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.
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'.
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: https://www.mja.com.au/journal/2016/205/9/sexual-transmission-hiv-and-law-australian-medical-consensus-statement
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.
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:
A sombre and moving opening to the MSMGF Pre-Conference as delegates killed in the shooting down of flight MH17 were honoured by a minute’s silence and tributes from plenary speakers, including Don Baxter and incoming President of the IAS, Chris Beyrer. Beyrer in particular pointed out that the tragedy highlighted the strong coalition that drives the HIV response, with researchers, activists and policymakers travelling together and losing their lives on the flight. Beyrer went on to encourage strong engagement at the conference, highlighting developments in biomedical prevention in particular. However, he acknowledged the risk of leaving behind vulnerable populations, particularly men who have sex with men in countries which feature violent suppression of homosexuality. Achieving basic coverage of HIV prevention in these contexts remains extraordinarily difficult.
Michel Sidibe, Executive Director of UNAIDS, emphasised how the violation of human rights of men who have sex with men and transgender people in many countries poses such a threat to the HIV response, fuelling stigma, discrimination and violence and preventing people from accessing HIV prevention and treatment. Sidibe implied that it is difficult to see how we could achieve bold global targets without fighting to protect the rights of all people affected by HIV and by encouraging peace, security, equality and health. Sidibe concluded by saying, ‘no more to exclusion, bigotry and AIDS.’
My colleague, Peter Aggleton, from the Centre for Social Research in Health, UNSW, gave a plenary presentation in which he argued that the current fixation on scientific solutions to HIV often appears to neglect the ways that people live and behave, failing to harness the creativity and passion of affected communities. Taking something of a risk at a conference with MSM in the title, Aggleton highlighted his role with others in creating the category ‘men who have sex with men’ to help describe a range of homosexually active (or not so active) men. Peter said that those ‘experts’ never realised the force that the label MSM would gather around itself, making invisible complex cultures, practices and identities. Aggleton highlighted the ways in which the professionalisation of the field, including the community sector, often distances activists and educators from the communities with which they work. He concluded that we need to remember the anger and passion that kept the concerns of gay, bisexual and other ‘MSM’ central to the response to ensure that biomedical strategies like ‘test and treat’ and PrEP are critically evaluated rather than unquestioned and imposed.
The final plenary speaker, Kene Esom from African Men for Sexual Health and Rights, argued eloquently for a nimble range of diplomacy, activism and engagement, both loud and public as well as quiet and behind the scenes, to challenge violence, educate policymakers and advocate for the rights of LGBTI people so that HIV prevention can gain purchase in more countries in Africa.