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.

EPIC-NSW  commenced in March 2016 and provides free access to prep for high-risk people at 27 sites in NSW.

The question posed in this presentation is: are EPIC-NSW  participants representative of people at high-risk of HIV?  

A comparison was made of participants against data of HIV notifications in New South Wales. For age groups (young men were slightly underrepresented), areas of residence, and Aboriginal and/or Torres Strait Islander the enrolment data was closely aligned to HIV notification data.

However for region of birth, NE and SE Asia born men were underrepresented, 2.5x and 2.4x lower respectively. In response, ACON developed specific initiatives to engage with men from NE and SE Asia using culturally appropriate engagement initiatives such as resources in 6 languages eg posters at train stations. In response, in the 3rd quarter 2017 there has been an increase in enrolments from men born in NE Asia of 103% and SE Asia of 83%.

The comment was made by the presenter that there Is more work to be done.  

However it was very interesting to see how close EPIC-NSW participants demographics correlated to HIV notification data.

 

 

Like the Partners study, Opposites Attract has demonstrated that undetectable equals untransmittable. There were no linked HIV transmissions after 591.2 couple years and 12000 acts of condomless sex protected only by viral suppression. Three incident HIV infections during the study were not linked to the positive partner on phylogenetic analysis highlighting the importance of PrEP for those having sex with other partners.

The true role of STI’s in HIV transmission requires further investigation says Dr Ben Bavinton of the Kirby Institute, noting that there were very high rates of STIs detected during the study despite no linked HIV incident infections.

The question of how soon is ‘safe’ to have condomless sex after ART initiation also requires further study.

The take away messages from Ben’s talk are the importance of regular STI screening in this group, PrEP for those having sex with other partners, and condoms or PrEP after starting ART.

 

Opposites Attract was a prospective longitudinal study of serodiscordant homosexual couples in Australia, Brazil and Thailand. Couples had testing and completed behavioural surveys at least twice per year during the study.

Meeting the 90-90-90 targets

NSW HIV diagnosis and care cascade 

Sweden and Denmark are the only countries so far that have met the UNSAIDS 90-90-90 targets. Yesterday, Phillip Keen from the Kirby Institute demonstrated that NSW has also reached this goal ahead of schedule with an estimated 91.3% of NSW residents living with HIV diagnosed, 92% receiving ART and 94.5% virally suppressed. Enhanced data collection and quality methods that have been introduced in NSW could be adopted elsewhere.

NSW now aims to have 90% of people diagnosed with HIV on treatment within 6 weeks.

Interventions internationally which have reduced access gaps 

In 2009, UNAIDS set an ambitious 90-90-90 treatment target to virtually eliminate HIV transmission. The goal was that 90% of people living with HIV would know their status, 90% would be on ART, and 90% would have viral suppression. Yesterday we heard about how these targets have been achieved in NSW and are on their way to being achieved in Australia, overall.

Hard work is left to be done in the remaining 10-10-10 who have not yet benefited from Australia’s improvements in early diagnosis, early treatment, treatment as prevention and PrEP.

Dr Jeffrey Klausner from the University of California, Los Angeles, is an expert and innovator in this area. He shared ideas that have worked internationally to close the gap in hard to reach groups and with limited resources including ART and HIV self-test vending machines. He has been involved in an online PrEP clinic that offers online eligibility screening and pathology ordering with a telehealth consultation and mail delivered PrEP. Given the inequitable access to and uptake of PrEP in Australia, the increasing demand for PrEP and the corresponding pressure on clinical services to deliver PrEP, this is a model well worth considering.

www.preptechyth.org

HIV & AIDS: Theme C Symposium – Addressing access and inequity in Australia’s HIV prevention response.

Hello from the Australian 2017 Sexual Health Conference

 

The session started after the afternoon tea when everyone was tired and looking forward to going home. The two MCs Heather Mugwagwa and Praveena Gunaratham steered the group to life.

 The presenter Ms Victoria Sande is a current Masters of Public Health student at Curtin University. She shared the stage with her counterpart Corie Gray. They discussed Barriers to HIV testing in the sub-Saharan Africa and South-East Asia immigrants to Australia.  

 

They discussed the following in a nutshell:

 Immigrants were diagnosed at a very late stage

 

Access to ART is limited compared to Australians.

They discussed reasons forHIV late diagnosis as based on their original background in Africa and Asia.  The need to go to the hospital was required only when one is critically ill. There was no need to visit the hospital when one is fit and strong. Their background discriminated against people with HIV. It associated HIV with bad behaviour were sufferers are labelled as prostitutes and unfaithful. Since HIV was incurable and the disease itself was referred to as a death penalty and this brought a lot of emotional issues and anxiety. It was best for one not to know his/her status because knowing was more killing than not.

 

Australia did not make it easier for them.They read in the media about their immigrant’s counter parts’ HIV positivity status being publicised in both electronic, digital and print media. They became worried about their privacy, stigmatisation and racism that comes with it. These factors further distanced them from testing, diagnosis and getting treatment early. They prefered to remain ignorant than to know their HIV status. They were also afraid that the Australian Government criminalises HIV infection, quarantines them, and denies them Permanent residence. They are also limited HIV treatment access as compared to their Australian counterparts.  It became more unattractive for them to know their status thereby delaying their early testing and treatment.

Their issues require immediate attention via accurate dissemination of information via their  Peers and immigrant educators. There is a need for other groups to understand their background and adjust so as to help them.

 

Early testing and diagnosis are important so as to reduce and limit the spread of HIV infection. There is need to broaden HIV testing e.g. by use of rapid testing, self-collection kits, and oral testing.

 

Please join us for a memorial event celebrating the life of one of Australia’s leading HIV advocates, Levinia Crook… https://t.co/N7dof5xaGa

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