ASHM Report Back

Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.

It is Saturday evening and the conference is over.  I have been sitting and reflecting on the experience of the last few days.  Our global political climate is becoming more conservative and less inclusive.  With summary executions of people who inject drugs in the Philippines, the leader of the opposition in Malaysia still in jail on "sodomy charges" and public whippings of male homosexuals in Banda Aceh, this shift is clearly gathering momentum in South East Asia.  

There is so much at stake.  The HIV and BBV sector in Health has spent decades studying and sharing the science around harm minimisation and access to healthcare for all.  We continue to champion the removal of stigma associated with HIV, sex work, same sex attraction, injecting drug use and transgender health. There are countless studies that show this approach is cost effective. Prohibition and punishment drive these behaviours underground, as people become too fearful of their safety, to access services.

Dr Adeeba Kamarulzaman, Dean of the Faculty of Medicine at University Malaya Medical Centre, was heading home after the APACC conference, to discuss these issues with a peak group of muftis in Malaysia.  She has been examining the Quran and has found many passages of the text that support the compassionate treatment of all people and the use of harm minimisation principles.  The tension between religion, health and politics has the potential to derail many of the public health gains we have made to date. 

We need to keep reminding our politicians and administrators of the Public Health principles that we know work. It is vital that we use our collective voice to call out stigma and discrimination when we witness it in our workplaces, communities and in the attitudes of our colleagues.  


Tagged in: APACC 2017

'I speak more truth than the Pope'

Professor Gracelyn Smallwood is Professor of Nursing at Central Queensland University and Adjunct Professor at the Division of Tropical Health and Medicine at James Cook University (JCU), Townsville, Queensland (QLD). She is also a Birrigubba, Kalkadoon and South-Sea Islander woman who participated in a panel on Thursday 17th November at the Symposium on Aboriginal and Torres Strait Islander peoples - 90/90/90 - but who are the 10/10/10?

After Dr James Ward re-presented data on the more than doubling of HIV diagnoses amongst indigenous people in Australia in 2015, he said 'we are a critical point in the epidemic' and clearly need to act urgently.  The panel discussed proposals and strategies to respond to this dire situation, such as ways to get more people tested, diagnosed and into care.  Here I try to capture some of what Professor Smallwood said, as without such insights from aboriginal people and without action on these at a much higher political level, the medical, scientific and health professions cannot solve this.

Professor Smallwood, with decades of nursing and midwifery experience in rural and remote communities as well as in the city, and over 50 years of advocacy for her people, gave a clear and compelling response.   'We need to implement the National Aboriginal Health Strategy, Bringing them Home report and all other reports that have been written and not followed through'.  'HIV will be the last nail in the coffin' she said, and she has said this before.   'Locals are key.  We need blackfellas as chief investigators and aboriginal health workers are the key players, start empowering them, ask *them* to be keynote speakers . Get deadly health workers into clinics to undertake testing'.  Hardly any money gets down to the local level.  There's is a 200% markup on food (in remote areas), jobs have been phased out, it is no wonder people are using drugs'... 'Give me any disease', she said and 'I will give you the answer'.  


Quote shared by on in Legal and human rights, stigma and discrimination
HIV and the law – a consensus statement

Paul Kidd from the HIV Legal Working Group (VAC and Positive Life VIC) launched a recently published consensus statement about HIV and the law at the ASHM hub during the afternoon break on Wednesday. The consensus statement was written by leading HIV clinicians and scientists and was published in MJA on the 7 November. 

Paul Kidd provided context around the development of the statement and an overview of the key points covered in the statement.

There have been at least 38
Criminal cases related to HIV transmission or exposure in Australia and the rate of prosecutions hasn’t decreased with advancements in treatment and prevention options. HIV-related criminal prosecutions require that legal professionals interpret scientific evidence on HIV transmission risk and the harms associated with an HIV diagnosis. History indicates that scientific concepts may have been inconsistently applied in Australian trials and some people have received very harsh sentences (arguably too harsh).


The statement outlines the latest evidence on HIV transmission risk, prevention and treatment. The main points covered in the statement:

       The risk of HIV transmission during sex is very low (and may have been overstated in HIV-related legal cases in the past).

       In addition to condom use, the following should be considered as taking reasonable precautions to prevent transmission:

o   If an HIV-positive partner has an undetectable viral load OR

o   if the HIV-negative partner is taking PrEP

       Phylogenetic analysis cannot prove causation in HIV-related cases.

       Most people living with HIV are able to take simple and effective treatment and will have a normal life expectancy.


The statement recommends:

       Legal cases relating to HIV transmission should consider the best scientific evidence on HIV risk and harms

       Alternatives to prosecution, such as the public health management approach, are often appropriate


Paul thanked the impressive contributors for their authorship and the wider working group for their commitment to the statement. I was lucky enough to be involved in the development of the statement and it was great to be present for the launch.


The statement is available on the MJA website at:


A PDF is available on the ASHM website: 

Excessive intellectual property protections for HIV  treatments:  the momentum  for reform

What a clear and informative presentation  Charles Chauvel , Team leader, Inclusive Political  Processes, Bureau for Policy and Programme Support, United Nations Development Programme, New York, USA delivered towards  the last end of Day One of the 2015Australasian  .HIV and AIDS conference

The ethics of patents has long troubled most health practitioners, and none more so, than those wanting  affordable  access to antiretrovirals  at  rates that will not deter people receiving,  needing or wanting HIV  treatment or prophylaxis.

Charles outlined that disease and poor health remain major barriers to sustainable development in  many countries. HIV and malaria and viral  hepatitis  continue to  kill  more that 5  million  people every  year and  most of the deaths occur in  low or middle income families. Even in rich countries, drugs like sofosbuvir are largely unaffordable to all the citizens. He also outlined that there are also non patent factors affecting access to medicines.

 Charles outlined that a patent is a type of intellectual property. It is a social contract between an inventor and society.  It gives the inventor the temporary and exclusive right to make use, export or market an invention in the country where the invention is patented.

 Patents affect access by creating protection on existing drugs, and the patents give exclusive control to  licence, manufacture and distribute the product. It also influences the kind of innovation which in undertaken in  the first  place.

 The Agreement on Trade – related Aspect of  Intellectual Property Rights was agreed to  in  1994 and came into  force in  1995. There was also another agreement setting minimum standards of IP protection and enforcement for countries to follow.

TRIPS Agreement Objectives (Article 7) states” The protection and enforcement of IPRs should contribute to the promotion  of technological innovation  and to  the transfer and dissemination of technological knowledge and in a manner conducive to social and economic welfare, and to the balance of rights and obligations.”

TRIPS Agreement  Principle (Article 8) indicate “ Members ……(should) adopt  measures necessary to  protect public health  and  nutrition, and to  promote the public interest in sectors of vital  importance to  their socio- economic and technological development, ………”  But the rights of the inventor Should also be protected.

Furthermore, there is IP “creep” and practices and measures since the original  Agreement have consolidated the Agreement.

Charles outlined the high  costs of ARVs. He said second  generation  ARVs cost 3.4  times more than  first  generation drugs.  Third generation ARVs cost 23.4  more than  the first generation  ARVs. He indicated India make over 80% of ARVs and their legislation  has enshrined the TRIPS agreement.

It also  seems TRIPS may be  further broadened and the term of patent protection  extended and create barriers to  medicines registration by “linking” IP to  marketing requirements.

The  Human Rights Commission  called for reform  in  2009 . It said “  …. Take into account the right o f everyone to the enjoyment of the highest attainable standard of  physical and mental health …..and supports public  health policies that  promote broad access to safe,  effective and affordable medicine.”

In  December,  2014, a resolution was put to the Secretary - General  of the UN calling for reform.  “We must continue to remedy the policy incoherence current in modes of international governance in matters of trade, finance and investment on one hand, and our norms and standards for labour, the environment, human rights and sustainability on  the other.”


For many people, changes to  TRIPS would be welcome and could not come too soon.

Charles Chauvel – thank you for your address and please keep up  your good work.



Darcy Smith

Tagged in: HIVAIDS2015
Sign the Melbourne Declaration


In 2011, Australia signed the United Nations 2011 Political Declaration on HIV/AIDS that sets 'bold new targets' for HIV/AIDS to 2015. Signatory countries agreed on the following 'strong, time-bound' targets by 2015:

▪   Advance efforts towards reducing sexual transmission of HIV by 50%

▪   Reducing HIV infection among people who inject drugs by 50%

▪   Push towards eliminating new HIV infections among children

▪   Increase the number of people on life-saving treatments to 15 million globally

▪   Reduce tuberculosis relation deaths in people living with HIV by half

The UN Declaration highlights action areas for improving universal access to HIV prevention, treatment, care and support. Public access to sexual and reproductive health services, particularly for women and children, are a cornerstone of 'working towards a world without AIDS'.

HIV in Australia

It's a given that Australia is better placed than many countries to meet these targets. And there is no better time to take action. Australia's HIV rates increased by 8% in 2011 and campaigners are saying that Australia have 'dropped the ball' on HIV/AIDS research and funding in recent times. 

In 2013, 1,236 people were diagnosed with HIV, similar to levels in 2012. For more information and a snapshot of HIV in Australia, the AFAO website features a short summary HIV in Australia Statistics Update 2013.

Despite some progress being made over the last 18 months, barriers to tackling rising infection rates remain. These include a lack of access to rapid HIV tests licensed for use in Australia, prohibitive treatment costs and unhelpful restrictions on people with HIV and their medical teams deciding when to start treatment.

The Melbourne Declaration

To strengthen the United Nations goals and reduce HIV infection rates in Australia, the Melbourne Declaration was launched in October 2012.

Action areas in the Melbourne Declaration include:

▪   Making rapid testing widely available in clinical and community settings

▪   Enhancing access to and uptake of antiretroviral treatment for HIV

▪   Making HIV pre-exposure prophylaxis available to people who at high risk of HIV infection

▪   Fast tracking treatment licensure and funding

▪   Mobilising and informing people with HIV, and in populations at high risk of HIV, about advances in treatment and prevention

▪   Support ongoing, high quality HIV research.

With the 20th International AIDS Conference in Melbourne comes renewed calls for action, leadership and commitment to get Australia back on track, and to help meet UN targets by 2015.

Show your Support.  Sign the Melbourne Declaration today!

You can follow the proceedings of the International AIDS Conference 2014 from the 20-25th July 2014 on Twitter using the hashtag #AIDS2014

Watch out for tweets from the #AIDS2014 Conference:








Further Reading

Bold new AIDS targets set by world leaders for 2015 

Melbourne Declaration Update 

HIV in Australia Statistics Update 2013




Tagged in: AIDS 2014 IAS2014
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