A fascinating and compelling presentation from Charles Chauvel from the a Global Comission on HIV and the Law and UNDP.

Charles spoke of the higher HIV prevalence in countries where sex work, injecting drug use and MSM are criminalised activities. He showed some graphs which clearly showed the relationship between reduction in harm reduction programs and increasing HIV. Charles gave the example of the Philippines where harm reduction services for PWID were dramatically reduced and HIV prevalence in PWID increased from 1% to over 40% in just 6 years. Although there are likely other factors at play here it is still a staggering increase.

It seems that attitudes are changing at a global level and hopefully we will see an end to the 'war on drugs' as this can hamper our efforts to reduce HIV incidence as well as access to those at risk who may need testing and treatment. We need more of a focus on drug use as a health issue and also the social issues which can contribute to problematic use.  

As Charles stated in his presentation, law reform is an effective way to reduce HIV transmissions and its free!

There were many highlights today but I will focus on some of the topics that resonated most with me related to technologies or interventions which could benefit marginalised groups in Australia. 

- Shoena Mitchell-Foster spoke on the higher uptake of self collected specimens versus othere traditional methods for cervical screening in a low income country setting in both HIV positive  and negative women. This study identified some of the barriers to traditional testing including the invasive nature of a pelvic examination and cultural considerations. Also to consider is ease of access to a primary health care provider particularly in very remote areas. Self collected specimens could negate the need for nurses or doctors to perform a Pap test. Considering the lower rates of cervical screening in Australian indigenous women, a national screening program using self collected specimens could be of great benefit in both urban and rural settings.

- Gail Matthews spoke about the CEASE study. She showed an excellent slide which illustrated the dense concentration of people co-infected with HIV and HCV in Sydney, NSW.. The slide also supported the idea that this would mean access to most of the clients could occur through only five or so health services where many of these individuals were already linked in. There are also a number of community S100 prescribers in the area. Eradication of HCV in this group seems a realistic prospect as many are well engaged with services however there is possibly a subgroup of very marginalised individuals who may find adherence more challenging and may require additional support to access and complete treatment. Definitely exciting times ahead in relation to HCV treatment!

- Prof Greg Dore spoke about HCV prevention and treatment in the criminal justice setting. Although not without its challenges, prison is quite a good setting to initiate, if not complete HCV treatment. The overall prevalence rate is a staggering 50% including the inmates who do not reporting injecting drug use. The nurse-led model is a fantastic way to increase access for  a population in great need and it's also a wonderful opportunity for nurses to use and develop skills and to work in an autonomous role. 

Looking forward to tomorrow's sessions!