12 months, to other
to what extent people
do you
4 45
agree that the following occurred?
25 19 6 2
People
Health don't
workers want to
treated mehave sex or
negatively
intimate relationship 1422 18 12
62 19 20
12 8 93
or different to otherwith me
people
In the last 12 months, have you experienced any0stigma or discrimination
20 40in relation to
60your sexual
80orientation?
100
Never Rarely Sometimes Often Always
Sexual orientation 64% was the overall
was the least likely
attribute to receive 38% 64% level of stigma for sex
workers Gay and bisexual men still report stigma, though rarely
negative treatment
Stigma related to sexual orientation was relevant to the 339 gay and bisexual men who did the
survey with 65 per cent of participants reporting it in the last 12 months, though this was generally
Participants reported they would behave negatively towards people experienced ‘rarely’ or ‘sometimes’ (56 per cent).
with
Usethe
of drugs injecting in 50-58
belowforattributes 14 per cent
23 of cases. 34 16 12
Fewer than one in four gay and bisexual men felt they had been treated negatively by health workers
HIV status 48 28 16 6 3 (23 per cent).
Hepatitis B status 50 28 15 4 3
In the last 12 months, have you experienced any stigma or discrimination in relation to your sexual orientation?
Hepatitis C status 50 29 15 4 2
2 33 28 28 8 1
Sex work 36 29 23 7 5 100
In the last 12 months, to what extent do you agree that the following occurred?
Sexually transmitted infection 42 28 18 6 6
Health workers treated me negatively 14 62 12 8 3
0 20 40 60 80 100 or different to other people
Per cent
0 20 40 60 80 100
Never Rarely Sometimes Often Always
Never Rarely Sometimes Often Always
Source: The University of NSW Centre for Social Research in Health
22 23We also need to invest in targeted In fact, an apparently “stable” level of HIV
Dr Graham Brown collaborative research that guides Mr Bill Bowtell AO infection cannot last over the medium
and strengthens the response and the term. Not all of those who become HIV
Program Lead – HIV and Executive Director, Pacific
partnership. At the Australian Research positive will have access to effective
Hepatitis C, Australian Research Centre in Sex, Health and Society, our Friends of the Global Fund treatments. The virus itself can mutate
Centre in Sex, Health and research programs have included working to become more resistant to treatment,
Society, La Trobe University At first glance, the graphs that outline the
with community organisations to enhance or to develop variants that might be more
progress of the global response to HIV/AIDS
peer-led programs and advocacy; infectious.
HIV is a shared global epidemic but also in 2018 are reassuring. Compared to ten
sustaining a 20-year partnership years ago, rates of new HIV infection and
a global movement. Advances in medical In short, our choice is simple – either the
of community, health services and deaths from AIDS have fallen significantly
treatment and prevention options for HIV global effort must continue to drive down
government to study the health and in every region, but not, of course in every
are driving major changes across our the graphs of new HIV infections and AIDS
wellbeing of people with HIV, and leading country within those regions.
communities, health services and HIV deaths, or, in time, the trend lines will
work in new and simpler ways to measure
policies. We have the knowledge to end begin to reverse.
quality of life of people with HIV. Thanks to a reasonable level of funding
the HIV epidemic, what we need is the being applied to back clever and In those countries and regions that have
commitment and investment to reach all innovative strategies to improve access to been most set against sane and sensible
affected communities. For more than three decades, new treatments and prevention services, HIV and AIDS policies – notably Russia and
In Australia we have seen reductions in Australia’s response to HIV has many millions have been saved from some central Asian states – HIV is being
new diagnosis among some communities required leadership from key the miseries of untreated HIV infection transmitted at concerning rates.
of gay men but not among all. We have and deaths from AIDS. Greatly improved
affected communities, policy access to HIV treatments, and in many Harsh and repressive policies aimed at
seen significant success with treatments
and legal reform, reorientation countries to PrEP prevention, have injecting drug users, LGBTI people and
for many people with HIV, but in sex workers have created very bad public
some communities, we still see many of health services, research transformed the lives of those living with
investment, challenging HIV or at greatest risk of acquiring the health outcomes.
diagnosed late, or experiencing increasing
comorbidities. The opportunities of personal and structural disease. So far, so good. In Australia, communities and
Undetectable=Untransmissable are still level stigma, and boldness But on closer inspection, the global governments know that universal access
not understood across all communities. in the face of sensitivities graphs indicate a trend that should to treatments for those with HIV, and PrEP
To increase the uptake of prevention concern us all. The great declines in for those at risk of infection, has set us on
and legalities around sex,
options, timely testing, and engagement recent years are leveling out. the path to defeating the HIV epidemic, at
with treatment, we must clear the highest sexuality and drug use. All of least in this country.
barrier, stigma. these are still critical today.
We have a moral obligation to help to
To achieve the ambitious goals of ending In the coming decade, the fund the global response to HIV/AIDS to
HIV and its related stigma, we need On World AIDS day in 2018, Australia is world is not on track to record ensure that great strides we have made
to strengthen our commitment to a well placed to lead in strengthening the in Australia are repeated in our region
partnership of community, research,
the same impressive rates
community and evidence-led, politically and around the world. At the 2019 Global
active, and rapidly adapting response. We medicine and government and combine of decline in HIV cases and Fund replenishment, I hope that Australia,
need targeted and sustained investment this with ground breaking advances in AIDS deaths that have marked working through members of Parliament
working across multiple social, policy, medical science to bring an end to the HIV the period 2007–17. It is a of goodwill and commonsense, will
behavioural, and health service levels. As epidemic. comforting but completely persuade the Australian government
a shared epidemic, we need to learn and mistaken illusion to believe that to hasten the end of HIV and AIDS by
share more with our neighbours in the significantly increasing our contribution
we can engineer a stable level
Asia Pacific and globally. to the Global Fund to Fight AIDS,
of new HIV infections at around Tuberculosis and Malaria.
the levels achieved in 2018.
24 2525So, NAPWHA has joined more than Criminalisation of sex work and blood
Mr Cipri Martinez 500 HIV organisations in 67 countries Ms Jules Kim borne viruses including HIV create further
endorsing the U=U message, a impediments to sex workers access to
President, National Association of Chief Executive Officer,
message that has now become a core testing and services. Earlier this year,
People with HIV Australia (NAPWHA) component of HIV prevention campaigns Scarlet Alliance trans woman sex worker, CJ Palmer, was
This World AIDS Day is an opportunity to in Australia, and around the world. The sentenced to six years in a male maximum
The successful response to HIV prevention
remind the wider community of what it universal endorsement of U=U has had a security prison for a charge of “grievous
by sex workers in Australia warrants
means to live with HIV in 2018. In the era remarkable effect on the lives of people bodily harm” for the transmission of HIV
celebrating. The success of sex worker-
of undetectable equals untransmissible with HIV. To know that you are no longer to her ex-partner. The insensitive and
led peer education, health promotion
(U=U) and pre-exposure prophylaxis, we infectious to a sexual partner is liberating. stigmatising media reporting around her
and outreach has resulted in exceptional
can all, positive and negative, contribute to case, the surrounding discriminatory
In another exciting development, people health outcomes. Rates of HIV for sex
ending the epidemic in Australia. public discourse and the perverse laws
at risk of HIV in Australia now have workers in Australia are among the
that still characterise a manageable
affordable access to a pill that will protect lowest in the world.
chronic illness as “grievous bodily harm”,
them against the virus, pre-exposure
strongly sends the wrong message that
prophylaxis (PrEP). Through PrEP and
Statements from leading you are better off to not know your status.
U=U, we now have the tools available The UNAIDS theme for this
international HIV researchers to end HIV in Australia. Not only that, In some states in Australia, sex workers
year’s World AIDS Day, “Know
are definitive: if people with such biomedical technologies have the can still have condoms used against us
your status”, highlights the
HIV are on effective treatment potential to dissipate the stigma that has as evidence of a crime. We are subject
substantial issues that remain
and maintain an undetectable been so detrimental for so many years to to costly mandatory testing regimes
the positive community. for sex workers. To know your and police entrapment is common
viral load, there is no risk
status is crucially important practice. With mounting evidence clearly
of transmission to a sexual It is important then, that we all keep to ending transmission of demonstrates the harmful impact of
partner. This is backed by the talking about the modern reality of living
stigma, discrimination, mandatory testing
with HIV. And not just on World AIDS HIV and ensuring people
findings of multiple studies, and criminalisation, the question remains
Day, but every day. Only by spreading the with HIV are linked to quality
including the Australian-led - why are sex workers still subject to
message far and wide can we break down services, prevention, treatment
Opposites Attract research. these unjust laws and policies that are
the sero-divide. and care. Yet significant contrary to the evidence base, and against
While science can never
barriers still exist for sex everything we know about achieving
deliver absolute certainty,
workers to know their status. positive public health outcomes?
this evidence is as certain and
Unacceptable levels of stigma To end HIV transmission and to improve
reliable as science can get.
and discrimination remain a the lives and rights for sex workers and
major issue for sex workers in people with HIV, we must leave no one
our daily lives and we still do behind and call for the removal of all the
not have access to adequate barriers to accessing prevention, testing,
anti-discrimination protections. treatment and care for everyone.
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