“Australia should lead a global HIV prevention revolution”

Today Bill Whittaker had an opinion piece in the ABC’s DRUM, arguing that Australia should lead a global HIV prevention revolution.

The global fight against AIDS is at a crossroads. On the one hand we have exciting new scientific evidence which could dramatically reverse the pace of the HIV epidemic and prevent millions of new infections, sickness and deaths.

On the other hand, there is weariness and complacency after 30 years of the epidemic as well as a global financial crisis putting tremendous pressure on national budgets around the world and threatening funding essential to reverse the relentless spread of HIV.

Mind-numbing statistics speak for themselves about the scale of the HIV epidemic and the work to be done: 30 million lives lost; another 33 million people living with HIV; and 7000 new infections occurring every day, mostly among young people.

New HIV treatments are having a tremendous impact in reducing illness and AIDS-related deaths, but the sustainability of providing HIV treatment – especially in low to middle-income countries – is threatened by the reality that for every one person put on HIV treatment, another two people become infected.

Recently, the United Nations agreed to a bold new Declaration to fight AIDS which Australia played a leading role in getting all UN Member States to endorse. A centrepiece of the UN Declaration are bold new HIV prevention targets for the global community to reach by 2015.

These global targets include reducing sexual transmission of HIV by 50 per cent; reducing HIV transmissions through injecting drug use by 50 per cent; and eliminating mother-to-child HIV transmissions – all by 2015.

So how would these targets be achieved under the UN Declaration?  Firstly, by dramatically scaling up prevention programs; by freeing up access to HIV testing; by increasing HIV education alongside wide availability of condoms and sterile injecting equipment; by promoting male circumcision in certain contexts; and by fully exploiting the potential of new technologies for communication and connecting people – such as social media, mobile phones and the internet.

The UN Declaration also calls for global action to ensure prevention programs properly focus on the three populations which are universally at higher risk to HIV, specifically men who have sex with men, sex workers and their clients and people who inject drugs.

Finally, the Declaration calls for new scientific evidence about the additional prevention benefits that HIV treatment can deliver to be capitalised on. So just as HIV treatment was revolutionised 15 years ago by combining different drugs – termed “combination treatment” – the Declaration heralds an era of “combination prevention”, where proven prevention programs and communication innovation are combined with wide availability of HIV treatment to help drive down rates of new HIV infections.

So what should this mean for Australia? Our rate of new HIV infections is running at around 1,000 new infections per year, mostly among gay men. But should we be satisfied with this level of new infections – the personal and community impact of this – and the something like $1 billion plus price-tag that comes with each 1,000 new infections? Of course not.

Australia’s current National HIV strategy and most state and territory strategies continue a lamentable drift away from setting bold, time-bound HIV prevention targets so essential to generate momentum and monitor progress.

Now is the opportunity for us to embrace “combination prevention”, re-double our efforts and set bold HIV prevention targets aligned with the 2011 UN Declaration to really drive down Australia’s HIV infection rates.  These targets should include:

• Reducing sexual transmission of HIV among men who have sex with men by 80 per cent by 2015.
• Eliminating HIV transmission from injecting drug use by 2015.
• Eliminating HIV transmission among sex workers and clients by 2015.

These prevention targets should be complemented by a treatment target of having 90 per cent of people with HIV in Australia on HIV antiviral treatment by 2013.

These are the kind of bold actions that the 2011 UN Declaration calls for and that all countries, including Australia, have pledged to implement.

Australia has shown great leadership and innovation in HIV prevention. One of the best things Australia can do to support a global HIV prevention revolution is to lead by example and champion what we are doing.  We must not miss this opportunity to re-vitalise our HIV prevention strategies and to help lead global efforts to stop the spread of HIV and its devastating impact on so millions of people around the world.

Bill Whittaker is one of the architects of Australia’s response to AIDS and has worked in HIV policy and strategy for more than 25 years. Bill is a member of Pacific Friends of the Global Fund’s Coordinating Committee.