WORLD AIDS DAY 2020 1DECEMBER Adj Prof Chief Executive Officer Australian Federation of AIDS Organisations Darryl O’Donnell

So much that seemed certain AFAO and its members responded was upended this year by swiftly and effectively to these new COVID-19. Yet as we mark challenges, advocating for telehealth, secure medicine supplies and targeted World AIDS Day and remember campaigns. While many those lost to the HIV epidemic, mainstream services closed down the bonds of our community during the initial crisis our members response remain strong. stepped up, reminding us that at their heart, the DNA of our movement is our As a movement forged in an earlier responsiveness and accountability to health crisis, COVID-19 was a novel those we serve. yet familiar threat. It demanded new tactics and That grit also characterised the HIV response strategy, but drew from the same community to COVID in Asia and the Pacific. Many of the reservoir of solidarity, empathy and courage. communities hardest hit by HIV suffered the Policy makers and clinicians quickly relearned the double whammy of COVID, confronting delays in importance of community norms, such as social medicine supplies, disruption to counselling and distancing, mask usage and hand sanitising. outreach services and the decimation of service This echoed the way gay men, sex workers and and entertainment industries that employ so many people who use drugs adopted and safer members of our communities. injecting in the 1980s. Civil society organisations we work with in Other important principles came to the fore: the region tackled these issues head on. Their positive reinforcement is far more effective than advocacy kept HIV on the agenda with domestic shame when you are fighting a virus without a and international funding agencies. COVID was vaccine or cure. And bipartisan consensus is the the emergency of 2020, but successfully treating glue of a national response. and preventing it must not be at the expense of Yet while the lessons of HIV informed the progress against HIV. COVID-19 response, the pandemic also disrupted No year is ever dull or straightforward in our progress against HIV. We grappled with complex community-led response, but this one was issues such as sexual practice at a time when especially unpredictable and challenging. I am COVID-19 made most things unsafe. We also hopeful 2021 will bring new opportunities to stride saw the rapid transition of HIV services to online forward in our mission. delivery and the redeployment of staff in public clinics to COVID-19.

2 Contents

Adj Prof Darryl O’Donnell | AFAO 2 Tim Wilson MP and Senator Louise Pratt 4 HIV globally in 2019 5 Senator the Hon 6 The Hon Greg Hunt MP 7 Senator the Hon and the Hon Chris Bowen MP 8 Adam Bandt MP and Senator 9 Eamonn Murphy | UNAIDS 10 Peter Sands | Global Fund 11 Supporting communities in Sri Lanka 12 Tania Rishniw | Department of Health 13 The Hon Michael Kirby AC CMG 14 Professor Sharon Lewin | Doherty Institute 15 Professor Anthony Kelleher | Kirby Institute 16 Coordination Professor Carla Treloar | CSRH 17 Michael Badorrek Professor Brendan Crabb AC | Burnet Institute 18 HIV stigma in 2020 19 Design & Production Alexis Apostolellis | ASHM 20 Biotext Professor Suzanne Fraser | ARCSHS 21 Scott Harlum | NAPWHA 22 Credits The World AIDS Day Jules Kim | Scarlet Alliance 23 booklet is developed by the Melanie Walker | AIVL 24 Australian Federation of Michelle Tobin | ANA 25 AIDS Organisations (AFAO) Novel approaches drive progress in the Philippines 26 through a grant from the Commonwealth Department HIV in Australia in 2019 28 of Health We also Felicity Young | AFAO 30 acknowledge the support of the Pacific Friends of . The booklet is part of the World AIDS Day Parliamentary Breakfast, which was initiated in 2010. AFAO recognises : Ma Nilar lives with his wife and daughter in rural Myanmar. Ma and his wife are Cover the leadership of Mr Bill HIV-positive and receive antiretroviral treatment with support from a peer outreach worker, who visits them at their farm in Shan State. Ma’s wife received treatment to Bowtell AO in conceiving protect her baby from HIV during her pregnancy. (John Rae/Global Fund) this event. 3 Tim Wilson MP and Chair and Deputy Chair Parliamentary Friends for Action on HIV/AIDS, Blood Borne Senator Louise Pratt Viruses and Sexually Transmitted Infections

2020 is a year that has New treatments continue to become reminded us of the risks of available which reduce the risks of health pandemics, and the side effects. Additionally, research has opened the possibility for people living need to tackle them head with HIV to move from daily pill-based on. COVID-19 may have regimens to injectable alternatives with taken priority in the public month-long lifespans. consciousness, but it should But our work is far from complete. The not deter us from our efforts to rising rates of transmission amongst tackle other viruses which pose Aboriginal and Torres Strait Islander serious health risks around the Australians and amongst culturally and linguistically diverse communities world. is a reminder that we need targeted As the UNAIDS 2020 Report Seizing education campaigns. We also have the Moment outlined, while progress the challenge of helping international has been made internationally, that students and other Medicare ineligible progress has not been even, and residents access treatment and be part the COVID-19 pandemic could delay of the solution of reducing transmission. progress to meet international targets Australia can meet this challenge. We by up to a decade. have a proud history of bipartisan World AIDS Day 2020 is an opportunity to refocus cooperation on HIV/AIDS, and have led the world our work alongside the risks of COVID-19. Each in transmission control and access to treatments. year new scientific advances and treatments We have strong community groups that coordinate become available to compound on the learning with health bodies and government for efficacy. and legacy of reducing transmissions, helping But we must also continue to confront the stigma improve the freedom of those living with HIV/AIDS many still face. All Australians are entitled to live in Australia and around the world. full and happy lives. We sit on the cusp of a new age of containing As parliamentarians we have a critical role to and treating HIV transmission. Prevention is play in terms of leading the national discussion, essential. With home testing kits supported by promoting community education and advocating community education campaigns we can reduce for effective strategies to improve the health and transmission rates further. The long-term wellbeing of all Australians. trend is declining thanks to these The purpose of the Parliamentary Friends developments, alongside the listing of for Action on HIV/AIDS, Blood Borne Viruses pre-exposure prophylaxis (PrEP) on the and Sexually Transmitted Infections is to be Pharmaceutical Benefits Scheme (PBS).

4 a strong and bipartisan advocacy group for together so that Australia can continue to be parliamentarians, the health community and a world leader in controlling and reducing those living with these conditions to educate and transmission rates, supporting those living with work together to inform policy based on science HIV and to look with optimism about what we can and efficacy. achieve in years to come together. On World AIDS day we pay respect to the work that has been done, and recommit to working

HIV globally in 2019

38 million 36.2 million adults People living with HIV 1.8 million children

25.4 million This is 67% of all People with HIV were accessing antiretroviral therapy people living with HIV

This is a 40% reduction 1.7 million from the peak People were newly diagnosed with HIV (2.8 million) in 1998

5 Department of Foreign Affairs and Trade

Minister for Foreign Affairs Senator the Hon Minister for Women Marise Payne

The COVID-19 pandemic has has reported that 84 per cent of their had a catastrophic impact HIV programming has experienced on global health security and disruption as a result of COVID-19. threatens hard-won progress The COVID-19 pandemic has also highlighted the leadership and against HIV/AIDS. This commitment of communities in the World AIDS Day provides an HIV response. These communities have opportunity to take stock of moved swiftly to respond to COVID-19, the achievements in the global including by using their knowledge and fight against HIV/AIDS and the experience to work towards ensuring gains that must be protected if we are to that those living with and vulnerable to HIV have the necessary information and services to protect end the HIV epidemic by 2030. themselves from these colliding health crises. Since the start of the HIV/AIDS epidemic, over Like COVID-19, the HIV epidemic is a shared crisis, 75 million people have become infected with and we must meet both challenges through global HIV, and 32.7 million people have died from cooperation. Australia is committed to continuing AIDS-related illnesses (UNAIDS). The global our strong leadership both domestically and on fight against HIV/AIDS is a story of compassion, the global stage, engaging with our longstanding resilience, solidarity and respect. Significant partner UNAIDS in developing the next global progress has been made. Recent UNAIDS data strategy to combat HIV/AIDS. shows that AIDS-related deaths have reduced In our region, new infections are concentrated in by 60% since the peak in 2004, and at the end of key populations and their partners. Australia is 2019 of the 38 million people living with HIV over working with long-standing partners, including 25 million were accessing antiretroviral therapy. the Global Fund and UNAIDS, to invest in HIV However, we must remain vigilant. This progress prevention in the Indo-Pacific. The Australian is threatened by the COVID-19 pandemic, with Government’s increased investment in HIV a compounding impact on the world’s most prevention will support the work of our partners in vulnerable, including those women and men, girls protecting the most vulnerable. and boys living with HIV. Globally, the COVID-19 We will not be able to move forward in the fight pandemic exacerbated the gender inequalities against HIV/AIDS unless we work together to and conditions for increased gender-based stop the reversal of decades of progress due to violence. We know the links between COVID-19. Despite these challenges, Australia gender-based violence and increased remains steadfast in our commitment to risk of HIV exposure and reduced eliminate HIV. access to treatments. The Global Fund to Fight AIDS, and Malaria

6 The Hon Greg Hunt MP Minister for Health Minister Assisting the Prime Minister for the Public Service and Cabinet

World AIDS Day 2020 is an peoples or people acquiring HIV opportunity to reflect on our through heterosexual sex. achievements and acknowledge We have to capitalise on the progress that we still have work to do. we have made if we are committed to eliminating the transmission of HIV in 2020 has been a difficult year, Australia. Our next steps will require with the COVID-19 global innovative solutions to engage with pandemic dominating our hard to reach populations. Any new time and attention, but the measures we take must be culturally importance of World AIDS Day appropriate and sensitive, as we is as strong as ever. So, appropriately, are dealing with some of the most vulnerable populations in our society. This may also mean Australia’s theme for World AIDS Day in we have to address the hard issues, and plan and 2020 is ‘Now more than ever’. implement services aimed at populations who find Australia continues to be a world leader in the it diffcult to interact with our health care system, response to HIV, with the overall proportion of such as those living in Australia who do not have people in Australia who have HIV lower than access to Medicare. The challenges are numerous, other comparable high-income countries and but not insurmountable. other countries in our region. We are very close to The commitment of community organisations, meeting the UNAIDS 90-90-90 targets, and we are researchers, clinicians, governments and people also tracking well towards achieving the UNAIDS living with, or, affected by HIV will be paramount 95-95-95 targets. as we face these final challenges. We have a The virtual elimination of HIV is within our reach. strong history of working together of which we The number of new HIV diagnoses is progressively should be proud, and I have no doubt we will declining and is the lowest in nearly 20 years. continue to do so in the years to come. More people are getting tested than ever recorded On this important day, we must pledge to continue and as a result they are receiving treatment earlier, to work collaboratively and with compassion. We which in turn has reduced the transmission rate must honour the lives lost to HIV by continuing to significantly. work towards eliminating HIV in Australia. However, challenges remain. We are not seeing Once this would have seemed impossible, but we corresponding decreases in HIV notifications have come a long way and our hope for the future among Aboriginal and Torres Strait Islander is stronger than ever.

7 Senator the Hon Penny Wong Shadow Minister for Foreign Affairs and the Hon Chris Bowen MP Shadow Minister for Health

World AIDS Day Australia 2020: that of our Australian born non- Much to celebrate, but a long Indigenous population. And while just way to go for our First Nations about every other indicator points to improvements towards eliminating HIV, Peoples, and our Pacific the diagnosis rates among Aboriginal neighbours. and Torres Strait Islander people are on the rise. As we come together on World AIDS Day, in the shadow of a global To reverse this trajectory, communities pandemic, we are reminded again of must be empowered to lead. the importance of collaboration and In our region, the global pandemic shared purpose in meeting our health has underscored the importance challenges. of Australia improving its efforts Australian governments have a shared to assist our Pacific neighbours in goal - to eliminate HIV transmission in making meaningful progress toward Australia by 2022. eliminating transmission. Though we will miss the previous With almost six million people 2020 target, the good news is we living with HIV in the Asia-Pacific are on our way to meeting the 2022 region and COVID-19 threatening target, having gone from 1,084 HIV access to essential health services notifications in 2014 to 833 in 2018. and infrastructure – the health and prosperity of our region is at risk. But we must do more. Bringing that down to zero is going to take concerted and sustained effort. This World AIDS Day, let’s reaffirm our commitment to doing all we can to ease the We must focus that effort among our First Nations burdens of HIV not only in Australia, but across Peoples, where we have seen diagnosis rates go our region, and in doing so - improve the lives of backwards. The rate of HIV diagnosis amongst hundreds of thousands of people. Aboriginal and Torres Strait Islanders is double

8 Adam Bandt MP and Leader of the Australian Greens Spokesperson for Family and Community Services, Senator Rachel Siewert Ageing, First Nations Peoples’ Issues and Mental Health

This World AIDS Day, we We support the development and should be just two years away implementation of a sustainable model from the virtual elimination of of access to HIV treatment and PrEP for people in this situation. HIV transmission in Australia, Australia must also play its part according to one of the key globally in eradicating HIV/AIDS. In goals of our National HIV the Asia-Pacific, we have an important Strategy. We’ve already role in providing support and funding missed that target once, to regional responses to HIV. Both having originally planned to regionally and internationally, our eliminate HIV transmission by contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria this year. To make sure we are is critical. While we welcome the successful by 2022, we need Australian Government’s continued concerted, ongoing action and commitment to the Global Fund with a sufficient investment into a $242 million pledge to the Fund’s Sixth strong community partnership Replenishment covering 2020-22, the Greens had called for a greater funding approach. commitment of $300 million, alongside A critical component of our work must a significantly increased aid and be a continued focus domestically on hard-to- development budget from the lowest ever levels. reach populations. In recent years, First Nations Australia must also play a leading role in the 2021 Australians have experienced a significant increase United Nations General Assembly’s High-Level in diagnosis rates, while newly diagnosed rates Meeting on HIV and AIDS, including support for among Australian-born non-Indigenous people participation by people living with HIV/AIDS and fell. We must do better and close this health civil society in the meeting, and the negotiation gap, directing adequate funding to First Nations of an updated UN Declaration of Commitment to community responses focusing on prevention ending HIV. and treatment. This includes funding support We want to take this opportunity to again to develop evidence-informed and long-term congratulate and acknowledge the tireless work community-led campaigns to reduce the incidence of the Australian Federation of AIDS Organisations of STIs in First Nations communities. (AFAO), the Pacific Friends of Global More broadly, we must continue to reduce barriers Health and the National Association of to access to HIV prevention and treatment. For People with HIV Australia (NAPWHA), example, those who are ineligible for Medicare and other partner organisations who face a wide range of challenges to accessing carry on this fight year round. healthcare in Australia to prevent and treat HIV. 9 Eamonn Murphy Regional Director UNAIDS Asia-Pacific

While Asia and the Pacific approaches are key to ending the boast some of the earliest colliding pandemics of HIV and successes of the HIV response, COVID-19. we are not doing enough to This crisis has also been a wake-up call, an opportunity to do things prevent new HIV infections. differently—better, and together. In Some countries are making many respects, the defeat of AIDS as impressive gains. But, in a public health threat depends on how others, there are still worrying the world responds also to COVID-19. increases in new HIV infections. Governments, donors, civil society and It is unacceptable that, in this region, 10 each and every one of us need to contribute to making the world a healthier place. young people become infected with HIV every hour. Now more than ever Australia’s bold leadership in the HIV response is showing the world what In 2020, the world’s attention has been focused it means to work together, in solidarity and to by the COVID-19 pandemic on health and how support those who are left behind. Australia pandemics affect lives and livelihoods. COVID-19 continues to set the global standard for an is showing once again how health is interlinked effective, innovative and inclusive national with other critical issues, such as inequality, response to HIV, backed by a strong partnership human rights, gender equality, social protection between government, clinicians, researchers and and economic growth. With this in mind, the communities. Australia has been at the forefront theme of World AIDS Day 2020 is “Global of harnessing the potential of emerging evidence solidarity, shared responsibility”. and technologies, including PrEP. Australia’s COVID-19 has demonstrated that, during a investments in the HIV response in the Asia Pacific pandemic, no one is safe until everyone is safe. region also address some of the most critical gaps Leaving people behind is not an option if we are in the HIV response due to complex and multiple to succeed. Eliminating stigma and discrimination, factors that are barriers to achieving the Fast Track putting people at the centre and grounding our targets. In particular Australia provides support in responses in human rights and gender-responsive areas of new prevention technologies from moving pilots to impactful scale up.

10 Peter Sands Executive Director Global Fund to Fight AIDS, Tuberculosis and Malaria

On World AIDS Day, we could lead to more than 500,000 extra commemorate the people deaths from AIDS-related illnesses in we have lost since the HIV sub-Saharan Africa in 2020–2021. We cannot let this happen. epidemic began, while The Global Fund responded quickly to recommitting to the ambitious the crisis, making up to US$1 billion yet achievable goal of ending available to help countries fight the virus as a serious public COVID-19, adapt life-saving HIV, TB health threat. and malaria programs and reinforce systems for health. Approximately Since 2002, the Global Fund US$130 million had been approved (as of partnership has saved 38 million lives. In 8 October 2020) for countries in the Asia Pacific countries where the Global Fund invests, AIDS- region that are an interest to Australia to respond related deaths have been reduced by 61% and to COVID-19. The Global Fund is also a founding new infections have been reduced by 41%. In partner of the ACT-Accelerator, the world’s largest 2019, Global Fund investments supported 20.1 to develop and equitably distribute million people to access antiretroviral therapy. COVID-19 tests, treatments, and vaccines. Among that number were 718,000 mothers who received lifesaving medicine that also prevented We must recognise that this is not just a fight transmission of HIV to their babies. We also saw a against one virus, but a commitment to finish the massive expansion of HIV self-testing, a powerful unfinished fights against HIV, TB and malaria, tool in breaking down the barrier to people strengthen our defenses against future pathogens, knowing their HIV status. and build better health systems to advance global health security. However, our progress against HIV has never been more delicately poised. The COVID-19 pandemic The Global Fund is grateful for Australia’s pledge poses new challenges to our collective mission. to the ACT-Accelerator and honored to have As lockdowns and other restrictions took hold, Australia as a partner as we defend the gains of HIV testing dropped by 50% in some places. the past two decades and recommit to making Additionally, prevention and treatment programs further progress against HIV and other diseases got disrupted. Recent studies have predicted that that continue to kill millions every year. a six-month disruption of antiretroviral therapy

11 Supporting communities in Sri Lanka

Since the middle of March there have Many of these people are daily wage earners been strict COVID measures in place in with no source of income during this time. They Sri Lanka with partial lockdown in 19 have little, if anything, in savings and sometimes minimal literacy skills. Many do not have bank districts and full lockdown in up to eight accounts or National Insurance cards meaning they districts. Only one family member is are not eligible for government aid. permitted to leave the home for essential Community based organisations have found that supplies once a day. many people are scared to ask for support, having been stigmatised and often criminalised in the past. HIV services have been heavily impacted with the only service continuing to function being With lockdown, these marginalised groups face antiretroviral medicine provision and a one to two- increasing difficulty in accessing support. This is hour STI clinic per week. partly due to the requirement of a curfew pass which entails reason for exit. Those working in the HIV response have worked to facilitate aid and provide support to community In response, HIV collectives have set up members most at risk of HIV as well as those living emergency funds allowing the general public to with HIV, who are increasingly vulnerable. donate funds which are then directly transferred to those identified via their trusted networks as being in need.

AFAO’s Sustainability of HIV Services for Key Populations in Asia Program (SKPA Program) with representatives from local community organisations in Sri Lanka. (AFAO) 12 Tania Rishniw Deputy Secretary Department of Health

World AIDS Day is an important people living with HIV had received occasion which allows us to a diagnosis, 96% people who had remember those who have lost received a diagnosis were in care with 89% receiving antiretroviral therapy their lives to HIV and reflect on (ART), and of the people receiving ART, our progress in responding to 95% had achieved a suppressed viral HIV in Australia. load. Being on the cusp of achieving this goal is significant, and places Australia’s achievements in reducing Australia as a world leader in the HIV transmission are the result of response to HIV. significant efforts over almost 40 years. This work is currently being guided by We can also see where we need to direct future the Eighth National HIV Strategy 2018-22, which efforts to maintain our momentum – particularly sets out the direction for Australia’s continuing actions to address the challenges faced by priority response to HIV, with ambitious targets and goals populations. Aboriginal and Torres Strait Islander steering our actions. The Blood Borne Viruses people continue to carry a disproportionate and Sexually Transmissible Infections Standing burden of new HIV notifications. Committee of the Australian Health Protection As we progress through the remaining life of Principal Committee, with membership from all the Strategy, we have to reconcile our successes Australian governments and relevant national with the challenges ahead. We have a strong community bodies, is charged with implementing foundation to build future activities upon, and these actions and I commend the work it is doing clear indications on where our efforts should be to progress the Strategy’s goals by 2022. directed. At this halfway point, we can see our sustained This year’s theme for World AIDS Day is ‘Now efforts to reduce HIV transmission, improve more than ever’ – this is especially relevant with treatment rates and reduce the personal and COVID-19 impacting on all of our lives. It is a social impacts of HIV are having positive impacts. time for us to recommit to our determination Australia is close to achieving the UNAIDS 90- to eliminate HIV transmission in Australia and 90-90 targets. Recent data shows that 90% of provide support to those people living with HIV.

13 Jurist, academic, HIV advocate and former Justice of The Hon Michael Kirby the High Court of Australia AC CMG

I participated with the World • Politicians must become informed Health Organisation at the and explain why unpopular beginning of the HIV epidemic initiatives are often essential; in 1988. The best scientists • Successful strategies oblige us to adopt generous aid policies and predicted a cure and a vaccine mutual support for countries less within 20 years maximum. fortunate than our own; and Still we are waiting, although • The voices of patients and their antiretroviral therapy appeared families are vital. Those voices must in the mid-1990s to save lives heard throughout the pandemic. and render those infected with HIV In the struggle against HIV, Australia and New incapable of transmitting the virus to Zealand led the world with sound policies, others. Viruses, we learned, are very established across party lines. We conformed, tricky targets. virtually before all others, to the foregoing lessons. We stayed the course against occasional In 2020, much of the world’s attention has shifted noisy opposition. We saved lives. We helped from HIV to COVID-19. But there are vital lessons neighbours to do likewise. We cooperated with to be learned from the earlier pandemic: the UN and supported the Global Fund. We • The foundation for policy on viruses must be maintained these efforts despite the new and good science, not politics, religion, guess work added demands of COVID-19. or prejudice; With COVID-19 we have largely shown the same • Respecting the human rights of those infected leadership and example. As Winnie Byanyima, is critical to successful national and global Executive Director of UNAIDS, said in August strategies; 2020, “Human rights are not only intrinsic, • Vulnerable groups face special prejudice and but they are also the very means by which dangers in pandemics; governments can successfully beat a pandemic”. • It is essential to mobilise global cooperation This was true of HIV in 1988. It is true of COVID-19 and to support WHO and the UN. Pandemics in 2020. An unexpected new target has emerged. cannot be treated as national problems alone; The focus must remain the same. AIDS is not over. COVID-19 has just begun.

14 Professor Sharon Lewin Director The Peter Doherty Institute for Infection and Immunity

Every World AIDS Day, I take combat a new virus. I see my fellow the opportunity to reflect scientists bring advances from HIV on the last 12 months, as a – such as point of care testing, new vaccines and antibodies – to COVID-19. scientist, a clinician and as an I am hopeful that some of the scientific individual. I pay my respects advances we will achieve through to those whom we have lost to tackling COVID-19 will accelerate our HIV and their families, loved search for a cure and a vaccine for ones and communities. In 2020, HIV. However, I am worried about the long-term effects of the pandemic on more so than any other year, the HIV sector. I worry about social we have been reminded of the great isolation for many people living with HIV. I worry success story of the HIV response and that scarce resources will be diverted from HIV what can be achieved with the right mix to deal with COVID. As a community, we need to of science, leadership and community. ensure that both pandemics remain high priorities nationally and globally. I must start by acknowledging Timothy Brown, In Australia, we continue to see a reduction in new the first person to be cured of HIV. Timothy’s HIV infections but not in all communities. Access death from a recurrence of his leukemia this year to treatment remains one of the highest in the was incredibly sad and a great loss. His personal world but we need to ensure that every person commitment to research and his community will living with HIV is provided with the best available be missed. He taught us that a cure for HIV is antivirals and the best care, which includes active possible and we need to keep working to make it a prevention of co-morbidities. We need to ensure reality for everyone. that all people live well with HIV, both throughout In these turbulent times of COVID-19, I remain and beyond the COVID-19 pandemic. proud to be part of the HIV sector, to apply the skills and experience of the past 30 years to

15 Professor Director Kirby Institute Anthony Kelleher

World AIDS Day 2020 is Our state-of-the-art laboratories have occurring in a time like no other been dedicated to investigating HIV in living memory. Amid the for three decades. We continue our work to find optimal treatments, and global COVID-19 pandemic, we hopefully a vaccine and cure for HIV. have witnessed great tragedy, But it has been testament to our highly but we also have great cause skilled laboratory scientists how nimbly for hope. and ably they have adopted new knowledge and practices to adapt to The mortality and morbidity rates for COVID-19. COVID-19 are astounding. But those This World AIDS Day is also an opportunity to of us who have been involved in the fight against reflect on how far we have come in the fight HIV/AIDS over the past three decades know all too against HIV/AIDS. There have been many lessons well the blight of an epidemic health crisis on our learned throughout the HIV/AIDS epidemic that communities. we have been able to deploy this year. Australia Since HIV/AIDS emerged in the 1980s, teams has done a remarkable job, as it did for HIV/AIDS of researchers, clinicians, governments and though the 1980s and 1990s; acting quickly and communities have worked together to establish responsibly across multiple sectors, to contain extensive global networks to better understand COVID-19 and mitigate the burden of disease on HIV/AIDS from all angles, and work towards our population. What we have seen, too, is our treatments, where astounding and transformative communities come together, to do what has been advances have been made. However a vaccine necessary to protect each other’s health. and a cure remain elusive. This year, these global HIV/AIDS remains a significant global health networks and collaborations have enabled us to challenge, and the disruption and dislocation quickly mobilise resources against COVID-19. of COVID-19 has made that challenge greater. For example, through our largest clinical trials We must continue to come together, utilise our network trialling a second-line HIV treatment, substantial and skilled workforce to maintain our spanning 14 countries across the Americas, Asia hard won gains, and forge ahead in our quest to and Africa, our researchers have been able to find a vaccine and a cure, as we adapt to living quickly establish a cohort study to determine the with yet another new virus. impact of COVID-19 on people living with HIV in low- and middle-income countries.

16 Professor Carla Treloar Director Centre for Social Research in Health UNSW

In the most exceptional year treatment as prevention (TasP). If we of 2020, it is very easy to be consider all forms of safe sex, the level distracted from usual business. of net prevention coverage during casual sex has increased from 69% in But it is at these moments 2015 to 75% in 2019. We believe this that we need to keep an ever is one of the main reasons that HIV vigilant watch on progress infections among gay and bisexual men towards the UN goals of have declined in Australia in the last 90-90-90 by 2020 as well as few years. becoming more and more Trends in some indicators however sophisticated in understanding where suggest that there are ongoing risks of potential HIV transmission and acquisition, among those and how progress could be better. who have never been tested for HIV or STI, Our Gay Community Periodic Surveys (GCPS) or those who are not fully aware of the latest have collected data since 1996 on the sexual prevention and treatment options, pointing to practices, risk and engagement in prevention and areas in which prevention responses could be care by gay and bisexual men. The GCPS data strengthened. We also know that community- as a whole suggest that among sexually active based HIV testing services were particularly and community-engaged gay and bisexual men, good at attracting younger and Asian-born men, the attainment of the 90-90-90 target has been who are of particular interest for HIV prevention achieved. However, reaching and sustaining the programs as the HIV epidemic diversifies in higher 95-95-95 target will require additional Australia. effort and tackling barriers to diagnosis and The 90-90-90 targets (or indeed 95-95-95 targets) treatment such as Medicare ineligibility, engaging do not refer to the experience of living with HIV overseas-born men and those not connected or the social conditions that impact quality of to sexual health services or gay community life. Our focus on the Australian national strategy networks. goal of reducing the negative impacts of stigma, During the last decade, especially the last three human rights and legal issues must continue to years, gay and bisexual men have increasingly be of highest priority and to be explored across adopted HIV biomedical prevention strategies, the diverse and intersecting populations of people particularly pre-exposure prophylaxis (PrEP) and living with HIV.

17 Professor Brendan Crabb AC Director and Chief Executive Officer Burnet Institute Chair and President Advisory Board Pacific Friends of Global Health

Globally, the COVID-19 Burnet Institute has been proactively pandemic is exacerbating social contributing to the COVID-19 response and economic inequalities, and in Australia through public health and laboratory-based research and threatens to derail decades of advocacy, implementing new initiatives hard-fought efforts to control and leveraging existing research other pandemics such as HIV. infrastructure. Burnet’s world-class This new public health threat sentinel surveillance system, ACCESS, has left people living with and is now rolled out across each state and territory and is being used to most at risk of HIV facing new monitor HIV-related outcomes during barriers to accessing adequate harm the pandemic. ACCESS data indicates COVID-19- reduction and prevention methodologies, related social restrictions have had a considerable HIV testing and treatment. impact on HIV testing and PrEP use in Australia. Ensuring an adequate and timely recovery in HIV While the COVID-19 pandemic will require a testing and uptake of preventative therapies to global, coordinated public health response of pre-COVID levels among priority populations unprecedented scale and cost, it is imperative that will require a concerted effort. We have the we are determined to maintain momentum in our opportunity to take advantage of new health goal of achieving HIV elimination. systems innovations, including strengthening of Great strides towards HIV elimination have been our contact tracing and moving to decentralised made in Australia and neighbouring countries models of care and surveillance, which can all be over the past decade. The Asia Pacific region has harnessed in our ongoing efforts to eliminate HIV. achieved a 12% decline in new infections since Just as the COVID-19 pandemic threatens to 2010. However, significant gaps remain, and the hinder our progress towards HIV elimination, the COVID-19 pandemic threatens to widen these lessons we have learned from addressing HIV can gaps. UNAIDS has reported significant, sustained be used to guide our response to COVID-19 both declines in HIV testing since January in almost all locally and globally. As we move to maintaining countries with available data, including countries a suppressed level of community viraemia for in our region. Although the impact on HIV COVID-19, and keep up the effort to do the same treatment access seems to be less severe, declines for HIV, governments must ensure community in testing will have consequences for timely engagement is central to decision making for both diagnosis and ongoing HIV transmission. pandemics.

18 HIV stigma in 2020

In 2020, a national survey of men who have sex with men found that 21% of participants reported feeling stigmatised within the past year by other people assuming they had HIV.

Number of participants: 973

79 13 7 2

0 20 40 60 80 100 Percentage

Never Rarely Sometimes Often/always Note: Total does not add up to 100% due to rounding

In 2020, a national survey of the Australian public found that 30% of participants reported that they would behave negatively towards people living with HIV.

Number of participants: 2,010

70 18 7 3 2

0 20 40 60 80 100 Percentage Never Rarely Sometimes Often Always

Source: Centre for Social Research in Health, UNSW Sydney

19 Alexis Apostolellis Chief Executive Officer Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM)

At the end of this long year, ASHM’s regional advisory group it is impossible to talk about became the taskforce’s arm to reach World AIDS Day without out to our neighbours in Asia and the Pacific with education, resources and acknowledging the impact of other support for people delivering the COVID-19 pandemic on the HIV, viral hepatitis and sexual health HIV response in our region. As services. Made up of 70 clinical, profoundly as HIV in Australia community and research members has been shaped by COVID-19, from ten countries across Asia and the Pacific, the regional advisory group has the pandemic has exacerbated sought to fill a critical gap in educating many of the already complex challenges the HIV workforce during the pandemic. faced by our colleagues in the HIV Driven by our colleagues on the ground in workforce around Asia and the Pacific. countries including Papua New Guinea, Timor Healthcare workers in the region face difficulties Leste and the Philippines, the group has helped getting HIV medicines to patients during lockdown health workers across the region share information conditions, insufficient access to personal and develop innovative ways of responding to HIV protective equipment and even a lack of basic in this new environment. access to information about COVID-19. But as the COVID-19 pandemic worsens globally Just one example: a doctor we work with in and cases continue to rise within the region, there Timor Leste told us that when the pandemic is still so much work to be done. While the region’s began, many fled the city to escape the virus. But HIV workforce operates with limited resources without transport infrastructure in much of the and under increasingly challenging conditions, country, this has made it even extremely difficult without further action we risk losing the hard- for HIV health workers to get vital medicines to fought progress we have made over decades of their patients. Australia’s regional support. When ASHM established its taskforce on blood- As 2020 ends and the COVID-19 pandemic borne viruses, sexual health and COVID-19 in continues, this World AIDS Day is an opportunity March, we knew that finding ways to support the to reflect on what we have learned over these HIV workforce beyond Australia and throughout decades of Australia’s work in the region, and the region would need to be a critical part of how we can take those lessons into this new and that work. uncertain future.

20 Professor Suzanne Fraser Director Australian Research Centre in Sex, Health and Society, La Trobe University

La Trobe University Australia to significantly affect quality of life. has long been a world Concern for the wellbeing of people leader in responding to HIV. living with HIV is about an ethic of care and responsibility – recognising that Lessons from the Australian support must remain core to Australia’s HIV response have particular HIV response. resonance in 2020 as we deal Among its goals, the National HIV with the COVID-19 pandemic. Strategy aims to see 75% of people Community engagement, living with HIV reporting good quality community support, and of life by 2022. Largely through our broader wellbeing – including mental HIV Futures Study and the PozQol (quality of life) measure, ARCSHS monitors progress toward this health and social connection – are key goal. Our research explores the elements that help to managing any infectious disease improve quality of life for people living with HIV in effectively and respectfully. This Australia. For example, we know that connection understanding is reflected in the Eighth to community and knowing other people living National HIV Strategy which includes in with HIV are associated with better wellbeing and lower perceived stigma. This points to the its targets a concern for improving quality potential benefits of investment in peer-based of life among people living with HIV. programs and services such as peer navigator Advances in the biomedical treatment of HIV initiatives that enable people who are newly have driven major changes in prevention and diagnosed with HIV to connect with other people treatnent. Encouraging earlier and sustained use living with HIV. of antiretroviral treatment (ART) by people living On World AIDS Day 2020, ARCSHS joins people with HIV is now seen as central to eliminating living with HIV, and our community, government HIV transmission in Australia and internationally. and research partners, in affirming the importance ART allows people living with HIV to achieve a life of quality of life and wellbeing for people living expectancy equal to that of anyone else. However, with HIV in all their diversity. In this we are this does not also ensure their mental health is committed both to the value and dignity of the well supported. Nor does it address the negative lives of the individuals and communities directly impact of HIV-related stigma, something known affected, and to ending the HIV epidemic for all.

21 Scott Harlum President National Association of People with HIV Australia (NAPWHA)

For World AIDS Day 2020 And we can do better to expand our I’d like to acknowledge the minds and in doing so expand our community of people living services as well. with HIV in Australia, and But this World AIDS Day I also want to acknowledge that we can do better the strength and diversity to engage and listen, on your terms. of that community, which We can do better by involving you, the has supported us for near- very people we want to reach, in the on 40 years, binds and development of and protects us again as we face health interventions. the uncertainty and fear of a second We can do better by valuing peers, and by pandemic in our lifetime. having peers working within our communities in clinics, in support services, in NGOs and in Aboriginal, Torres Strait Islander or Anglo government services. We can do better by valuing Australian; born overseas, from Africa, South peers translating, supporting, empathising, and America, South East Asia; a man, woman, trans informing us – in the HIV sector – of what is or non-binary; gay, straight, lesbian or bisexual; needed to improve your health. And we can do a person who uses drugs; in a custodial setting; better with clearer pathways for the exchange a sex worker; a long-term survivor or newly of information, and by being open to listen and diagnosed; adolescent, young, middle-aged or quicker to act. older… your face changes, but not the richness On World AIDS Day 2020 I acknowledge the power of experience and the opportunities to listen and of my peers and I challenge us all to harness the learn which come from being your peer. diversity of our communities to improve our future We know that the people who are more likely to response to HIV. test late, less likely to treat and more often lost to follow-up come from ‘unconnected’ communities.

22 Jules Kim Chief Executive Officer Scarlet Alliance, Australian Sex Workers Association

Sex workers in Australia in the National HIV, Hepatitis and STI continue to maintain low Strategies. The findings of this research prevalence of HIV sustained will inform critical stigma reduction interventions for sex workers and through ongoing investment will provide an important baseline to in health promotion and provide an annual measure of their prevention efforts of impact on the experience of stigma by peer based sex worker sex workers. organisations. In longstanding, Another key barrier are the regulatory effective partnerships with and legal issues that sex workers government, researchers, community face such as criminalisation, licensing, forced registration and mandatory testing in some and the health sector, the leadership of jurisdictions. The varied regulatory framework sex workers and their organisations has in each state and territory that sex workers are ensured that prevalence of HIV among subject to impede our access to prevention, Australian sex workers has remained treatment, testing and health services, reduce among the lowest in the world. our ability to implement workplace health and safety strategies and increase our risks to BBV and Unfortunately stigma and discrimination against STI. There is strong evidence to support that the sex workers remains unacceptably high, creating decriminalisation of sex work improves access to barriers to HIV prevention and access to healthcare workplace health and safety, access to healthcare services. Recent research conducted by CSRH and justice, and reduces HIV risk and rates. examining the expression of stigma towards sex In June this year, the Northern Territory became workers found 64% of the general public and only the second jurisdiction in Australia to 31% of the health workforce reported they would decriminalise sex work. The Sex Industry Bill behave negatively towards a person because 2019 was passed in NT parliament on 26th of their sex work. Despite these incredibly high November, 2019 and was implemented in June levels of stigma and discrimination experienced 2020 providing sex workers access to the same in the daily lives of sex workers, including in WHS and industrial protections as other workers accessing health services, sex workers do not in the Territory. And there is cause to be hopeful in have access to anti discrimination protections other states and territories with active sex worker across many states and territories of Australia. led campaigns for poistive law reform, to repeal There remains an urgent need to ensure consistent criminalisation, licensing, registration anti discrimination protections for sex workers and mandatory testing; provide crucial throughout Australia. anti discrimination and anti vilification Scarlet Alliance have partnered with CSRH to protections for sex workers; and to fully conduct a survey exploring the experiences of decriminalise sex work for our rights, stigma among sex workers as a priority population health and safety. 23 Melanie Walker Chief Executive Officer Australian Injecting & Illicit Drug Users League (AIVL)

Globally, people who inject This year, AIVL has also worked with drugs are 22 times more likely key partners such as the RACGP to to acquire HIV than those develop the Interim Guidance for the Delivery of Medication Assisted who do not inject, and locally, Treatment of Opioid Dependence in Indigenous Australians who Response to COVID-19: A National inject drugs account for 12% of Response. This provides a national new HIV notifications among framework for the provision of opioid Aboriginal and Torres Strait maintenance treatment in healthcare settings. Encouragingly, take-away Islander Peoples. In Australia, doses of pharmacotherapies have been needle and syringe programs remain increased throughout this period. the most effective means to prevent We have also continued to work with key research transmission in this key population. institutions to inform study into the effects of However, the lack of this harm reduction COVID-19 on people who use drugs and their measure in custodial settings remains access to harm reduction measures and services. and continues to disproportionately Despite some of the hardships and challenges affect Indigenous Australians. that COVID-19 has presented, the Australian sector has shown its ability to promptly respond The COVID-19 pandemic has impacted our in strong collaboration with the interests and communities and the sector in unprecedented needs of our communities at the forefront of our ways. As a result, we must find innovative ways actions. Notwithstanding this, globally and locally, to respond to ensure that HIV and the harms it a reinvigorated response to the needs of key causes are not overlooked. Additionally, we need populations at risk of HIV is a key priority in these to continue to fight the persistent issue of stigma unprecedented times. and discrimination faced by our criminalised The Australian Injecting and Illicit Drug Users community. League (AIVL) is the national organisation Community-led responses are as critical as they representing people who use/have used illicit have ever been. drugs and is the peak body for the state and territory peer-based drug user organisations.

24 Michelle Tobin Chair Anwernekenhe National HIV Alliance (ANA)

Aboriginal and Torres Strait Aboriginal and Torres Strait Islander Islander people experience people need tailored and differentiated lower HIV testing rates, lower approaches to HIV prevention and treatment. Mainstream health pre-exposure prophylaxis infrastructure must draw on our (PrEP) uptake, higher HIV wisdom, lived experience, and direct diagnosis rates, delayed HIV engagement within GIPA/MIPA diagnoses, and higher rates of principles, as a step to revitalise the HIV diagnosis among women, HIV prevention, testing and treatment landscape. compared to their non- While the Anwernekenhe National HIV Indigenous counterparts. Alliance (ANA) Us Mob & HIV booklet produced I am a proud Aboriginal woman of the Yorta Yorta in partnership with AFAO is being updated and Nation living with HIV since 1990. I am a mother, reprinted, as Chair I am still deeply disappointed grandmother, daughter, sister and aunty and a the ANA remains unfunded. This reality speaks descendant of the Stolen Generation. volumes to the funding and policy priorities of policy makers. Despite this, we are encouraged Our mob faces an unacceptable situation. Two by the appointment of two Aboriginal Project years ago, Kirby Institute data showed that the Officers, working closely with the ANA to ensure rates of HIV diagnoses for my mob were double the voice of Indigenous Australians is heard within that of non-indigenous people. In 2020, I am sorry the Australian HIV response. to say these figures have changed little. STI rates of chlamydia, gonorrhoea and infectious syphilis We have seen significant impacts from COVID-19 on are now 3, 10 and 6 times greater than non- our mob’s resilience. Physical distancing has strained Indigenous populations. the way we access and engage with services. For many of us already living in crowded housing As an Aboriginal Health Program Officer at conditions or with poor access to healthcare, our Positive Life NSW, I lead an Aboriginal co- risk of COVID-19 is heightened. Despite COVID, the designed needs assessment project to generate Positive Aboriginal Torres Strait Islander Network a culturally sensitive HIV service delivery model (PATSIN) continues to work closely with HIV sector in collaboration with an advisory committee of partners to create a 2021 Resilience Retreat when Aboriginal and Torres Strait Islander people. it’s safe to gather together again. Co-designing a culturally aware and appropriate service model with, by and for Aboriginal and While the latest HIV epidemiology data still Torres Strait Islander people is just the beginning show our mob continuing to shoulder to generate the valuable understanding, a disproportionate burden of HIV and knowledge and solutions my community needs to STIs, I am hopeful that the co-designed reduce HIV transmission. approaches to HIV prevention and treatment will be firmly grounded in community by next World AIDS Day. 25 Novel approaches drive progress in the Philippines

Since late February, the Philippines has been under enhanced community quarantine due to COVID with movement limited to only accessing basic necessities. This has severely impacted HIV prevention and treatment as resources are diverted to address the impact of COVID-19. Access to antiretroviral medicine, PrEP, and testing has been limited. ­United by the value of self-worth, LoveYourself is a community of 2,000-strong volunteers who aim to reach out to others to propagate ideas, Approximately 7,000 clients with HIV rely on LoveYourself for attitudes, and practices and provide spaces that uninterrupted access to life-saving medication and other HIV encourage one to dare to be oneself, to care for services. (EBagasol/LoveYourself) and love oneself, and to share oneself.

LoveYourself staff at an intra-country meeting to exchange ideas and develop skills to respond to HIV. (EBagasol/LoveYourself)

26 LoveYourself is a community of volunteers who aim to reach out to others to propagate ideas, attitudes and practices that encourage people to take care of their health. Despite the lockdown Love Yourself has demonstrated how to maintain pre-existing services while progressing important objectives. With clinics being suspended and quarantine measures in place they have: • Digitally mapped operational HIV facilities/ treatment hubs so patients can see what is open and closed before leaving their homes. • Increased the number of phone hotlines for arranging medicine delivery. One of LoveYourself resident nurses Norman Libao contacts a client via phone call. (EBagasol/LoveYourself) • Employed motorbike riders to collect and deliver medicines. This has ensured continuity of care for people with HIV and continued income for motorbike riders. • Maximised the opportunity of quarantine to use chatbots for sign up to HIV programs and delivered testing kits to clients for free via motorcycle riders. Recently, they have also opted to pick up clients who want to get tested, and bring them to their clinics, so that other health services can be provided in a wrap around service. • Helped to set up telehealth options. • Maximised digital approaches for campaign related activities such as an online concert Nurse Ron (left), together with staff, ensures all scheduled to deliver HIV prevention and treatment deliveries are accomplished before the day ends. Operating messaging. from 10 AM to 5 PM from Wednesday to Sunday, health and program staff of LoveYourself facilitate delivery of medicines for an average of 100 clients a day. (EBagasol/LoveYourself)

27 HIV in Australia in 2019 903 12% new HIV notifications decline since 2015

Exposure classification 59% men who have sex with men 23% heterosexuals 8% other/unspecified 7% men who have sex with men who are injecting drug users 3% injecting drug users

29,045 people living with HIV

26,025 this is 90% of people living with diagnosed HIV people with HIV 23,134 people with diagnosed HIV are this is 97% of people achieving viral suppression receiving ART

We know people who have HIV are 20% invested in their health and the health of people with HIV have a of the community and do all they can to detectable viral load prevent transmission of HIV.

28 Late diagnosis of HIV in Australia

Late diagnosis is where an individual, at the point of diagnosis, is immuno-compromised such that they are at increased risk of other infections. To reduce late diagnoses of HIV in Australia we need to increase community based rapid testing and self-testing.

60

50

40

30

20

10 Percentage of late diagnoses of late Percentage 0 2010–11 2012–13 2014–15 2016–17 2018–19

Men who have sex with men Heterosexuals Injecting drug users Men who have sex with men who are injecting drug users Other

HIV among gay and Rapid uptake of PrEP, in combination bisexual men in Australia with treatment as prevention, has led to declines in HIV notifications among 600 Australian-born gay and bisexual men. Australian-born This trend has not been observed among 500 overseas-born gay and bisexual men. There has been a 44% decrease in HIV 400 notifications among Australian-born gay and bisexual men vs. stable notifications 300 among overseas-born gay and bisexual men across the last six years. HIV notifications 200 Overseas-born Carefully informed messaging – in language – is needed to ensure 100 overseas-born gay and bisexual men have access to the same information as 0 2014 2015 2016 2017 2018 2019 Australian-born gay and bisexual men.

29 Felicity Young President Australian Federation of AIDS Organisations

When HIV emerged in the troubling epidemic among indigenous 1980s, the idea that no one people as well as significant increases had to die of an AIDS-related among people born overseas, especially gay and bisexual men. illness was unthinkable. Responding to this will require sensitive Almost four decades later, leadership to ensure meaningful and improvements in treatment safe inclusion of these communities in and care, highly effective our new approaches. prevention and social solidarity For the Asia-Pacific region, this means have made this achievement ensuring that funding is allocated possible. Approaches such as to community-led programming, especially for key populations – gay men, men who have sex treatment-as-prevention and PrEP with men, people who use drugs, sex workers have had amazing impact on reducing and transgender people. Many of our regional transmission in recent years. U = U neighbours are moving into the middle-income (Undetectable Equals Untransmittable) bracket and are starting to fund their own HIV is now a central part of our community responses – but what is not yet secure is funding for key population-led interventions – especially in dialogue. the prevention space. But now especially in our region, political and Countries that continue to criminalise, stigmatise financial commitment is waning. and discriminate against key populations and An estimated 1.7 million people worldwide their behaviours undermine effective, evidence- acquired HIV in 2019, marking a 23% decline in based HIV responses. Ensuring gender-responsive new HIV infections since 2010. However, that is programming and acknowledging the diverse 1.7 million too many. issues facing women, girls, men, boys, and transgender communities is of paramount While testing has increased, a large number of importance. We need to do more to tackle gender- HIV-positive people still lack access to lifesaving based violence, trans and homophobic violence. treatment. The most recent data show that only Failure to do so will place key populations in a 25.4 million people with HIV (67%) were accessing highly precarious position and the gains to date antiretroviral therapy (globally). That means 12.6 will be lost. million people are waiting for treatment. These people could needlessly die without Global Solidarity, Shared Responsibility is the concerted global action. global theme for World AIDS Day 2020. This means we need renewed ambition and greater We need to ensure the communities innovation in response to HIV. Now is not the time most affected by HIV are always placed to slow down or lose our focus. at the centre of the HIV response in Australia and regionally. Australia has a 30