WORLD AIDS DAY 2019

SUNDAY 1 DECEMBER Contents

Adj A/Prof Darryl O’Donnell 2 Adj A/Prof Darryl O’Donnell the Pacific, but only 75 per cent are aware of Tim Wilson MP and Senator Louise Pratt 4 Chief Executive Officer their status. Senator the Hon Marise Payne 5 Australian Federation of AFAO welcomes the Australian Government’s AIDS Organisations recent announcement to increase its The Hon Greg Hunt MP 6 contribution to the Global Fund to Fight AIDS Tuberculosis and Malaria by ten per cent. HIV Globally in 2018 7 Australia’s profound strides against With funding from the Global Fund, AFAO Senator the Hon Penny Wong and the Hon Chris Bowen MP 8 HIV haven’t happened by chance. Our has been working on the Sustainability of HIV progress is powered by the sustained Services for Key Populations in Asia Program Senator Richard Di Natale 9 commitment and insight of those (SKPA) to stop HIV transmission and AIDS- Mr Eamonn Murphy 10 communities touched by the epidemic. related deaths by 2030. Champion Community Centres: Enabling and Mobilising Communities for This commitment brings us to an auspicious Working with community groups at risk of More Strategic HIV Services for Key Populations 12 moment. As we mark World AIDS Day 2019, HIV HIV in Asia, the goal is to build the advocacy transmission has declined to a near two decade skills that deliver a sustainable approach Mr Peter Sands 14 low, with 833 diagnoses recorded in Australia to funding. Many Asian countries are AFAO’s national PrEP campaign 15 in 2018. More frequent testing, treatment approaching middle-income status, which as prevention and the increased adoption of will reduce their eligibility for international Professor Brendan Murphy 16 PrEP are driving this drop in transmission. development funding. Professor Sharon Lewin 17 While we welcome declining transmission, there is always more work to be done. But in Asia key populations are often HIV in Australia in 2018 18 marginalised, making it difficult for them to The Hon Michael Kirby AC CMG 19 Gay and bisexual men continue to shoulder secure domestic funding for HIV prevention the burden of HIV in Australia, despite a programs. SKPA is working to avoid the trap Professor Anthony Kelleher 20 30 per cent drop in transmissions over the of middle income leading to a decline in Professor Brendan Crabb AC 21 past five years. HIV prevention work. SKPA is one example We know incredible efforts of gay men at where Australia is playing a significant Professor Carla Treloar 22 a community level have driven the uptake role in reducing HIV’s health and economic Mr Alexis Apostolellis 23 of PrEP and testing. Now we need the burden in Asia and the Pacific. HIV partnership at the heart of Australia’s HIV response for almost four decades 24 resources to replicate this community-based In 2019, Australian organisations working approach across other populations. Of huge internationally on HIV issued a consensus Professor Suzanne Fraser 26 concern to me is that we have seen no statement to help guide Australia’s international Mr Cipri Martinez 27 decline in HIV diagnoses among Aboriginal and regional leadership on HIV. We look and Torres Strait Islander populations. forward to working with our regional partners Ms Jules Kim 28 The first step is supporting communities and the Australian Government to ensure Ms Melanie Walker 29 with education on prevention and testing. Australia’s policy settings are right when it This requires cultural sensitivity and comes to regional HIV prevention and care. Ms Michelle Tobin 30 significant investment in Aboriginal and Mr Bill Bowtell AO 31 Our progress against HIV, both in Australia Torres Strait Islander health workforces. and across the region is impressive. HIV Stigma in 2018 32 We also grapple with an enduring challenge However, epidemics are dynamic, and Mr Robert Griew 34 among our near neighbours. Around six further strides are only possible with million people are living with HIV in Asia and renewed financial and political commitment.

Cover photo: Lux Sophal is a 32-year-old Cambodian woman with 4 children, including her twelve month old child, Khun Sreypheap, who appears in this photograph with her. She is HIV-positive as is her 13 year-old son. 12-month-old Sreyreap has been tested once so far and is HIV-negative. She received HIV treatment, to prevent mother to child transmission, through a Global Fund funded program. 2 Credit: Credit: Global Fund/John Rae 3 Tim Wilson MP and on HIV/AIDS, and have led the world Senator the Hon Marise Payne We are also sharing our expertise to fight in transmission control and access to the epidemic in our region. The Australian Senator Louise Pratt Minister for Foreign Affairs, treatments. We have strong community Volunteers Program continues to provide Minister for Women Chair and Deputy Chair groups that coordinate with health bodies opportunities for skilled Australians to Parliamentary Friends for Action on and government for efficacy. contribute to HIV/AIDs prevention and HIV/AIDs, Blood Borne Viruses and Today is an opportunity to reiterate our response. Our Australia Awards program But we must also continue to confront the Sexually Transmitted Infections shared commitment to ending the HIV is building the capacity of key individuals stigma associated with people living with epidemic by 2030. HIV. All Australians are entitled to live full from the region to strengthen domestic World AIDS Day is an opportunity to and happy lives. Recent UNAIDS data shows a 16% decline in responses. remember and honour those we have new infections globally since 2010. For the As Parliamentarians we have a critical role to Australia is also committed to global efforts lost, work to support those living with first time, more than half of all people living play in terms of leading the national discussion, to achieve universal health coverage - we HIV/AIDS, and to redouble our efforts to with HIV are virally suppressed, and the promoting community education and are investing with key partners such as the stop new transmissions and stigma. number of AIDS-related deaths has more advocating for effective strategies to improve World Bank and Bloomberg Philanthropies than halved since the peak in 2004. Each year new scientific advances and the health and wellbeing of all Australians. to support Indo-Pacific countries invest in treatments become available, improving But there is more to do, especially in our essential health services. The universal The purpose of the Parliamentary Friends the freedom of those living with HIV/AIDS in region. In 2018, 5.9 million people were living nature of this effort means leaving no-one for Action on HIV/AIDS, Blood Borne Viruses Australia and around the world. with HIV, there were 310,000 new infections behind. It implies a comprehensive approach and Sexually Transmitted Infections is to be and 200,000 AIDS related deaths. The to service delivery, including HIV services, We sit on the cusp of a new age of containing a strong and bipartisan advocacy group for epidemic is concentrated in key populations and strong community engagement. and treating HIV transmission. Prevention is Parliamentarians, the health community and and their sexual partners – including gay essential. With home testing kits supported those living with these conditions to educate The Australian government continues to men and other men who have sex with men, by community education campaigns we and work together to inform policy based on work to address inequalities and barriers sex workers, transgender people, people can reduce transmission rates further. science and effectiveness. to accessing prevention, diagnosis, and who inject drugs and prisoners and other The long term trend is declining thanks to treatment. Our efforts will improve access Critically, our purpose is also to make sure incarcerated people. These marginalised and these developments, alongside the listing to comprehensive sexual and reproductive communities affected by HIV, including gay disadvantaged groups make up more than of pre-exposure prophylaxis (PrEP) on the health and rights services. and bisexual men, transgender and gender three-quarters of new HIV infections. Pharmaceutical Benefits Scheme (PBS) diverse people, Aboriginal and Torres Strait Compassion, understanding, respect Australia is committed to the global fight New treatments continue to become Islander people, sex workers, people who and partnership with communities, civil against HIV/AIDS. We value the crucial available which reduce the risks of side inject drugs, people from or who travel society, and key populations are critical to role of longstanding partners, including effects. Additionally, research has opened the to high prevalence countries, people in an effective approach to eliminating HIV civil society, the Global Fund to Fight AIDS, possibility for people living with HIV to move custodial settings, and people living with and accelerating better health for all. Tuberculosis and Malaria, and UNAIDS from daily pill-based regimens to injectable HIV are heard in our Parliament. in convening the HIV/AIDS community to alternatives with month-long lifespans. On World AIDS day we pay respect to the progress the global response. But our work is far from complete. The rising work that has been done, and recommit To this end, Australia was pleased to rates of transmission amongst Aboriginal to working together so that Australia can announce a 10 per cent increase to our Global and Torres Strait Islander (ATSI) Australians continue to be a world leader in controlling Fund contribution for the sixth replenishment and amongst culturally and linguistically and reducing transmission rates, supporting those living with HIV and to look with period. Our support to Global Fund is having diverse (CALD) communities is a reminder optimism about what we can achieve in an impact in South-East Asia and the Pacific that we need targeted education campaigns. years to come together. - for example, in 2018 more than 8,700 Australia can meet this challenge. We have HIV-positive mothers received treatment to a proud history of bipartisan cooperation prevent mother to child transmission.

4 5 The Hon Greg Hunt MP from 1 December 2018, and Biktarvy® HIV Globally in 2018 (bictegravir/emtricitabine/tenofovir Minister for Health alafenamide) from 1 March 2019. Australia continues to be a world leader However, there are challenges still 37.9 million Estimated HIV prevalence in selected countries remaining. We are not seeing significant in the response to HIV. Our response people living with HIV New Zealand is a success story, approaching 40 declines in the number of notifications of years, involving education, prevention, HIV acquired through heterosexual sex, Australia among Aboriginal and Torres Strait Islander treatment, care and research. United Kingdom (2017) peoples, or in overseas-born men. In 2018, The Morrison Government will continue the HIV notification rate remained two times 23.3 million Butan people with HIV had Australia’s world-leading response to HIV, higher among Aboriginal and Torres Strait access to treatment Laos building upon the efforts of Governments Islander people compared to Australian- over recent decades. Our aim is for Australia born non-Indigenous people. Viet Nam to be one of the first countries in the world to eliminate new HIV transmissions. The 2019–20 Budget includes an investment Malaysia

of $45.4 million from the Morrison y 1.7 million r t Indonesia We are well on our way - the number of n Government to support the implementation people were newly u o new HIV diagnoses today is at its lowest in of Australia’s five national Blood-Borne diagnosed with HIV C United States (2016) nearly 20 years. Prevention is affordable and Viruses (BBV) and Sexually Transmissible accessible. More people are being tested Infections (STIs) Strategies. I am confident Source: UNAIDS 2018 Cambodia and treated earlier, and there is a focus on these Strategies will make a real difference Brazil reducing stigma and discrimination. in reducing the health impacts and stigma of Myanmar HIV notifications are at their lowest since BBV and STIs, including HIV. 2001. Researchers at the Kirby Institute I applaud the great progress that has been Papua New Guinea report 833 confirmed HIV diagnoses made in recent years to reduce new HIV Ukraine in Australia in 2018. This compares to infections in Australia, and to increase 937 cases in 2017 and is a 23 per cent access to HIV prevention and treatments in Thailand reduction since 2014. The decline is highest countries and regions most affected by HIV 0.0 0.2 0.4 0.6 0.8 1.0 1.2 in gay men and other men who have sex with and AIDS. men – a 30 per cent reduction since 2014. Prevalence (%) I also commend the very dedicated people Making pre-exposure prophylaxis (PrEP) who have never wavered in the fight – for HIV affordable and accessible has been including people living with and affected by a real game changer. The Government’s HIV, community organisations, researchers $180 million listing of PrEP on the and clinicians. The response has been a Pharmaceutical Benefits Scheme (PBS) collective effort and we must remain united, in early 2018 was a landmark moment focused and continue to work together. in the response, and will benefit up to 32,000 people. World AIDS Day raises awareness about the issues surrounding HIV and AIDS in Australia In addition to PrEP, other new medicines and around the world. It is a time to show for the treatment of HIV have been support for people with HIV, and to remember made available on the PBS including people who we have lost to the epidemic. Juluca® (dolutegravir and rilpivirine) 6 7 Senator the Hon Penny Wong And it’s why we will continue to support Senator Richard Di Natale Australia has a significant role in sending the Government’s efforts on HIV wherever a clear message to the world and our and the Hon Chris Bowen MP Leader we can – and hold the Coalition to account region that funding to eliminate HIV should Shadow Minister for Foreign Affairs; where we must. Australian Greens be prioritised. To do so we must maintain Shadow Minister for Health our contributions to the Global Fund to But of course, the opportunity to eliminate On World AIDS Day we remember Fight AIDS, Tuberculosis and Malaria. transmission is not yet shared across our These contributions are critical, with This World AIDS Day, Australia is on the region. those who have passed and those living verge of a historic achievement. with HIV. We wear our red ribbons and the Fund providing US$15 for every US dollar committed by Australia, totalling Nearly 6 million people in the Asia-Pacific recommit to take the actions necessary All Australian governments – the US$2.9 billion from 2014-2016. Australia region live with HIV and there were over to achieve zero new HIV infections. And Commonwealth, states and territories must commit $300 million over the next 300,000 new HIV diagnoses last year. there is much left to do. – have now agreed on a shared goal three years from Australia’s development of eliminating HIV transmission in In Papua New Guinea, for example, Last year we saw the listing of PrEP on budget to set a strong example and Australia by 2022. treatment services are improving but health the Pharmaceutical Benefits Schedule; a ensure the Fund can continue its work in a workers struggle to connect people with historic moment after a long campaign that sustainable and consistent way. Australia That opportunity was unthinkable when the services in remote provinces and among key the Greens were proud to be a part of. Now must also play a leading role in the 2021 HIV/AIDS epidemic first swept Australia in populations. PNG has the highest incidence we must ensure that those at risk know United Nations General Assembly’s High- the 1980s. and prevalence of HIV in the Pacific – and it’s that they are able to access it and no other Level Meeting on HIV and AIDS, including It has been made possible by a sustained increasing. barriers, like the pervasive stigma around support for participation by people living with this issue, prevents them from doing so. HIV/AIDS and civil society in the meeting, response in the decades since – a response Australia has a deep interest to ensure a and in the negotiation of an updated UN underpinned by partnership, harm reduction prosperous, stable and healthy region. It is a critical time for HIV prevention in Declaration of Commitment to Ending HIV. and non-partisanship. Australia, with worrying figures showing a We can and should do more to help reduce 33% increase in new HIV diagnosis rates The task ahead is significant. On World AIDS But effectively eliminating transmission the health and economic burden of HIV in among First Nations peoples, while rates Day it is time that Australia show leadership in the next three years won’t be automatic our region and improve the lives of hundreds among Australian-born non-Indigenous and make these commitments, which we or easy. of thousands of people – particularly the people have decreased by 22% over the same know will be pivotal in driving down HIV most vulnerable and isolated communities. Around 850 Australians are still diagnosed period. We will only eradicate this disease with infection rates at home and abroad. with HIV every year. In Australia and in our region, we must a renewed focus on funding and implementing the national strategies and in particular the As a former GP and having worked in HIV And in some areas we are going backwards. redouble our efforts to make HIV history. strategies for Aboriginal and Torres Strait prevention overseas, this is an issue of It should shock us all that the rate of new Islander blood-borne viruses and STIs. personal significance to me. While I am diagnoses in Aboriginal and Torres Strait pleased to have the opportunity to raise Islanders is now above other Australians. Stigma and discrimination has always played the profile of this issue each year on a part in this challenge. It is time for a new, For these and other reasons, Australia will World AIDS Day, the challenge for policy concerted campaign to break down stigma miss its previous target to eliminate HIV makers and for all of us, is to keep the and discrimination, encourage safer sex and transmission by 2020. focus going throughout the year. I want to encourage early testing; as well as key regulatory take the opportunity to again congratulate We cannot fail again. reforms at the state and federal levels. and acknowledge the tireless work of the That’s why Labor announced substantial It is also crucial that researchers continue Australian Federation of AIDS Organisations commitments to make HIV history ahead to progress the knowledge base around HIV (AFAO), the Pacific Friends of the Global of the 2019 federal election. and other blood borne viruses, including Fund and the National Association of People community surveillance. To do so we must With HIV Australia (NAPWHA), and other ensure these infections are prioritised by the partner organisations, who carry on this NHMRC and MRFF. fight year-round. 8 9 We can start with investing adequately played a pivotal role in PrEP scale-up, Mr Eamonn Murphy Discriminatory attitudes and criminal laws and smartly, and by looking at what’s including raising awareness, acceptance Regional Director still push people to the margins of society. making some countries so successful, like and demand for PrEP as an additional tool This must end. In 2018, in Asia and the Australia. Australia continues to set the within combination HIV prevention. However, UNAIDS Asia and the Pacific Pacific one third of all new HIV infections global standard for an effective, innovative Australia also understands the HIV epidemic were among key populations and their and inclusive national response to HIV, has not yet ended in the country, and that The global determination to defeat partners, who are not being considered backed by a strong partnership between further expansion of PrEP access combined AIDS, as one of history’s greatest health enough in HIV testing and prevention government, clinicians, researchers and with a continued focus on testing, treatment, crises, has inspired a commitment programming. communities. Australia has been at the condom promotion and harm reduction will within the 2030 Agenda for Sustainable Innovative approaches like pre-exposure forefront of harnessing the potential of be essential for accelerating declines in HIV Development to end the AIDS epidemic prophylaxis (PrEP) are contributing to the emerging evidence and technologies, infections. as a public health threat by 2030. including PrEP. The rapid scale-up of revitalisation of the HIV response to stop I count on Australia’s leadership to However, I am increasingly worried that PrEP to people at substantial risk of HIV new infections. However, PrEP is slowly be the engine that spurs the region to despite this commitment, the sense of infection has had a significant impact on becoming available to key populations in this revamp HIV prevention efforts, empower urgency has been lost. Complacency is the country’s epidemic, contributing to a region and awareness and access to PrEP communities and re-commit towards our stalling the AIDS response and we risk 30% decline in new HIV infections among remains far below what is needed. common goal of ending AIDS as a public losing the momentum for change. gay and bisexual men nationally between To change the course of this epidemic, we health threat by 2030. In Asia and the Pacific, that boasts some of 2014 and 2018. Community organisations need bold leadership now more than ever, the earliest successes of the HIV response, to put HIV back on the agenda. It means annual achievements are getting smaller, making sure governments put appropriate the pace of progress is slowing down and policies in place that empower vulnerable the 2020 targets are unlikely to be met. populations. Ending AIDS as a public health Regionally, 69% of all people living with HIV threat is possible if we focus on people not know their HIV status and, among them, diseases, create road maps for the people 78% are accessing treatment, —surviving, and locations being left behind and take a thriving and living healthy lives. This is good human rights-based approach. news. But let us not forget the 2 million people that are still waiting for treatment. That is why we need a strong civil society movement to transform our prevention We are not doing enough to prevent new HIV response. The theme of this year’s World infections. 310,000 people became newly AIDS Day is “Communities make the infected with HIV in 2018, a 9% decline since difference”. Their leadership and advocacy 2010. However, that number has barely ensure the response remains relevant and changed since 2016. While some countries grounded, keeping people at the centre. are making impressive gains, there are still World AIDS Day offers an important platform unacceptable and worrying increases in new to highlight the role of communities at a time HIV infections in others, like in Pakistan and when reduced funding and a shrinking space the Philippines where new HIV infections have for civil society are putting the sustainability increased by 57% and 203% respectively, in of services in jeopardy. the past 8 years. It is unacceptable that every hour 10 young people become infected with HIV region-wide. Photo: With Global Fund support, this clinic at the Kawthaung District hospital in Myanmar offers a wide range of health services for women and children and specialises in treatment to prevent mother-to-child transmission of HIV. Credit: Global Fund/Jonas Gratzer 10 11 Champion Community Centres: Enabling and Mobilising Communities for More Strategic HIV Services for Key Populations

Ronivin Pagtakhan and With support from the current Global Fund John Oliver Corciega National Grant, as sub-recipient of Save the Children Philippines, LoveYourself is LoveYourself Inc. replicating its community-based service delivery model to reach more KPs— The Philippines has the fastest growing particularly those “hard-to-reach” or HIV epidemic in the Asia-Pacific. unwilling to visit public HIV facilities—and Between 2015 to 2017, local government increase the rates of testing and treatment efforts to reach and test key populations among them. “Champion Community (KPs) yielded low positivity rates (2%), Centres”, as they are called, are envisioned highlighting the need to increase to be one-stop alternative service delivery efforts to seek out more at-risk KPs. settings, expanding differentiated HIV care among KPs through both outreach LoveYourself, a volunteer-driven KP-led and facility-based prevention, testing and Figure 1. Champion Community Centre Capacity Development Framework community-based organisation (CBO), treatment services. established community centres to provide contributed almost as much share (17.4%) to technical assistance for sustainability and HIV education, testing, counseling and Since October 2018, investments have been the total number of newly diagnosed cases community systems strengthening—from treatment among men-who-have-sex-with- made for the establishment/refurbishment nationwide as that of health facilities in 38 social marketing and communications and men (MSM) and transgender women (TGW). and operations of twelve other CBO-led Global Fund-supported local government resource mobilisation to strategic planning, From 2012 to 2017, it tested over 68,000 Champion Community Centres in high- units (LGUs) (19.2%). Compared to LGUs’ community-based research and monitoring- clients in three community centres in Metro burden areas across the country. From 2.6%, the Champion Community Centres and-evaluation. Manila, contributing 17% of the total number July 2018 to March 2019, LoveYourself and also yielded a higher positivity rate of 6.8% As CBOs play a significant role in drumming of diagnosed cases in the country. the twelve Champion Community Centres among MSM/TGW tested between July 2018 up demand for PrEP, mass testing, self- to June 2019. testing and condom distribution, their A year since, LoveYourself and Save the community centers will be mobilised, Children Philippines administered an with SKPA support, as additional access organisational assessment to determine points to scale-up these innovations. partner CBOs’ capacity gaps and needs— Moreover, at least two community centers service delivery-wise and beyond—and which are transgender-led/focused will be to plan for actions to fully develop their championing trans health services including Champion Community Centres into one- hormonal replacement therapy. stop-shops. (Figure 1) With sufficient and continuing support, Guided by this assessment, the Global Fund CBOs—with their established networks of Multi-Country Grant Sustainability of HIV KPs and demonstrated higher positivity Services for Key Populations in Asia (SKPA) rates—are evident, if not more compelling, Program under the Australian Federation entry points for expanding HIV prevention, of AIDS Organisations is reinforcing testing and treatment coverage among those country efforts with complementary most at-risk.

Photo: Staff and volunteers at Love Yourself Victoria 12 13 Mr Peter Sands aged 15-24 in sub-Saharan Africa are twice AFAO’s national PrEP campaign Executive Director as likely to be HIV-positive compared to young men of the same age. In the hardest- With the addition of scaled-up PrEP to show the diversity of these men’s Global Fund to Fight AIDS, hit countries, it’s six times as high. Tuberculosis and Malaria access, alongside increased testing and experiences. These include an Aboriginal To end the HIV epidemic by 2030, we must other HIV prevention tools (including man, an Asian man, a South American man, condoms and treatment as prevention), a man of trans experience and a man from Australia has shown remarkable build more just and equal societies, and significant decreases in HIV diagnoses rural Australia. leadership in global health, contributing remove human rights and gender-related among gay and other men who have sex a total of $A709.48 million to the Global barriers to health. Additionally, we must step The campaign was launched in early March with men (MSM) have been reported Fund to date. In October 2019, Australia up our investments in innovative programs 2019, and video content is a key component in Australia. However, not all gay and pledged $A242 million for the Global that can help us achieve results faster, and of the campaign. This has included campaign other MSM have experienced these Fund’s Sixth Replenishment – a 10% more cost-effectively. introduction videos and an animated PrEP decreases. To ensure Australia achieves explainer video. The first of a series of increase over the previous period. In October, French President Emmanuel the greatest impact from PrEP, we need episodes in which we hear from the five Australia has also invested heavily in Macron led the world in raising to ensure that it reaches the populations men from the campaign as they share their bilateral initiatives to fight HIV across US$14.02 billion for the Global Fund’s that will benefit from its use. stories, experiences and the benefits of Asia and the Pacific and beyond. Sixth Replenishment. This will help save being on PrEP was also recently launched. 16 million lives over the next three years, cut AFAO has developed a national digital Together, we have contributed to delivering The website and the captions for all of the the mortality rate from HIV, TB and malaria PrEP campaign, Get PrEP’D, targeting gay HIV treatment to more than 23 million videos have also been translated into Thai in half, and build stronger health systems. and other MSM, and with a specific aim of people and cutting the number of deaths and Spanish, and the spoken videos also A significant amount of the resources raised reaching sub-populations of these men, from AIDS by more than 55% since the peak provide captions in English for deaf and will go to fight the epidemics in Asia and that are not currently utilising PrEP. These in 2004 – from 1.7 million to 770,000 in 2018. hearing-impaired people. the Pacific, supporting progress toward In the fight against HIV, tuberculosis and sub-populations include, Aboriginal and the health-related targets of the 2030 AFAO is working with our members, malaria, Australia has supported the Global Torres Strait Islander men, men of culturally Sustainable Development Agenda. affiliates and other partners to support their Fund partnership to save 32 million lives as diverse backgrounds, men and masc people local implementation. This includes the of the end of 2018. of trans experience and men from rural and We have come a long way in the fight against amplification of campaign products through HIV in the last decade. Now we must make regional communities. We are at a crucial stage in the fight local digital channels (websites, social media smarter investments to end this epidemic. against HIV. Overall HIV incidence rates are The campaign has been informed by existing and other promotions) and offline channels, As we strive to achieve that goal, we will declining, but the total number of infections research and literature, and by new market including events and peer education. continue to count on Australia’s leadership. research commissioned through the project. is still unacceptably high, at 1.7 million The Get PrEP’D campaign is successfully This provided important insights into these new infections in 2018. This number is not targeting gay and other MSM, as well as populations’ knowledge, understanding dropping fast enough to meet the UNAIDS specific sub-populations of these men, that and attitudes of PrEP, and importantly target of fewer than 500,000 people infected would benefit from PrEP by not only raising per year by 2020. investigated the barriers to these men using awareness of PrEP, but by also addressing PrEP. These insights informed the website the barriers to using PrEP identified in the Persistent gender and human rights barriers content, video content and messaging for development of the campaign. drive new infections and reduce uptake and advertising for appropriate and effective retention of health services. As a result, targeting to these populations. www.getprepd.org.au members of key populations, such as men www.facebook.com/getprepdaus who have sex with men, transgender people, The campaign features five PrEP users sex workers, people who inject drugs, and representing these sub-populations across the different campaign elements (website, their partners now account for over half of videos, advertisements and social media) all new infections. Girls and young women

14 15 Professor Brendan Murphy are more likely to experience comorbidities. Professor Sharon Lewin people who use drugs in countries like the They may also unknowingly transmit the Philippines, assisting the worrying emerging Chief Medical Officer Director virus. Continued efforts to enhance access issues such as iatrogenic transmissions in Department of Health to HIV prevention methods, expand testing The Peter Doherty Institute for Pakistan or high rates of drug-resistance in coverage and support early commencement Infection and Immunity Papua New Guinea, and assisting all to reach Australia continues to be a world of treatment within these populations are a the 90-90-90 targets. A major component of leader in the response to HIV and priority going forward. Over the last 5 years, increased testing, reaching these targets is Australia’s ongoing high rates of uptake of antiretroviral financial contributions to bilateral and the success of our response is built The Eighth National HIV Strategy 2018-22, therapy (ART) and increasing use multi-lateral efforts such as the Global Fund. on a model of partnership between launched to coincide with World AIDS Day of pre-exposure (PrEP) have led I hope, as you read this, we are celebrating a governments, people living with HIV, 2018, guides our partnership approach over to impressive declines in new HIV successful Replenishment Conference! community-based organisations, health the next four years to virtual elimination professionals and researchers. Through infections across Australia. This of HIV transmission by 2022. This includes change is certainly something we Finally, in an era where the medical research their concerted efforts, more people are sustaining the virtual elimination of HIV budget in Australia has doubled with the being tested for HIV, people living with should and must celebrate. We are transmission among people who inject the envy of many countries across the establishment of the Medical Research HIV are initiating treatment earlier and drugs, sex workers and from mother to child. Future Fund, we must continue to play a more are achieving a suppressed viral world and have much to be proud of. The Strategy also contains goals to reduce This has been a joint effort between leading role in the development of a vaccine load. In addition, improved access to the mortality and morbidity, and to eliminate and a cure for HIV. With 37 million people HIV prevention methods, including the community, clinicians, researchers the stigma and discrimination, related to and government – a testament to the living with HIV and 1.7 million new infections PBS-listed pre-exposure prophylaxis HIV. Australia is well placed to achieve these a year globally, we will not eliminate HIV (PrEP), are helping to reduce the HIV partnership that has underpinned goals with the continued and dedicated the HIV response in Australia since the globally without these tools. number of new HIV diagnoses. efforts of all partners in the response. beginning of the epidemic. In 2019, a second man was cured of HIV In 2018, Australia recorded its lowest following a bone marrow transplant in However, as always – we should never number of HIV notifications since 2001 at London. There was much excitement with be complacent. New infection rates have 833. This represents an overall decline in the announcement, but we have a long way unfortunately not declined in all key HIV notifications over the past five years to go in developing a safe and effective cure populations. The number of new infections of 23 percent nationally, and 30 percent in for all people living with HIV. Significant each year in Australia remains largely gay men and other men who have sex with investment in fundamental science is still unchanged in heterosexuals, Aboriginal and men. This is very encouraging and is largely needed. 2019 was also the year we were Torres Strait Islander people, and gay and attributed to the successful uptake of PrEP reminded that we put a man on the moon bisexual men born overseas. We need to do in gay and other men who have sex with - 50 years ago. We should draw inspiration more to reach and engage people at risk men. It highlights the critical role PrEP will from both these stunning scientific in these groups and we need targeted and play in our HIV response going forward. achievements and continue to strive innovative prevention programs developed in for a cure for HIV for all. However, the latest data also reveals that the conjunction with these communities. Now, HIV epidemic is increasingly heterogeneous more than ever, it is unacceptable to leave - we are not seeing significant or any anyone behind. declines in the number of notifications of HIV acquired through heterosexual sex, among It is also not enough for us to achieve the Aboriginal and Torres Strait Islanders or in virtual elimination of new HIV infections in certain culturally and linguistically diverse Australia only. We need to support the HIV populations. These groups are more likely response across our region. In addition to to be diagnosed late and, as a result, they access to ART and PrEP, this importantly involves protecting the human rights of

16 17 HIV in Australia in 2018 Leadership in the HIV Epidemic be cured and that has been added to the Pharmaceutical Benefits Scheme. A seminar The Hon Michael Kirby AC CMG HIV Transmission on World Hepatitis Day on 29 July 2019, also at the Kirby Institute, disclosed the I thank AFAO and its partnership with “missing piece of the Hep C elimination % Male-to-male sex New diagnoses 62 the National Association of People puzzle” as it impacts people who use drugs, in Australia with HIV Australia (NAPWHA) and and especially prisoners and their sexual 833 % Heterosexual sex 23 Pacific Friends of the Global Fund for partners and families. sponsoring this annual reminder of the % Male-to-male sex and injecting drug use HIV and AIDS repesent a tragedy. But here 7 epidemic and for distributing it to all too the gift of inspired leadership has been Members of Parliament, Senators and decline compared % Other/unspecified vital to the global response. Amongst the 5 stakeholders throughout our country. % to the average of world leaders have been Halfdan Mahler, 18 the last four years 3% Injecting drug use HIV and AIDS remain a major challenge who insisted that WHO take up the HIV for the world. Yet, in Australia we have challenge, virtually from the start. Jonathan made great progress as is evident in the Mann who taught the world the AIDS announcement by the Kirby Institute on 3 paradox and demanded a human rights The rate of diagnosis is around twice as high among July 2019 that HIV diagnoses in Australia had approach to this epidemic. Then came Peter vs 4.7 2.3 Aboriginal and Torres Strait Islander people than people dropped to the lowest number in 18 years. Piot, the first Executive Director of UNAIDS. per 100,000 than Australian born non-Indigenous people With 833 notifications in 2018, this is the With critical funding support, he promoted lowest number since 2001. It represents a the provision of antiretroviral therapy to decline of 23% over five years. This is largely millions who would have otherwise have the result of reductions in the number of HIV died. Piot’s successor was Michel Sidibe who 89% 95% 27% diagnoses that are reported as attributable pushed forward to bring sceptical leaders in of people of people on of people with HIV to sex between men (a 30% decrease over Africa and elsewhere into harmony with the diagnosed with HIV treatment have including people living five years). There have been no declines global strategy. Now, on 14 August 2019 the with undiagnosed were on treatment an undetectable in diagnosis amongst heterosexuals or third leader of UNAIDS has been appointed: in Australia viral load HIV do not have an undetectable viral load in the Aboriginal or Torres Strait Islander Ms Winnie Byanyima. Chosen by the UN populations. Once again, our Indigenous Secretary-General, she has committed people are in need of greater attention and herself to the objective envisaged in the Late* HIV Diagnoses by Risk Exposure Category support from the rest of us. Sustainable Development Goals: the end of AIDS as a public health threat by 2030. 60 I pay special tribute to the Kirby Institute and She acknowledges that the dimension of 50 also the Burnet Institute, Doherty Institute and the challenge cannot be underestimated. Penington Institute. They are world leaders in 40 But she has promised to “speak up for the outstanding science and research. We can be people left behind and champion human 30 proud of them and of our scientists. rights as the only way to end the epidemic”. Percentage 20 We can also, on this occasion be proud So on this World AIDS Day 2019 we need 10 of our politicians. The initiatives taken to rededicate ourselves to these goals. in the earliest days of HIV to reach out 0 Australia must re-energise its contributions 2009-10 2011-12 2013-14 2015-16 2017-18 to vulnerable populations helped get us to our region and the wider world. AIDS where we are, with declining numbers of can only be defeated as a global challenge. Heterosexual sex Bisexual sex Injecting drug use infections. But so have other initiatives And when we have succeeded there, it will Male-to-male sex taken by politicians in more recent times be essential to carry the lessons of AIDS deserve acknowledgment. Certainly, into all essential healthcare challenges. * A late diagnosis is defined as such when CD4+ cell count is less than 350 cells/μL these include the addition of antiretroviral Working together, we will succeed. Source: Kirby Institute 2018 drugs to treat HCV, a virus that can now 18 19 Professor Anthony Kelleher The reduction in new cases of HIV have been Professor Brendan Crabb AC the national supply of new treatments Director most significant among gay and bisexual Director and CEO including dolutegravir, which can provide men in Australia, the focus population of better health outcomes for people with Kirby Institute these studies, but this success has made the Burnet Institute treatment resistance. For much of 2018, gaps in our efforts more pronounced. This even HIV testing kits and the standard This World AIDS Day is an opportunity is reinforced by the latest HIV surveillance We’re close to the end of the HIV first-line treatment medicines were not to pause and reflect on how far we data, released in July, which reveals epidemic as a public health threat in available in many clinics. have come, and to renew our focus on significant declines among gay and bisexual Australia, but Papua New Guinea is The halting of previously funded community how far we have yet to go, in the fight men, but rates remaining stable among still facing a myriad of challenges. education in 2017 has resulted in many against HIV/AIDS. heterosexual and Aboriginal and Torres Treatment of HIV should be as effective people in key populations still not knowing Strait Islander populations. Furthermore, we in PNG as in Australia. But it doesn’t In Australia, we are fortunate to have that treatment is effective and not seeking are not seeing reductions among those who work if people can’t access treatment or had broad support and coordinated effort testing. Burnet has developed a new HIV are ineligible to access Medicare. We must if there is treatment resistance. Both of across government, academia, clinicians, treatment literacy toolkit for HIV infected continue to come together across sectors these are occurring in 2019. and importantly, the community to find the to find innovative ways to refocus testing, “expert patients” to use structured methods best treatments for people living with HIV, treatment and prevention initiatives by Of 48,000 people estimated to be living with to explain treatment literacy to clients. and prevention strategies to drive down identifying the gaps and developing insightful HIV in PNG, only 27,000 are on treatment. This is effective but is only available so far transmissions. and informed programs that are accessible Many people remain undiagnosed due to through the eight peers we have been able to and acceptable for all Australians. inadequate testing. 41% of sex workers who train and support in just two cities. The key This year, we can confidently say that the are HIV positive, and 23% of men who have population organisations are keen to provide availability of pre-exposure prophylaxis (PrEP), We ignore at our peril the epidemics continuing sex with men and transgender people who more treatment education but currently have the HIV prevention medication, together on our doorstep. Our innovation and insight are positive, don’t know their status. Others no resources. with testing and treatment initiatives, means should inform the expansion of efforts into know they have HIV, but are unable to start the virtual elimination of HIV transmission our region. This year at the Kirby Institute, The availability of effective treatment treatment because of lack of available and in Australia is now a real possibility. Our we were pleased to launch the Cooper medicines should now mean that HIV consistent supplies of medicines. EPIC-NSW study was the largest population- HIV/AIDS Research Training (CHART) treatment can be provided by Community level trial of PrEP to have been conducted in Program. It was established in the name Treatment resistant strains of the virus Health Workers, not just HIV specialists. It Australia, and was the culmination of cross- of our inaugural director, Professor David are now being transmitted in PNG, at the should mean that HIV treatment becomes sector collaboration. PrEP is now available Cooper, to carry forward his ethos of capacity same time as new treatment resistance is a standard service in all primary health through the Pharmaceutical Benefits building, to enable the development of locally generated when people stop treatment. Of centres. The current inconsistent supply Scheme, and affordable, across Australia. informed solutions developed by an in-country people newly acquiring HIV, 17% experience of ARVs means the opposite: staff need to We cannot underestimate the impact this workforce sensitive and responsive to domestic treatment resistance. Of those who interrupt be trained in complexity, provide extended has had in communities, who now have constituencies. It is the coming together treatment then later return to it, 42% have consultations, and continue running HIV choices when it comes to negotiating of dedicated people in our region, where treatment resistance. standalone clinics. In 2017, some clinics relationships. It is exciting progress. opportunities are created to most effectively were already giving patients six months’ Better access to both testing and sustained work towards alleviating the burden of HIV supply of medicines, but now they can only Likewise, our Opposites Attract study treatments can be managed through better globally. We all have a role to play in this. hand out one month’s supply. This increases has contributed to the global evidence collaboration between governments, health costs of service provision and interrupts demonstrating the risk of an HIV Now is not the time to stand still. Despite providers and communities. The technologies patients’ lives. positive person on antiretroviral therapy promising results in our country, it is our are available, including new regimens not so responsibility to continue the momentum passing on the virus to an HIV negative prone to treatment resistance. World AIDS Day is a time to celebrate our and share the lessons learnt more broadly. person is effectively zero when their successes, but also to remember there is With sustained and increased efforts, we Systems are failing to distribute reliable viral load is undetectable. There is a long way to go, even among some of our have the opportunity to make great inroads supplies of medicines and testing global momentum around U=U, or closest neighbours. to achieving the UN’s 90-90-90 targets not technologies. Lack of financing is limiting Undetectable=Untransmissible. just in Australia, but globally. 20 21 Professor Carla Treloar Stigma affects all communities living with Mr Alexis Apostolellis While these are dramatic reminders of the Director HIV. Our Stigma Indicators Monitoring Chief Executive Officer challenges for PNG, other countries in our Project has documented the extent to which region share similar obstacles – in particular Centre for Social Research in Health people living with HIV experience stigma Australasian Society for HIV, fear of actual experienced stigma and and the sources of this stigma. Significant Viral Hepatitis and Sexual discrimination from health care providers. Health Medicine (ASHM) Our Gay Community Periodic Surveys proportions of people living with HIV report This is entirely unacceptable, and Australia (GCPS) have collected data since being treated negatively in health settings is no different in this regard. Evidence 1996 on the sexual practices, risk and and being rejected by potential sexual At the Australasian HIV & AIDS shared in Perth that mandatory testing engagement in prevention and care by partners. Social support acts as a buffer to Conference in Perth in September, laws and policies meant to protect first gay and bisexual men. The GCPS data the negative effects of stigma and promotes ASHM hosted a meeting between line responders around their concerns of have shown dramatic changes in the positive wellbeing, but people living with HIV the leaders of the HIV response blood borne viruses transmission, typically last few years, with a rapid uptake of in Australia who are socially isolated may in Papua New Guinea, our closest in the context of assault. are not based in PrEP and growing engagement with HIV be at increased risk of the negative effects neighbour. Those present, including either current evidence nor ethical effective treatment as prevention by community- of stigma. This points to the importance of representatives from the PNG practice. engaged men. Within the GCPS, the promoting strong social support systems government, the PNG National AIDS Finally, our sector has still much work to UNAIDS 90-90-90 treatment targets (through peers, community and the health Council, community representatives do in Closing the Gap in the rates of HIV, were met some time ago. system) to counter the negative impacts and health providers, used the meeting syphilis and other sexually transmissible of stigma. to issue an urgent Call to Action: However, when we look at sub-groups, the a demand that partners, donors, among Indigenous communities and First results are more complicated. Our National governments and people with HIV Peoples throughout Australia. Delegates at Gay Asian Men Periodic Survey shows gay unite, to arrest and reverse current the Perth conference signaled their support Asian men continue to rely on strategies HIV trends in PNG. This can only be for significantly more work to be undertaken such as consistent condom use or the achieved, this Call to Action states, and resources targeted alongside Aboriginal avoidance of anal intercourse to prevent HIV. through renewed donor engagement, and Torres Strait Islander peoples from This is in stark contrast to the GCPS in which improved collaborations, greater youth to elders through the Noongar there has been a dramatic shift towards involvement of affected communities, Boodja Statement. biomedical strategies such as “U=U” and strengthened health systems and the ASHM remains committed to supporting PrEP. In addition, our surveys suggest that continued development of a competent our sector at home and in our region with PrEP uptake has been concentrated in the and confident clinical workforce. our neighbours in the Pacific and beyond, eastern states and territories and among through high quality community informed educated and employed gay men. Of particular note PNG has the fourth highest pre-treatment drug resistance events, tools and trainings for the work force Examining the factors that drive inequitable among first-line HIV treatment initiators and acknowledge that uneven progress for access to innovations such as PrEP, in the world; additionally there were 300 2020 interim UN targets in the HIV response especially using in-depth, qualitative children born with HIV in 2018 and it is in many countries have some way still to go research, help us to unpack trends in expected that this number will be much and Australian organisations continue to surveillance data, and contribute to the higher in 2019; stigma and discrimination have both a duty but also the resources and national response in ensuring that no part remain significant barriers for people to expertise to lend support. of the community is left behind. access services compounded by geographic challenges, staff shortages and drug stock-outs.

22 23 supported across the Parliament and in the key members of the Liberal Party opposition HIV partnership at the heart of Australia’s HIV broader Australian community. and then with politicians from almost all parties in the Commonwealth Parliament. response for almost four decades The solid foundations of the response Bill Bowtell AO In October 1982, the first Australian case had to endure across years and decades, The HIV coalition forged by Bob Hawke, Neal of this disease was reported. and beyond the political lifetime of any Blewett, Andrew Peacock, Dr. Peter Baume Pacific Friends of the Global Fund one Australian national, state or territory and other political leaders in the mid-1980s Senior Private Secretary to The newly-elected Hawke government government. When things were at their most has been at the heart of Australia’s HIV Neal Blewett 1983-87 was therefore confronted with a rapidly uncertain, and picking the right way through response for almost four decades. deteriorating public health emergency in the controversy, anger and foolishness (Bob Hawke’s) work, along with The essential elements of the HIV strategy “ which both the nature and the method of was very hard, Prime Minister Hawke health minister Neal Blewett, have been endorsed and built upon by transmission of the malady was unknown. could well have faltered in his commitment ensured Australia’s response to successive governments and Parliaments Even when the viral nature of HIV was to these policy settings, and caved in to the AIDS epidemic was the best from 1983 to the present. confirmed in early 1984, there were no those advocating sanction, isolation and in the world. ” remotely effective treatments and only a quarantine of those with, or at greatest risk, On World AIDS Day 2019, we should Hon Scott Morrison, Prime Minister, 3 July 2019 glimmer of hope that behavioural changes of HIV/AIDS infection. endorse the words of Prime Minister Scott Bob Hawke became Australia’s Prime Minister Morrison and acknowledge the principles might inhibit the spread of the virus. But Bob Hawke never budged. in March 1983, just when the immense threat of cooperation and inclusion laid down by In the grim years of the mid-1980s, the to public health posed by the emergence of Instead, he oversaw the emergence of a Bob Hawke and Neal Blewett that have been imperative need was for the Australian HIV/AIDS was becoming apparent. resolute policy consensus around HIV first with at the heart of our outstanding response to government to build the closest partnerships his opposite number, Andrew Peacock and HIV/AIDS. Over the critical early years of the Australian with doctors, clinicians, carers and HIV/AIDS response, Bob Hawke, his government researchers to devise the best possible and the Parliament encouraged the formulation policies to contain the spread of HIV. and implementation of HIV/AIDS policies on But the critical insight of the Hawke care, treatment, research and prevention government, and then the Parliament, was that were radical, sometimes controversial to insist and ensure that those most affected but have proven to have been right. by HIV/AIDS were placed at the centre of the In Australia, we gave priority to prevention national mobilisation against HIV/AIDS. and to working with affected communities Dr Neal Blewett, the Health Minister in to bring about behavioural changes that the Hawke government, insisted that the greatly reduced the rate at which HIV was Australian HIV response had to be based being transmitted. on careful accumulation and weighing of Over time, this meant that many tens of science and evidence and total repudiation thousands of young Australians were not of prejudice and panic. This approach was infected with HIV and many deaths from strongly supported by the former Liberal AIDS averted. Party Health Minister, Dr. Peter Baume, and senior members of the opposition. Bob From the early 1980s onwards, a small Hawke endorsed Neal Blewett’s approach number of cases of a new mystery ailment and unwaveringly supported the creation of had been reported in the United States and radical and bold initiatives across HIV care, some other countries. Photo: The Hon Dr Neal Blewett AC (Australian Health Minister, 1983-1990) and the Hon Dr Peter treatment, research and prevention. Most Baume AC (Senior Shadow Cabinet Minister 1983–1991) discussing the bipartisanship that defined People afflicted with the symptoms of this importantly, Bob Hawke and his government Australia’s early response to the HIV epidemic at the May 2018 AFAO Members’ Meeting. hitherto unknown disease were presenting knew that, if it were to succeed, the in the final stages of illness. Australian response to HIV/AIDS had to be 24 25 Professor Suzanne Fraser scale, finding that while 63% of people Mr Cipri Martinez Australia’s Mandatory Disease Testing Laws, Director living with HIV reported good quality of life, President and a report on Medicare Ineligible PLHIV in there was much diversity of experience. Australia. As John Rule, NAPWHA’s Senior Australian Research Centre in Sex, Most people were doing well and reported National Association of People Research Manager stated in his foreword with HIV Australia (NAPWHA) Health and Society, La Trobe University good health, strong levels of social support in Futures 9 “Whilst there is currently an and connection, and access to quality and exciting narrative about biomedical advances The National HIV Strategy has set affordable health care. At the same time, the It is heart-warming and joyful to know and HIV prevention, Futures now spanning Australia a series of ambitious goals survey found high levels of poverty among the commitment and efforts of people over twenty years uncovers many areas of to be met by 2022. people living with HIV, with one in three with HIV (PWH) have contributed to the concern – mental health, social isolation reliant on government benefits as their main overall decline of HIV rates in Australia. and the negative impact of other social These include three key targets: source of income. Mental health issues were We are very fortunate to live in a determinants of health. More investment is • that 95% of all people living with HIV will also a concern, with over 50% having been country that provides universal health needed to ensure good quality of life for all know their HIV status; diagnosed with depression at some point in care, a system that is underpinned by PLHIV in Australia, particularly now that the • that 95% of those diagnosed will receive their lives. Many participants also reported the idea that respect for life and dignity population is living longer with HIV.” sustained antiretroviral therapy; and being socially isolated, or lacking support of all life is a core Australian value In 2019 the worldwide theme for WAD is from others, and many were concerned – values that are exemplified in the • that 95% of those receiving antiretroviral “Communities make the difference” When therapy will have undetectable viral load. about HIV-related stigma or rejection. Australian Partnership Response to HIV. at their best, communities are made up of The Strategy recognises that achieving Levels of access to testing, treatment, Most PWH gain beneficially from the people who choose to deeply accept, love these goals will require a focus on broader social support and care vary by cultural Australian health care system, however it’s and support each other. We consciously quality of life and wellbeing for people living community, gender, sexuality, age and reach is not perfect or even. To achieve the choose to make a loving difference in each with HIV. Poor quality of life, poor mental geography. Our qualitative project, A Study virtual elimination of HIV in all populations other’s lives. When this happens, our quality health and experiences of stigma can of HIV Management, Care and Support we require a greater and more meaningful of life soars, our dignity soars, our creative hinder access to testing and care, and also Needs among People from Migrant and reach and engagement with PWH and resolve to meet challenges takes places, we hinder treatment maintenance. Conversely, Mobile Populations in Australia, has been their most affected communities. The can and will virtually end HIV. We owe this supporting health through viral suppression investigating these differences and is Institute estimates that there are 28,180 to each other and in loving remembrance of does not by itself ensure quality of life. In now also beginning to produce results. Its people living with HIV and only 21,710 have those who we have lost to HIV/AIDS. short, quality of life and health relate to each findings will assist government bodies, an undetectable viral load. This means other, but one does not guarantee the other. health services and community support approximately 6,470 are not yet receiving With this in mind, ARCSHS has been working agencies in planning and delivering the quality of life and advantages of being on several research projects that aim to culturally sensitive and appropriate services on treatment. Listening to and supporting develop better understandings of quality of for people living with HIV from migrant individuals on their journey is a crucial piece life for Australians living with HIV. and mobile populations, as well as their of the equation. communities more broadly. Measuring quality of life presents many As highlighted in HIV Futures 9, resolving challenges. In partnership with peer- On World AIDS Day 2019, ARCSHS joins positively the social determinants of led organisations, research, health and with its government and community health for each person with HIV is the real community services, and industry, ARCSHS partners, and research collaborators, as challenge for peers, professionals and has developed an effective and practical way well as with people living with HIV across the partners in the Australian Partnership to measure quality of life of people living with country, to affirm the importance of quality Response to HIV. In the past year NAPWHA HIV (the PozQoL scale). of life and wellbeing for people living with has released four substantial pieces of HIV in all their diversity, as we also continue work that directly address this; a report ARCSHS’ latest HIV Futures study of the to work together towards an end to the HIV on HIV and Ageing in Australia, a Stigma health and wellbeing of people living with epidemic for all. and Resilience Framework, an Audit of HIV in Australia incorporated this new 26 27 Ms Jules Kim been recognised as definitively linked to a Ms Melanie Walker AIVL renewed its call for a greater focus on Chief Executive Officer reduction in HIV risk and rates and critical Chief Executive Officer key prevention and harm reduction initiatives to removing barriers to health and safety for in the context of International Overdose Scarlet Alliance sex workers. And there has been positive Australian Injecting & Illicit Awareness Day on 31 August. AIVL is calling progress to support the need to fully Drug Users League (AIVL) for the implementation of widespread peer This year has been a significant year decriminalise sex work across the states distribution of the opioid overdose reversal of progress in Australia’s successful and territories of Australia, with active sex The Australian Injecting and Illicit Drug drug naloxone and enhanced resourcing for and sustained HIV response. There has worker led campaigns gaining momentum Users League (AIVL) is honoured to peer-based overdose prevention programs been a greater recognition of the need and supporters throughout Australia. provide a message of support ahead of across the country. In the context of rising to respond to the structural drivers of Decriminalisation of sex work is a technical World AIDS Day 2019. The theme of this rates of overdose, there needs to be an the epidemic. There has been a solid recommendation by the World Health year’s World AIDS Day is “Communities enhanced focus on the implementation focus on the need to address stigma and Organisation and UNAIDS, and recognised make the difference”. AIVL is the of evidence-based prevention and harm discrimination, and legal and human as crucial to public health and in facilitating national organisation representing reduction measures for all the different rights barriers to people’s health and a access to HIV prevention, treatment, people who use/have used illicit drugs communities we serve. continuing recognition of the centrality support and care. Decriminalisation of sex and is the peak body for the state In recent months, AIVL has also expressed of people with HIV and priority work is necessary for sex workers health, and territory peer-based drug user frustration at the revival of Australian populations as essential to positive safety and human rights and fortunately, organisations. It is a pleasure and Government plans to impose drug testing on outcomes in relation to prevention, around Australia, we are seeing a growing a privilege to provide a message of welfare recipients. AIVL continues to point treatment, education, support and care. awareness of this fact. support on behalf of the communities that AIVL represents. out there is no point identifying people with We are one year along in a robust set Sadly, sex workers continue to experience alcohol and other drug (AOD) problems if of National Strategies for 2018-2022, unacceptable levels of stigma and We come together again on 1 December to there is inadequate access to drug treatment developed with consultation and input from discrimination across all settings, including show our communities’ support for people services for those who need them. A recent all stakeholders. We have seen positive in healthcare. Despite Australia’s enabling living with HIV and to commemorate people review by the National Drug and Alcohol commitments from all governments to laws protecting against discrimination who have died of AIDS related conditions Research Centre found there is substantial meeting the ambitious, yet achievable for most priority populations, anti- or other conditions associated with HIV. unmet demand within the AOD treatment targets of the National HIV Strategy. discrimination protections for sex workers This time last year we saw the launch sector across Australia, with an estimated remain absent in most states and territories. of Australia’s new National Blood Borne 200,000-500,000 Australians each year Sex workers in Australia continue to The devastating impact of stigma and Viruses (BBV) and Sexually Transmissible unable to access treatment for problems maintain virtual elimination of HIV- a key discrimination on health outcomes is well Infections (STI) Strategies, including the associated with drug or alcohol use. achievement that is unique to Australia. documented. Evidence demonstrates the Eighth National HIV Strategy. AIVL is The important work of peer led programs In summary, in 2019, AIVL is excited by impact of stigma and discrimination on particularly grateful that custodial facilities and organisations have been critical to this some new developments in the domestic health, including mental health, access to have been included as priority settings success and must be maintained. There has context but emphasises that criminalisation, health care and barriers to services and for action moving forward. The focus on been a growing recognition of the need to stigma and discrimination continue to support. Now we must all act to address custodial settings in the new Strategies progress changes to the legal and human disproportionately affect the communities stigma and discrimination experienced by will not only enhance effectiveness of rights barriers to the health, safety and we serve and are issues that present an people with HIV and priority populations. interventions for this population but also rights for all Australians, regardless of ongoing challenge to our efforts going We must act to remove barriers to HIV strengthen the effectiveness of initiatives race, colour, gender, sexuality, BBV status, forward. In 2020, we look forward to being prevention, treatment, care and support to reduce the impact of all BBVs and STIs drug use, occupation, socio-economic able to welcome an enhanced focus on cost and to call on governments to protect and for the broader Australian community. The status, migration status, language, religion, effective prevention, treatment and harm promote the human rights of all people with emphasis on needle and syringe programs culture or geographic location, including reduction measures to meet the diverse HIV and priority populations. Our continued (NSP) in custodial settings is particularly custodial settings. Key to this for sex needs of all our affected communities. leadership in the HIV response depends significant. workers is the need to decriminalise sex upon it. work. Decriminalisation of sex work has 28 29 Ms Michelle Tobin The benefits of both PrEP and Treatment Mr Bill Bowtell AO In Australia, we have known for decades Chair as Prevention also need to be thoroughly Executive Director that proper information combined with easy promoted and communicated. Awareness availability of basic technologies – condoms, Anwernekenhe HIV Alliance (ANA) and availability of PrEP is nowhere near Pacific Friends of the Global Fund clean needles and testing – can greatly where it should be. Any Aboriginal or Torres reduce HIV infection in at-risk populations. Aboriginal and Torres Strait Islander Strait Islander person with a medium to The Global Fund to Fight AIDS, But in many countries, it remains difficult communities shoulder an ever larger high risk of HIV must be made aware of Tuberculosis and Malaria was established to overcome cultural and other barriers to share of Australian HIV transmission. this extraordinary new medicine and given in 2002 because millions of people in the implementing programs that can reach all In one of the world’s wealthiest nations, access to it. developing world who were suffering those who need help. this is intolerable. the ravages of HIV/AIDS, tuberculosis Similarly, we need a step change in testing. and malaria did not have access to the However, the arrival of PrEP – pre-exposure While the broader HIV prevention effort An estimated 20 per cent of Aboriginal and treatments they needed to stay alive. prophylaxis – that protects HIV-negative delivered Australia’s lowest rate of Torres Strait Islander HIV infections are people from infection is an immensely transmission since 2001, new transmission undiagnosed. This compares with only seven The name of the Fund indicated its objective significant development. among Aboriginal and Torres Strait Islander per cent in the non-indigenous community. and purpose – to FIGHT the challenges of people has now doubled since 2011. This is undoubtedly fueling our epidemic delivering treatments to those who had In the richer countries, including Australia, and every testing tool in our arsenal must be already been infected by the three diseases. the widespread introduction of PrEP The latest technology and medicine is deployed to firstly improve awareness of HIV has contributed to recent considerable simply not cascading into our communities. In the almost two decades since its founding, status, and then promptly move those who reductions in new HIV infection rates. We have a different epidemic, with greater the Global Fund, with the generous support are positive onto treatment. transmission through heterosexual sex and of many donors including Australia, has It’s now time for the well-proven benefits of injecting drug use than non-indigenous Critically important are the skills of the more than fulfilled the promise made by its PrEP to be delivered around the world. Australians. And while the non-indigenous Aboriginal and Torres Strait Islander founders. PrEP comes as a pill to be taken once a day. population experiences signs of declining HIV workforce. Despite best efforts and In HIV/AIDS, the Global Fund has provided the stigma, this is not the case in Aboiriginal and intentions, there is simply not enough It therefore offers a way to sidestep the funding and the management mechanisms Torres Strait Islander communities. investment. Areas such as primary and cultural and religious obstacles that in some to deliver effective HIV therapies and specialist care, management, surveillance societies react against traditional prevention These dynamics demand a vastly technologies rapidly and comprehensively and research suffer from a chronic shortfall measures. differentiated approach to HIV prevention to countries and populations throughout the of resources. Culturally appropriate training and treatment, buttressed by serious developing world. Two decades ago, we mobilised to meet the and skill development is an urgent priority. resourcing. moral imperative to deliver HIV treatments Consequently, the Global Fund has played a A wealthy, advanced nation such as Australia to all those with HIV. We need a tailored approach that begins with critical role in driving down the rates of new can and must do better in preventing and better awareness of HIV through culturally HIV infections and deaths from AIDS in every There is still a long way to go, but we have treating HIV among its Aboriginal and Torres appropriate, community-level communication. region of the globe, and especially in those made immense progress. Strait Islander people. By next World AIDS This must be particularly focused on women countries who have adopted inclusive policies Day, I hope to have better news to report. Now, the demand we must make of the and people who inject drugs. to those with or at risk of HIV infection. Global Fund and our governments is So, in broad terms, the FIGHT to better treat to gear-up to deliver PrEP – effective those already with HIV infections is slowly prevention – to all those at risk of being won. acquiring HIV. But increasingly we must redirect our energy It’s time to enlarge its mission and to and resources to PREVENT those most change the name of this great organisation at risk of acquiring HIV from ever being to the Global Fund to PREVENT AIDS, affected by this eminently avoidable disease. Tuberculosis and Malaria.

30 31 HIV Stigma in 2018

The Australian Government Department of Health blood borne virus and sexually transmissible infection strategies explicitly aim to “eliminate the negative impact In 2018, 22% of health workers surveyed (n=550) indicated that they would ever behave negatively of stigma, discrimination, and legal and human rights issues on people’s health”. towards someone because of their HIV. To monitor experiences of stigma among priority population groups, two survey phases Would you behave negatively towards other people because of their HIV?

were conducted (in 2016 and 2018) with people living with HIV, health care workers, 78 16 6 and men who have sex with men (MSM).

Twice as many (44%) reported that they had witnessed other health workers behaving negatively Just over half of < % indicating that it towards patients with HIV during the last 12 months. PLHIV surveyed 10 often or always occurred in 2018 reported In the last 12 months, have you witnessed any health workers behaving negatively towards 56% patients/clients because of their HIV? any stigma This is lower than the 74% of PLHIV who reported any stigma in 2016 56 20 19 4

In the last 12 months, have you experienced any stigma or discrimination in relation In 2018, 82% of MSM reported any stigma related to their sexual orientation, including 12% who to your HIV? indicated it ‘often’ or ‘always’ occurred. This was a larger proportion than the 65% of MSM who Phase 2 (n=729) 44 24 23 6 3 reported any stigma in 2016.

Phase 1 (n=181) 2 24 19 37 11 7 In the last 12 months, have you experienced any stigma or discrimination in relation to your sexual orientation? Phase 2 (n=1272) 18 33 36 12 2 In 2018, the proportion of PLHIV who reported any negative treatment from health workers (33%) was also lower than in 2016 (51%). Phase 1 (n=339) 2 33 28 28 8 Health workers treated me negatively or differently to other people Phase 2 (n=735) 5 62 14 13 3 2 Stigma related to HIV was also relevant to HIV-negative and untested MSM. Nearly three-quarters of non-HIV-positive participants (72%) reported feeling stigmatised by others assuming they are Phase 1 (n=181) 4 45 25 19 6 2 at risk of HIV, including 18% who ‘often’ or ‘always’ felt this was the case.

Do you ever feel stigmatised by other people assuming you are at risk of HIV? In 2018, 57% of PLHIV reported that people did not want to have sex or an intimate relationship with them, a similar proportion to 2016 (60%). The proportion who indicated that this was ‘often’ 28 27 28 12 6 or ‘always’ the case was lower in 2018 (19%) than in 2016 (29%). 0 20 40 60 80 100 People didn't want to have sex or an intimate relationship with me N/A Never Rarely Sometimes Often Always Phase 2 (n=734) 20 23 15 24 13 6

Phase 1 (n=180) 22 18 12 19 20 9 Source: Data from PLHIV in 2018 obtained from HIV Futures 9 (Australian Research Centre in Sex, Health and Society, La Trobe University) 0 20 40 60 80 100

N/A Never Rarely Sometimes Often Always

32 33 Mr Robert Griew The three-year program aims to end HIV President transmission and AIDS-related deaths in Bhutan, Lao PDR, Malaysia, Mongolia, Papua Australian Federation of New Guinea, the Philippines, Sri Lanka and AIDS Organisations Timor-Leste by 2030.

Australia is a world leader when it The challenge is to demonstrate to domestic comes to HIV prevention and care. funders the value in their community-led However, some of our nearest responses. neighbours in Asia and the Pacific are This is particularly challenging in countries experiencing expanding epidemics. where gay and bisexual men, injecting-drug users, and sex workers are marginalised and Across the region there are almost lack political clout. six million people living with HIV, yet one quarter of these people are unaware of their In many respects, SKPA reminds us that the status. fight against stigma, particularly to secure domestic investment in HIV programs, is Australia can, and should, play a significant now key to prevention and care. role in reducing the health and economic burden in the region. This would not only In Australia, despite HIV transmission rates improve the lives of hundreds of thousands at a near two decade low, stigma remains of people, but it would bolster our own a significant hurdle when it comes to health security and regional prosperity. prevention. In 2019, AFAO launched the consensus Further investment in focused public health statement by Australian organisations campaigns and improved training of the HIV working internationally in the HIV sector. workforce is vital. Among other things we called for a national strategy to guide Australia’s international We must continue to invest in the approach. community-led responses of those who carry the biggest burden of HIV, gay and We are committed to working with the bisexual men. They have recorded a Australian government to get the policy 30 per cent decline in transmission over settings right on an international approach. the past five years, but rising notifications among Asian gay men is concerning. We need to better target our current Credits investment in Asia and the Pacific, so our Similarly we must invest more in The Australian Federation of AIDS Organisations neighbours can avoid the middle income trap community-based intervention and (AFAO), National Association of People with HIV and sustainably fund HIV prevention. education for Aboriginal and Torres Strait Australia (NAPWHA) and Pacific Friends of the Islander HIV prevention and care. Global Fund thank all contributors to the World With funding from the Global Fund to Fight AIDS Day 2019 booklet. AIDS, Tuberculosis and Malaria, AFAO is Australia’s past investment in HIV is paying working on the Sustainability of HIV Services dividends. We can’t afford to lose that With special thanks to the Commonwealth for Key Populations in Asia Program (SKPA momentum. Department of Health and Mr Bill Bowtell AO. Program). Design and production: Biotext, Canberra, www.biotext.com.au 34 35 This publication and the World AIDS Day Parliamentary Breakfast has been generously sponsored by: