EXPERT REACTION: AIDS epidemic over in Australia

Embargoed until: Publicly released:

AIDS in Australia has been virtually eliminated, says an Australian-led international team of researchers. Scientists say that while 1000 Australians are diagnosed with HIV every year, effective and easily-accessible therapies mean that few people progress to AIDS. However, they warn that the number of people diagnosed with HIV is too high and often quite late, and advocate for a long-term strategy to stop HIV from spreading. Below, Australian experts give their views.

Organisation/s: The University of Melbourne, The University of New South Wales, Australian Federation of AIDS Organisations

Media Release

From: Australian Federation of AIDS Organisations et al.

Australians need to work together to end HIV as nation marks extraordinary progress against AIDS

Australia’s top HIV/AIDS epidemiologists, scientists and community sector representatives have marked extraordinary progress against AIDS and declared that it is now possible to virtually eliminate HIV infections in Australia with appropriate investment in research, community-led health promotion and access to new HIV prevention technologies, such as PrEP.

While HIV was traditionally the precursor to AIDS, advances in the effectiveness of HIV medicines and access to them means very few Australians who are able to access HIV therapies now progress to AIDS.

The announcement marks the culmination of a thirty-three year response, spanning science, medicine and community outreach and activism. While noting the progress against AIDS, the elusive goal of ending new HIV infections remains an enduring challenge. More than 1000 new infections occur each year. New technologies, if appropriately supported and monitored, have the potential to achieve virtual elimination of new HIV infections by 2020.

Australia's national surveillance of HIV/AIDS is led by the Kirby Institute at UNSW Australia.

“Australia has made tremendous progress both in treating and preventing HIV and preventing it from progressing to AIDS,” Professor Grulich, Head, HIV Epidemiology and Prevention Program at the Kirby Institute, said.

“While we continue to see a number of people diagnosed late with HIV, some of whom have AIDS-type symptoms, the AIDS public health threat has morphed into an HIV prevention challenge. We continue to see more than 1000 new HIV diagnoses a year in Australia.”

“In fact, with new prevention tools such as pre-exposure prophylaxis (PrEP) Australia has a real chance of both consolidating our tremendous progress against AIDS and reaching the ambitious goal of virtual elimination of HIV transmission by 2020,” Professor Grulich said.

According to Darryl O’Donnell, Chief Executive Officer of the Australian Federation of AIDS Organisations (AFAO), “Australia’s progress against AIDS is tremendous. We will never again in our communities have the horror of so many loved ones dying. We don’t have to worry that HIV will inevitably lead to illness and death. Good access to treatment and testing and a community-led approach is critical to maintaining Australia’s effective response to HIV.

“But the job isn’t done. Too many people are still being diagnosed with HIV, and often they’re being diagnosed much later than we’d like. The virtual elimination of new HIV infections requires long-term investment in the organisations that have responded to the needs of HIV in our affected communities for thirty years. These are the community organisations that have supported gay men and communicated honestly about new research into treatment and prevention.”

“Successive governments have invested in the HIV/AIDS response since the early 1980s. Australia’s success in fighting AIDS is globally recognised. Now we must go the next step and end new HIV infections.”

According to Mr Cipri Martinez, President of the National Association of People Living with HIV Australia, “the virtual elimination of AIDS cases in Australia is an important milestone, but a crucial element to ending HIV in Australia is to encourage the uptake of anti-retroviral medicine so that HIV positive people can become undetectable and un-infectious to others.

The most successful community responses will include early combination prevention, testing and treating strategies.”

“Getting to zero new HIV infections in Australia means redoubling our efforts with vulnerable communities including, women, non-community attached gay men and people from non-English speaking backgrounds. These people are most likely to be diagnosed and treated late and can sometimes develop AIDS-defining conditions. Those few individuals can be confident that in most cases their symptoms can be quickly and easily addressed with effective treatments.”

“The only way we can reduce the number of HIV infections to zero by 2020 in our region I by focusing intense advocacy and resources on those people most at risk of new HIV infections, especially young gay men and people who inject drugs,” said Martinez

According to Professor Sharon Lewin, Director of the Doherty Institute, a joint venture of the University of Melbourne and Royal Melbourne Hospital, “Australian HIV scientists and researchers continue to make outstanding contributions to the fundamental and clinical research and to the introduction of pre-exposure prophylaxis, PrEP, which prevents HIV.”

“I am especially pleased that we are also working on an effective cure for HIV infection.”

“At the forthcoming International AIDS Conference to be held in Durban, South Africa in the week of 17 July 2016, we will be informed of the latest scientific and medical developments in HIV treatments and research for an HIV vaccine and cure”, said Professor Lewin.

According to Mr Bill Bowtell AO, Executive Director of the Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria, “we cannot end HIV in Australia until we eliminate AIDS and HIV in the world.”

“In recent years, we have seen stunning declines in global deaths from AIDS, and a sustained fall in new HIV infection rates, but globally, millions are still dying from untreated AIDS, and being infected by HIV.”

“We must continue progress towards expanding access to HIV treatments by supporting the Global Fund, which is the key financing mechanism for fighting HIV/AIDS.”

“This year, the Global Fund will be asking donors including Australia, to increase their support for the Global Fund to enable the great gains against HIV/AIDS to be sustained and improved,” said Mr Bowtell.

“I hope that the new Australian government will respond generously to the Global Fund’s appeal for increased funding to protect the world from HIV, malaria and tuberculosis; said Mr Bowtell.

There are around 1,000 people diagnosed with HIV diagnosed each year in Australia. Within the Asia-Pacific region, 180,000 people died from AIDS-related illness last year. Of the five million people in the Asia-Pacific who are living with HIV, only two million are on antiretroviral treatment.

The decline of AIDS in Australia can be attributed to many factors, including:

A world-leading universal healthcare system where access to HIV care and treatment has been determined by clinical need and where affected individuals have been treated free of stigma or discrimination
An effective community response engaging key populations such as gay men, sex workers, people who inject drugs, with education programs designed to encourage and normalise HIV testing, inform early identification of HIV before the onset of AIDS, and support a healthy culture of 'safe sex' and ‘harm minimisation.’
Increasingly well-tolerated and effective treatments for HIV infection, combined with a secure ongoing supply which is easily and affordably accessible to individuals, ensuring that HIV can be quickly suppressed and AIDS stopped from developing.
Innovative new treatments such as PrEP, a well- tolerated anti-retroviral treatment that, taken daily, provides almost complete protection from HIV infection. PrEP has been approved for use in Australia and is being made available in trials being administered by the Kirby Institute in Sydney, and also the Alfred Hospital and Burnet Institute in Melbourne and the Queensland AIDS Council in Brisbane. PrEP is currently being considered for funding under the Pharmaceutical Benefits Scheme (PBS).

Interviews

Kirby Institute, Head HIV Epidemiology and Prevention Program, Professor Andrew Grulich about the decision to stop collecting statistics on AIDS deaths and the virtual of AIDS in Australia;
Internationally renowned scientist, and a world leader in HIV cure research, Director of the Doherty Institute (joint venture between The University of Melbourne and The Royal Melbourne Hospital), Professor Sharon Lewin about advances in HIV treatments and the progress towards a cure for HIV;
Darryl O’Donnell, Chief Executive Officer, Australian Federation of AIDS Organisations
David Menadue OAM, National Association of People with HIV Australia
Bill Bowtell AO, Executive Director of Pacific Friends of the Global Fund

To arrange interviews, please call Daniel Brace 0412 806 034

Expert Reaction

These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.

Edward Holmes is a Fellow at the NHMRC and the Australian Academy of Science, and a faculty member at Marie Bashir Institute for Infectious Diseases and Biosecurity, Charles Perkins Centre, and the School of Biological Sciences at the University of Sydney

This is tremendous news that highlights the excellence of the Australian health care system. However, it is critical to remember that AIDS is still public health scourge in many other countries, with more than 1 million people dying of AIDS globally in 2015.

Last updated: 03 Nov 2016 7:15pm

Roger Short is an Emeritus Professor at the Faculty of Medicine Dentistry and Health Sciences at the University of Melbourne

Having worked on HIV infection for the past decade, I was surprised by the over-optimistic assessment that the AIDS epidemic is over in Australia. We need to be reminded of the historic statement by the Dutch professor Erasmus that "Prevention is better than cure". Controlling HIV is a perfect example. Although the world’s developed countries may be able to contain the HIV pandemic by using expensive therapeutic drugs, in developing countries preventative techniques like male circumcision and condoms are likely to be far more acceptable and effective.

Last updated: 03 Nov 2016 6:24pm

Rebecca Guy is an Associate Professor and Program Head at the Surveillance Evaluation and Research Program at the Kirby Institute for Infection and Immunity in Society at the University of New South Wales

Before 1996, virtually everyone with HIV eventually developed AIDS. In those days, many people with HIV did not get tested while they were well, so could never be counted in the statistics. But once they started to become ill with AIDS, they inevitably saw at doctor, and got tested and diagnosed. So back then, tracking AIDS cases gave a much clearer picture of how the epidemic was going than tracking HIV. All this changed in 1996, when effective treatments were introduced, and people with HIV stopped getting AIDS. Now a much higher proportion of people with get tested and diagnosed while they are well.

And they are encouraged to start treatment immediately, which stops them from getting AIDS. But there are still about 15% of people in Australia with HIV who have not been tested and diagnosed. AIDS cases still develop in this group, but virtually all can now be quickly and effectively treated.

Last updated: 03 Nov 2016 6:37pm

Susan Kippax is Emeritus Professor at the Social Policy Research Centre at the University of New South Wales

While the ‘AIDS epidemic’ may be over in Australia, as reported in the Sydney Morning Herald today, the ‘HIV epidemic’ is not. Antiretroviral drugs mean that the majority of those who are infected with HIV are likely to live healthy lives and are unlikely to succumb to AIDS: it is in this sense that one might say that the ‘AIDS epidemic’ is over.

However HIV infections continue to occur and over the past ten years in Australia new HIV diagnoses have increased by 13% (HIV, viral hepatitis, and sexually transmissible infections in Australia. Annual Surveillance Report 2015. Kirby Institute, University of New South Wales, Sydney. 2016.) Indeed worldwide there is growing concern that HIV prevention has stalled (see papers in the latest issue of the Lancet HIV2016; 3, e283-332).

Last updated: 03 Nov 2016 4:10pm

Darryl O'Donnell is Chief Executive Officer of the Australian Federation of AIDS Organisations (AFAO)

Australia’s progress against AIDS is tremendous. We will never again in our communities have the horror of so many loved ones dying. We don’t have to worry that HIV will inevitably lead to illness and death. Good access to treatment and testing and a community-led approach is critical to maintaining Australia’s effective response to HIV.

But the job isn’t done. Too many people are still being diagnosed with HIV, and often they’re being diagnosed much later than we’d like. The virtual elimination of new HIV infections requires long-term investment in the organisations that have responded to the needs of HIV in our affected communities for thirty years. These are the community organisations that have supported gay men and communicated honestly about new research into treatment and prevention.

Successive governments have invested in the HIV/AIDS response since the early 1980s. Australia’s success in fighting AIDS is globally recognised. Now we must go the next step and end new HIV infections.

Last updated: 03 Nov 2016 7:50pm

Andrew Grulich is Professor and Program Head of the HIV Epidemiology and Prevention Program at the Kirby Institute for Infection and Immunity in Society at the University of New South Wales

AIDS in Australia has become uncommon, and we are doing better than almost anywhere else on earth but it is not over. 150 people a year present with severe immune deficiency, and while most improve with treatment, they are at risk of dying. This particularly effects people who don’t test for HIV – e.g. people who don’t speak English, women, some gay men. Continued focus on increasing HIV testing is critical to get these numbers down.

Australia’s success is due to high level continuing investment in the community response, research and clinical services. The strength of our surveillance monitoring system, which alerts us to changing trends in infection so that we can respond swiftly has also played an extremely important role. While we have no vaccine or cure – we need continued high level investment in HIV research, community organisations and clinical services.

Unfortunately, while AIDS is under control, we are seeing over 1000 new HIV diagnoses a year which is about 30% higher than a decade ago.

New HIV prevention technologies give us a realistic chance of driving HIV infections down in the next few years: we need to rollout PrEP (pre exposure prophylaxis*) to high-risk gay men, and to do this, we need the PBS to fund the use of the drug.

If we invest in PrEP, HIV testing, and early HIV treatment, we can work towards the virtual elimination of HIV by 2020.

With PrEP we have targets to virtually eliminate HIV transmissions in Australia for 2020. These targets may seem ambitious, but with continued investment, Australia is well positioned to make it happen.

Last updated: 03 Nov 2016 4:00pm

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