Pa m a g oa z i n e sf o r pie o tp l e il i vvi n g wei t h h iLv / a i d s i! ovc t o b ie r 2n0 0 7 g IAS 2007, Sydney Australia PROMISING SIGNS, MORE COMMUNITY INVOLVEMENT, NEW TREATMENTS BY PAUL KIDD the partnership was threatened by want to help people, not judge recent political developments. them.” major HIV/AIDS “Recent comments by high Maura Mea, an HIV- medical conference in governmental authorities have cast positive woman from Papua Sydney has generated doubt on Australia’s commitment New Guinea, reminded the lots of news on the to reduce stigma and discrimination audience of the importance of treatments front. for people living with HIV,” said maintaining a strong Several of the big guns IAS president Pedro Cahn. involvement by people living of recent HIV drug “Fortunately, neither the scientific with HIV/AIDS in the development have community nor the Australian response to the epidemic, in continuedA to perform well in clinical people support these statements. our region and globally. trials, and there are promising signs in We stand united with local and “One of the keys to dealing with toxicities, neurological global AIDS community to ensure addressing the HIV epidemic is complications and more. that people living with HIV have to address stigma and The International AIDS Society the right to travel without discrimination,” she said. “An conference on HIV Pathogenesis, harassment or the requirement to important way of doing this is Treatment and Prevention is held disclose their HIV status.” to put a real human face to every second year. It’s one of the Professor David Cooper, of the epidemic and embrace the major events on the HIV calendar, Australia’s National Centre in HIV principles of Greater and regularly delivers significant news. Epidemiology and Clinical Research, Maura Mea from Papua New Guinea Involvement of Positive People This year’s IAS conference was held said Australia’s partnership is speaking at the opening ceremony of (GIPA) in decisions that affect right here in Australia, at the Sydney “worth not just saving, but actively the conference their lives. Those principles Convention Centre from 22-25 July. nurturing.” But he warned that are as important today as they This was the biggest HIV-related recent rises in HIV infections meant restrictions on HIV-positive people were when they were first developed conference ever held in Australia, the partnership was in danger of coming to Australia on tourist visas, in 1994.” attracting more than 5000 clinicians, fragmenting as the issue becomes and there was no intent to change activists and government increasingly politicised. this. But for people seeking NEW DRUGS representatives from around the world. “Pointing fingers of blame will do permanent residency, he confirmed There is a lot of excitement about new At the opening session, speakers nothing to curtail infections,” he told the government’s intention to treatments at the moment, with repeatedly referred to the contentious the crowd. “Threatening to demonise implement new restrictions. several new agents, many from plans by the federal government to people living with HIV infection will Australia is a “big-hearted and entirely new drug classes, currently in place new restrictions on HIV-positive not help. Making recent immigrants compassionate country,” Abbott said, late-stage trials. The good news is that immigrants. from developing countries the alleged however applicants for permanent many of these drugs are continuing to While Australia’s long-standing culprits will not help.” residency will have to give “enforceable perform well, displaying strong partnership between government, Federal health minister Tony undertakings” to seek treatment. efficacy and good tolerability. researchers and affected communities Abbott, representing the Australian But he stressed that the measures was applauded, speakers warned that government, noted that there are no were being introduced “because we CONTINUED PAGE 2 CONTINUED FROM PAGE 1 who were randomly assigned to receive either maraviroc or INTEGRASE INHIBITOR efavirenz, plus Combivir (AZT Raltegravir (Isentress, plus 3TC). The study is formerly MK-0518) is an looking to see the proportion experimental integrase of people who achieve inhibitor being developed by undetectable viral loads (below Merck. Integrase inhibitors 400 copies/ml and below 50 target a different part of the copies/ml) at week 48. HIV life cycle to existing The results showed that in treatments – by interfering this trial, maraviroc was with the integrase enzyme, ‘statistically non-inferior’ to which HIV uses to insert its efavirenz in the number of viral DNA into human cells. patients below 400 copies, As they represent an entirely but performed slightly less new class of HIV drugs, the well in achieving viral load development of effective below 50 copies: 65.3 percent integrase inhibitors has the of participants taking maraviroc potential to radically improve had viral load below 50, treatment options. compared with 69.3 percent Forty-eight week data from of those taking efavirenz. The a major phase-2 trial of drug was however well- raltegravir was presented to tolerated, with similar rates the conference, with the drug of discontinuation in both showing similar efficacy to study arms, and importantly efavirenz in people who had there were no signs of not previously taken HIV Exhibition stands at the IAS conference increased rates of malignancies treatments. The 189 people in patients taking maraviroc. participating in this study response to it, while four results and show that this new class, and again 48-week The issue of increased were randomly assigned to others had an initial response new treatment is very results from a clinical trial malignancies has led to the one of five groups, four of followed by a viral rebound. effective in treatment-naive were presented in Sydney. abandonment of other drugs which took different doses of At 48 weeks, more than 83 people and relatively easy to CCR5 inhibitors work by in this class, and continues to raltegravir; the fifth group percent of people taking tolerate. There are also signs blocking one of the co- cloud another CCR5 inhibitor received efavirenz at the raltegravir had viral load that raltegravir is capable of receptors used by HIV to gain being developed by Schering- standard dose. All below 50 copies/ml. There producing much faster entry to human cells. There Plough, vicriviroc, which was participants also took Truvada were very few cases of people reductions in viral load has been some concern about the subject of a separate (FTC plus tenofovir). The discontinuing treatment due compared to efavirenz, and them because HIV is able to presentation in Sydney. Week objective was both to see to side effects or toxicity while the clinical significance use an alternative co-receptor 48 data from a study whether raltegravir was as problems, a sign that the drug of this is not yet understood, (CXCR4) in some people, and involving 188 treatment- effective as efavirenz, and to is well tolerated. Diarrhoea it does suggest that, assuming so the participants in this experienced people were find the most appropriate was somewhat more common further trials continue to trial had been pre-screened to presented, updating earlier dose of the new drug. among people taking higher report good results, this drug ensure they had ‘R5-topic’ results unveiled at last year’s The rate of virologic failure doses of raltegravir compared will have a big role to play in virus, which uses the CCR5 International AIDS (defined in this study as with efavirenz, while CNS HIV therapy in the future. co-receptor. People with ‘X4- Conference in Toronto. having a viral load over 400 side effects such as abnormal tropic’ or mixed virus were Vicriviroc produces very at the 24-week mark) was dreams, and increases in CCR5 INHIBITORS excluded from this trial and are pronounced drops in viral similar in both the raltegravir cholesterol and triglycerides Maraviroc (Celsentri) is a unable to use this treatment. load (about 2 logs) at both and efavirenz groups at about were significantly more common CCR5 inhibitor being The MERIT trial is a phase- the 10mg and 15 mg doses, 3 percent. Only one person in those taking efavirenz. developed by Pfizer. This is 3 study involving 721 however a 5mg arm in this taking raltegravir had no These are impressive another drug from an entirely treatment-naive participants, trial was discontinued due to

between the trial and ARV positive individuals with Aptivus now treatment services were hepatitis C had smaller available on PBS available to all participants increases in their CD4 cell From September 2007 TREATMENTSBRIEFS who seroconverted while on count after starting HIV Aptivus (Tipranavir), a new the trial. therapy than patients who protease inhibitor became were only infected with HIV. available for S100 Treatment for Vicriviroc remains effective prescribing in Australia. in treatment-experienced Manufactured by Boehringer designed to test whether the Sydney. In this analysis the Hepatitis C co patients, according to data Ingelheim, the 250mg soft vaccine prevented HIV outcome was 'futility' - there infection does presented at the 4th capsules have been infection; or whether was no difference in either International AIDS Society approved for listing on the vaccinated individuals who HIV acquisition in the vaccine not significantly Conference in Sydney. Pharmaceutical Benefit later seroconvert would have and placebo arms, nor was impair immune However, uncertainty remains Scheme (PBS) for the lower viral set points, due to there a difference in viral set- about the drug’s relationship following indication: the vaccine facilitating a points. 'Futility' also means recovery in HIV- with cancer. Eight Aptivus, co-administered better immune response. The that if the trial continued, it is positive people malignancies in total have with 200mg of ritonavir, is trial had sites in North and highly unlikely that any been reported amongst indicated foe a combination South America, the statistically differences who are taking vicriviroc-treated patients in treatment of HIV infection in Caribbean and Sydney – between vaccine and antiretroviral comparison to two in the highly treatment experienced 3,000 people in total, and 18 placebo could emerge. placebo arm of the trial. adult patients with evidence of those participants were Adverse events were similar therapy, a Vicriviroc, a CCR5 of viral replication, who have from Sydney. It was a 'test of between vaccine and study found inhibitor being developed by HIV-1 strains resistant to concept study' – with an placebo groups, except that There is conflicting data Schering-Plough, is being multiple protease inhibitors. insufficient size to prove injection site reactions were about the effect of Hepatitis examined in the ACTG 5211 efficacy, but large enough to higher in the vaccine group. C co infection on the trial. Investigators presented show either if there was The vaccine was based on immunological status of HIV- 48-week data to the Sydney Halted Merck some evidence of efficacy, or a common cold virus called positive people. Although two conference, updating the 24- vaccine study to demonstrate if the vaccine adenovirus 5, which studies presented to the IAS week data presented at the The Merck vaccine trial, was completely ineffective. stimulated cell-mediated Conference in Sydney have 16th International AIDS known as the STEP study, There have been 45 immunity – the 'killer T-cell' found that co-infection Conference in Toronto in testing an experimental seroconversions on the trial – response. All participants essentially has no negative 2006. Investigators plan to vaccine in HIV-negative, high- 24 in the vaccine arm and 21 received condoms and safe impact on the immune follow patients enrolled in the risk people, was found to be in the placebo arm. No sex information and systems of people with HIV, ACTG 5211 trial for a total of ineffective. The trial was seroconverters were from counselling. Linkages a third found that HIV- five years. PositiveLiving " 2 lack of efficacy. At week 48, the which can be life-threatening if looking at the systemic immune proportion of participants with abacavir is taken again in the activation that occurs immediately undetectable viral load was 27–37 future. The large international after infection, the loss of immune percent, much higher than in the PREDICT trial was designed to cells in the gut, and evidence from placebo arm (11 percent). But two measure the ‘negative predictive SMART and other studies which THISissue additional cases of cancer among value’ of the genetic test – i.e. used specific CD4 thresholds to those taking the drug, adding to six whether using this test, physicians start treatment. A fascinating study malignancies at the 24-week stage, could be confident that a from Canada also looked at the Community participation in IAS mean that the question of any hypersensitivity reaction would not impact of earlier treatment of HIV 4 causal relationship between occur. The results were very clear, prevention in a country with vicriviroc and increased incidence with none of the 1956 participants similar treatments access and a Ten years on 5 of cancer will need to be who had a positive test having a comparable epidemic to Getting the snip: the Male investigated. clinically proven hypersensitivity Australia’s, concluding that an Encouraging early results for reaction. The availability of this increased uptake of treatment Circumicision debate 6 another drug in the CCR5 test now means that doctors and would significantly reduce new HIV Criminal HIV transmission inhibitor class, INC9471, were also patients can rule out the possibility infections. booklet/Health ministers’ presented in Sydney. This is a drug of a dangerous allergic reaction to There still isn’t any widespread which has shown good activity abacavir, reducing both the consensus on what the ‘magic meeting on Reckless against HIV in test-tube studies overdiagnosis of allergic reactions number’ – the right CD4 count at Endangerment 11 and has a long half-life, making it and patient anxiety when starting which to start treatment – is. suitable for once-daily dosing. In a abacavir. Current UK, US and Australian randomised trial involving 23 guidelines suggest that treatment Verbatim people, INC9471 was given as WHEN TO START TREATMENT can be delayed until 250 or 200, HIV testing is essential. For monotherapy for 14 days to 19 The question of what is the best however there seems to be little patients, while a further four time to start antiretroviral support for doing so, and indeed people to be able to know their received a placebo. Of the 19 treatment was the subject of a few clinicians now believe there is HIV status and thus to have participants taking the active drug, number of presentations at the a benefit in delaying treatment 18 had a viral load reduction of at conference, and as previously once the CD4 count falls to 350. access to treatment and care least one log, and 16 had greater reported in PL there seems to be a We aren’t back to ‘hit early, hit and support and also to take than 1.5 log reduction, and there swing back towards earlier hard’ (the catchcry of a few years were no serious adverse effects. treatment initiation. While the ago, before lipodystrophy and steps to protect others. Yet, it’s Two participants had a change in risks of developing long-term other long-term toxicities estimated that less than 20 HIV tropism from R5-tropic to X4- toxicities have for some years been emerged) but the pendulum is percent of people globally that tropic over the course of the study, used as an argument against earlier certainly swinging back. From the a finding that will require further initiation of HAART, improved perspective of a positive person, are infected know that they’re study. tolerability and the emergence of it’s hard not to wonder when the infected. Why is that? Certainly new classes of drugs mean the clinicians will make up their minds ABACAVIR HYPERSENSITIVITY question is very much back on the and stop treating us like guinea testing has not been as widely SCREENING agenda. Scientists are also starting pigs! The good news is that this accessible as we hope it will be An Australian-developed genetic to understand better the question is now being actively test for abacavir (Ziagen) mechanics of early infection, explored and several studies are in the future, and also people hypersensitivity reduced the rate of particularly the changes that being planned which will shed have been afraid of testing for allergic reactions to zero in a large happen to immune cells located some light on it in due course. randomised control, the inside the gut, and this suggests a Watch this space. a variety of reasons – stigma, conference heard. About five benefit for starting treatment discrimination, even violence percent of people taking abacavir earlier rather than later. Paul Kidd is a former editor of develop a severe allergic reaction A symposium session at the Positive Living. A referenced version of against them, all very real and shortly after starting the drug, conference canvassed the issues, this article can be found online. tragic phenomena. Christine Grady R.N., PH.D., Department of Bioethics, United States National Institutes of Health There’s also an argument being Women living pushed forward in advocating for this provider initiated HIV testing. You know, they say it’s going to expand access to care, treatment and support, and we positive at IAS feel this is a miscalculation By Katherine Leane As co-chair of women@ napwa, members of the media to taking HIV treatments for 10 and it’s misleading. our national positive women’s promote the profile of positive years after contracting her HIV Promise Mthembu, network, I was sponsored by women from both a global from a blood transfusion in the South African HIV/AIDS activist Boehringer Ingelheim to attend perspective and the culture mid eighties. Although I have the IAS Conference recently within Australia. My specific now lived with HIV for 18 How does the stigma reduction held in Sydney. My role was to present the years I am still always moved participation involved a Australian perspective where by the power and privilege of happen? We are assuming that women’s roundtable titled positive women are still sharing in a positive persons if we test more people stigma “Women Living Positive” as a considered a minority and to story .The opportunity to will just disappear, just by the panel member along with four discuss the vital role that peer promote the various women’s other women. The facilitator networking plays and the networks is something I am virtue of people knowing was Dr Cindy Pan, the availability of support services passionate about especially their HIV status. researcher Dr Francoise-Barre and resources. when it means positive women Promise Mthembu, Sinoussi is from the virology At many levels this was both who feel isolated will hear South African HIV/AIDS activist department, Paris and Dr an interesting and valuable there is support available and Sharon Walmsley a professor experience personally and women who understand, care All quotes from HIV Testing – Increasing of medicine in Toronto, Sarah professionally. The opportunity and will listen. Access, Increasing Uptake, and Protecting W who is a positive women to meet and network with such If you would like to know Human Rights session at 4th IAS Conference from QLD and myself, dynamic, resilient women was more about NAPWA or the on HIV Pathogenesis, Treatment Katherine Leane representing huge. Linking up with Sarah a women’s networks please go to and Prevention the NAPWA women’s network. young positive mother of two our page on the website The event was aimed at from QLD, who has been (www.napwa.org.au). PositiveLiving " 3 BY JOHN DAYE opportunity to come together and explore issues. ydney played One of the successes of host to one of this role is that it provided the leading an opportunity for scientific dialogue between the HIV/AIDS community and the conferences on pharmaceutical industry the global Community over aluvia (kaletra) S calendar in July supply in Thailand. this year. Close to 6800 In Australia, physicians people came together from in the HIV sector all over the world to share collaborate with knowledge and experience participation community responses, and in dealing with HIV at the have made this a central International AIDS Society AIDS and understanding part of the way they work. Conference (IAS). The the epidemic. This partnership with International AIDS Society Going onto the community has long been is the world’s professional Conference Organising a feature of the Australian society for scientists, Committee of IAS response and we believe clinicians, researchers and generated some initial there are lessons to be advocates engaged in HIV/ apprehension about learnt for other countries AIDS research, clinical whether I would be considering their own practice and prevention. accepted and taken response. It is also now an The conference, held every seriously by other accepted principle within two years, is an members of the committee IAS that the greater opportunity to develop a especially as they were involvement of HIV- better understanding of leading clinicians, positive people in research HIV basic science, clinical scientists and researchers. and the other dimensions science and biomedical As a community treatment that affect their lives is prevention. The success of advocate I was treated fundamental. It ensures a conference this size equally by other members that activities are relevant hinges on the work of of Conference Organising and consider positive many individuals and a Committee and my and to work closely with with organisations people’s needs and the great deal of planning and concern about how well I the scientific community particularly dealing with personal ramifications of preparation. represented the issues for to ensure that research is harm reduction and actions planned to deal After representation by positive people quickly relevant to the concerns of intravenous drug use, with with HIV. To illustrate how NAPWA to the IAS, for dissipated. I needn’t have people most affected.” a strong focus on the links receptive the Conference the first time the been apprehensive. I was As the co-chair of the between HIV and human Organising Committee was Conference Organising able to have meaningful Community Advisory Group rights; Maura Mea, a to input, a suggestion from Committee nominated a input and reflect the views and its representative I treatment activist and the Community Advisory HIV-positive advocate to of the Community was to convey its ideas to founding member of IGAT Group to include a HIV- the deliberations of its Advisory Committee. This the Conference Organising Hope, the national positive person in the work. As I firmly believe was an important role that Committee. I attended two organisation for people opening ceremony for the that knowledge and ensured HIV-positive face-to-face meetings of living with HIV/AIDS in first time was unanimously understanding are the best people were engaged in the the Conference Organising Papua New Guinea, she endorsed. Maura Mea things we have in fighting staging of this conference Committee in Bangkok and also is involved in APN+; from Papua New Guinea the many challenges of at the highest level. When Sydney with a role to feed Evan Collins, a Canadian was nominated, as she is a HIV, I felt honoured to be asked about community information about treatment advocate active staunch HIV-positive a representative from partnership, Professor community involvement in in the community treatment advocate in a NAPWA at this important David Cooper, a the conference and response to HIV since the country that is conference. In addition to prominent HIV specialist program. I also participated 1980’s who was the Co- experiencing great the Conference Organising from Sydney and co-chair in several teleconferences chair of the Community challenges as transmission Committee, I was involved of the conference said that of the Conference Programme Committee for rates skyrocket. Maura in the preparations for the “partnership and Organising Committee. AIDS 2006; Robert spoke passionately about conference as the co-chair collaboration with From the outset the Baldwin, an Australian the needs of HIV-positive of the Community community were essential Community Advisory Group activist involved in people in PNG and the Advisory Group and as a if we are going to be were clear they wanted to community HIV activities region and the debilitating community representative successful with the work maximise a community for many years, earlier affects of stigma and on the clinical science we doing in HIV. This has presence in the conference. within NAPWA and later discrimination, finishing track. Through my long been the cornerstone The Community within APN+, who works her talk with a plea to the involvement I endeavoured of the Australian response Advisory Group was a in the Asia Pacific region audience to “talk with us, to promote high and clearly a model that diverse and skilled group focusing on empowering not about us.” I was community visibility and would benefit all of HIV-positive treatment and skilling local positive honoured to present the engagement. It’s been countries.” A similar view advocates from around the people to influence closing statement in the challenging and rewarding was expressed by the world including: Frika treatment, care and closing ceremony on behalf for all those involved in Executive Director of the Chia, Co-chair, a prevention issues and of the Community bringing together this conference Craig McClure, passionate activist from policy; Rob Lake, an Advisory Group. My talk conference. At heart, who went further by saying Indonesian with extensive Australian activist who has was a summation of the community advocates want “ the involvement of involvement in the Asia also been involved in important things that took to see scientific advances community in the Pacific Network of Positive NAPWA and is now place during the conference translate to appropriate conference is critical on People (APN+), Treat Asia working as the Executive from the perspective of the actions that improve the many fronts – to interpret and the International officer of PLWHA NSW. community. quality-of-life of HIV- data into the realities of Treatment Preparedness In the lead up to the Being involved has its positive people. every day life for people Coalition; Mauro conference Ron Rosenes demands: long distance Community involvement living with HIV and those Guarinieri, originally from from the Canadian telephone calls at night was developed with HIV- most at risk of HIV Italy and now in Hungary, Treatment Action Council with all the difficulties of positive community infection, to advocate for the current President of was appointed to the complex decision making, organisations, out of a accelerated the Global Network of Community Activist but due to the makeup of shared recognition of the implementation of new Positive People (GPN+) Liaison Program and he the terrific Community unique expertise and scientific insights into and has been a treatment played a pivotal role in Advisory Group I believe it perspectives they can bring treatment and prevention activist for many years ensuring community has been highly successful. to the response to HIV/ programs on the ground, with extensive involvement delegates had an We were fortunate to have PositiveLiving " 4 IAS secretariat support from Andrea Nanniperi and Bernard Amahaya Kadasia who have both done an excellent job devoting a lot of energy to staging community activities. The Community Advisory Group’s purpose was to plan and oversee a range of community Ten initiatives including the welcome of community delegates to the conference at a reception held by Clover Moore, Lord Mayor of Sydney; the Community years Forum “A Vision for the Future”; the Positive Lounge at the conference venue; Planet Positive; the Community Exhibition Booth; Engagement Tours on visiting Kirkton Road Clinic, Sydney Sexual DAVID MENADUE GETS OUT THE CRYSTAL BALL Health Centre, Scarlet Alliance and the AND LOOKS TO THE FUTURE OF HIV Conference Activist Liaison Program. The Community Advisory Group ensured that the t’s a pleasant change appropriate government the inability of health analyses the likeliness of conference kept a reduced to be attending a interventions and HIV authorities to control problems for each person fee for participants from function about the prevention measures. public health epidemics with each drug. He spoke developing countries and future of the HIV Some high prevalence including HIV. of “pharmoepigenetics” at least 15% of the large epidemic and to countries could be in even Then, thank heavens; we where we are able to scholarship program went actually think that greater chaos (e.g. got the best-case scenarios. control the immune to HIV-positive advocates. there’s a reasonable Zimbabwe, Congo) and Scientists and governments system of each person These people worked chance you might be HIV would be contributing cooperate to attack HIV on better (rather than just the together ensuring events herIe to see it happen! Not to the inability of these all fronts, it is regarded as HIV) leading to like the community forum that the things discussed at countries to develop a number 1 health priority individualised therapy and which brought expertise to the Community Forum, economically and around the world, we all with stronger genetic the local community in organised by PLWHA NSW politically. There could be say, “We can beat this” considerations able to be Sydney and the social and ACON as a part of the a shortage of condoms and it happens. There is an made about the likelihood activities for the IAS proceedings, were all worldwide—it is said that effective microbicide, an of future co-infections. conference such as Planet pleasant. Acknowledging currently African men only 100% effective vaccine, He also spoke about Positive which gave that the world is never have access to an average PREP is a safe and useful possible new classes of positive delegates an perfect in its responses to of three condoms a year. intervention, safe sex as drugs. Something called opportunity to meet with a tricky virus like HIV, Needle and Syringe well as safe injecting is “disintegrase” local positive community Professor Stephen Kent Exchange Programs taught in schools and (theoretically an advance all ran successfully. from the University of (NSEP) could be shut NSEPs are uniform around on the new integrase I have found my Melbourne started off the down as governments react the globe. inhibitors), the use of experience of being session with “the best and in repressive ways against Of course Professor monoclonal anti-bodies in involved in this conference worst case scenarios for injecting drug users. Kent thinks the real future therapy, maturation to be rewarding and HIV in ten years’ time.” Vaccines might be shown lies somewhere in the inhibitors, antisense, TRIM stimulating both personally Some of it was a little to enhance HIV infection middle of all these and NEF as a part of new and professionally as a HIV unsettling. through immune predictions. Partially therapeutic approaches. treatment advocate. Professor Kent started activation rather than effective scientific There could be an oral During the conference I by saying that prevention provide the panacea we are interventions will not solve form of fusion inhibitors had the pleasure of has been dealt a blow by all hoping for. Pre- the problem alone- we will or implants of T-20 to meeting and spending time the recent reported failure Exposure Prophylaxis still require HIV replace the current with many people doing of diaphragms (in a late- (PREP)—where individuals prevention efforts and a injections. There will tremendous work in HIV. I breaker presentation at the take a drug like Tenofovir role for community certainly be more drugs do encourage others with conference) and news that regularly to try to prevent leadership in ten year’s acting on whole cells to yet another microbicide HIV-- might be proven to time. Circumcision uptake help fight the virus an interest in community trial has not worked. These contribute to drug will probably take a (following on from activism to put their hand interventions would be resistance in the generation to work, there Maravoric, the CCR5 up and play a role in these very helpful to women in community rather than is a chance for an effective inhibitor). major meetings that their desire to prevent reduce HIV transmissions vaccine by 2011 (using a We will have to watch discuss issues affecting the picking up HIV as they overall. new concept called “elite more for cancers in HIV- lives of HIV-positive could be used independent Professor Kent controllers”) and there is positive people and there may people around the world. of their partner’s continued with the now strong evidence that possibly be vaccines to Positive people are able to knowledge or compliance. Doomsday stuff – some of maternal transmission can prevent them. Cardio- ground the scientists, While circumcision might us were looking around for be stopped using antivirals. vascular treatment will clinicians and researchers help reduce HIV a stiff drink — when he Melbourne GP Jonathan improve. There is a possibility in the lived experience of transmissions in Africa, suggested that HIV might Anderson gave a more of stem cell injections to HIV in both the developing for instance, but we don’t not be the worse thing you upbeat analysis, talking reduce the effects of and developed countries of know what the uptake of can get in the future. about some very futuristic lipodystrophy, as well as extra the world. such measures would be, There might be a worse possibilities. He discussed corporeal skin growth being limited in their pandemic than HIV – bird the concept of transplants and even the very John Daye is NAPWA’s potential. flu or something similar “pharmogenetics” where futuristic possibility of face Co-convenor of the Health, The worst-case scenario might finally come into its doctors are able to select transplants! With ageing and Treatments and Research would be that the HIV own. Climate change the best antiviral drugs for the continued psychosocial Portfolio epidemic fails to have its might increase the someone based on a RNA spread checked by numbers of refugees and messenger system which CONTINUED PAGE 7 PositiveLiving " 5 t the beginning in both arms of these studies estimated $550 per person foreskin you may well contracting HIV was of his – the circumcised and the whereas African countries disagree that removing it will understood. There were issues presentation at uncircumcised – rates were and countries in Asia like not affect your sensitivity and such as how soon after the the IAS lower in the former group. Papua New Guinea, sexual pleasure. A very procedure a circumcised man Conference in Cambodia and Thailand with sensitive penis head could could have sex again as the Sydney SAVING MILLIONS OF LIVES? low circumcision would cost well be a very nice thing, after wound created by the researcher, Professor Robert Bailey from about $181 per person. all. Anecdotally some of my procedure could be a pathway David Templeton the University of Illinois, uncircumcised gay friends for HIV transmission itself. It A from the speaking at the recent IAS HOW IT HELPS believe from observation of is also necessary to study National Centre in Conference, claimed that How circumcision has this their circumcised partners, whether there was any Epidemiology and Clinical widespread male circumcision protective effect is not always that it is easier to be aroused protective benefit to a female Research spoke about how he in sub-Saharan Africa would explained in the research. A and to have orgasm if you are partner if their partner was envisaged getting the prevent 5.7 million new cases brochure handed out at the not circumcised but I guess HIV-positive and also to see if attention of Sydney’s gay of the disease and 3 million conference claims that that may not be regarded as there was any benefit for men community to his research deaths over 20 years. He said circumcision reduces by scientific evidence! who have sex with men (see findings: “Here is a snippet of the trials have shown three-fold inflammation and below). my research on male uncircumcised men were infection of the skin of the NO DIFFERENCE IN circumcision” or “Here is a more than 2.5 times more penis (which one in ten SENSITIVITY CLAIMED POTENTIAL PROBLEMS AND taste of . . . you get the drift. likely to get it from female circumcised men experience The scientists in favour of CRITICISMS Slightly rude jokes aside, partners. There was reduced sometime). This risk circumcision at the Criticisms of the push for with discussions of sex and risk of the circumcised males supposedly rises to 1 in 3 if conference, including Greg widespread circumcision has penises invariably inviting a contracting genital ulcers and the man is a diabetic. The Londish from the University included the potential for bit of mirth in our society, warts, reduced risk of penile increase in HIV risk is caused, of NSW, stated that it was greater risk-taking or the issue of male circumcision cancer, and females had less the brochure says, when HIV found that there was no “behavioural disinhibition” by has become a serious and chance of catching chlamydia enters via the vulnerable difference in sensitivity those circumcised in the false somewhat contentious issue. from a circumcised partner. inner lining of the foreskin on reported by the newly belief that they were now To some, the thought of cutting off part of the human body even for laudable prevention purposes is an intrusive step too far; it may THE MALE CIRCUMCISION DEBATE well infringe on an individual’s human rights and have a psychological impact if undue pressure was applied to have the procedure. Some regard it as a dangerous initiative that will undermine established safe sex cultures, particularly in the developed world. Professor Gary Dowsett from La Trobe University regards it as something that “has been proffered to displace the getting disappointment of previous ‘silver’ or ‘magic’ bullets that have not worked as well as we had hoped.”(1) For HIV- positive people it seems a non-issue although of course it may have implications for our HIV-negative partners. With some 45 research projects so far all confirming a protective benefit for heterosexual males of an average 60%, and in the face thDavid Menaduee examines s the issuesn for andi p of limited HIV prevention resources in the developing against circumcision as an HIV prevention tool world though, it is perhaps not surprising that the World Health Organisation (WHO) But other sexually a healthy penis but can also circumcised men in the sub protected against HIV. Bailey recently stated that, “Male transmitted infections were infect via sores anywhere on Saharan African trials, with said that both groups studied circumcision should be not reduced. A question after the penis. over 99% of the circumcised as a part of the Orange Farm considered as part of a his presentation asked The brochure goes to make participants in the Rukai trial cohort in South Africa comprehensive prevention whether his figures would so claims that women prefer the in Uganda for instance, showed no greater sexual risk- package.” easily translate into practice appearance of the reporting sexual satisfaction. taking after twelve months WHO was making their once circumcision programs circumcised penis although no Londish actually supported but it does need to be pointed statement after the results of were rolled out outside of research is quoted. (2) It also this claim further by saying out that both groups received three trials which enrolled a trial protocols. states that sexual function is that thermal imaging had free condoms as a part of this total of 10 000 participants Professor Bailey noted that the same or better in been done to compare the trial and extensive counselling in Uganda, Kenya and South there would be costs involved circumcised men, with the sensitivity of penises with and about the relative risks Africa, countries where with the procedure that problem of over-sensitivity of without a foreskin and they involved. Would this heterosexual vaginal inter- would be higher in countries the head of the penis didn’t find any difference. counselling be provided for all course is the predominant with higher rates of experienced by many Professor Bailey did point as a part of the circumcision mode of HIV transmission. circumcision currently. This uncircumcised virtually out that any roll-out of process and would the need Circumcision did not provide was because the more people eliminated. The difficulty for circumcision programs would to purchase condoms be a complete protection against you did the procedure with, any male (including myself!) need to involve women as factors working against safe HIV, but researchers the greater the reduction in trying to make a judgment on well as men in the education sex practices in the real concluded that circumcision the unit cost. Countries with the truth of that statement is programs which must world? Where will the funds reduced the risk of HIV low prevalence of of course obvious—you have accompany them. Counselling come from for these acquisition in the study circumcision such as Pakistan, either not had a choice in the was necessary pre- and post- programs and will the relative groups. While there were Bangladesh and the matter as the procedure was procedure to ensure that the expertise, both from medical high rates of HIV acquisition Philippines would cost an done at birth or if you have a relative risk of still and counselling staff, be PositiveLiving " 6 available in these areas of the to insist on not using !#Circumcision status may world? ITS USE FOR GAY MEN? condoms after the procedure. become a marker of HIV Comments from the So what of the use of In a press release following status, as circumcision of Ten audience at the end of the circumcision as a preventive the conference the Australian HIV- positive men is not session raised the difficulties measure in men who have sex Federation of AIDS being proposed; years some female partners would with men? David Templeton’s Organisations (AFAO) stated !#Ritual circumcision itself now have to be able to insist findings from the Health in that they believe male may be a route of HIV on on condoms with males likely Men Study in New South circumcision has no role in transmission; FROM PAGE 5 to believe they had reduced Wales (a cohort of 1427 HIV- the Australian epidemic. They !#Circumcision has a 2- the risk enough already. A negative gay men) that there said there is no demonstrated 10% incidence of issues associated with HIV, researcher from India pointed was no association between benefit on men who have sex complications; and our need for care and support out the strong cultural and HIV seroconversion and with men; that correct !#If circumcised men have will continue. Nursing homes religious beliefs attached to circumcision status in their condom use, not sex before wound-healing and in-home support needs circumcision with some three-year study period. circumcision, is the most their vulnerability to HIV will increase. Brain and other beliefs expressly forbidding it. Templeton pointed out the effective means of reducing infection increases. inflammation complications Another audience member difficulty in researching gay female-to-male transmission could lead to problems like pointed out that the time it men on this topic as most gay and African data cannot be FOR AUSSIE dementia. Through all this, would take to do the level of men did not take the active extrapolated to the Australian HETEROSEXUALS? community groups will still be circumcision necessary role only in sex and some epidemic in any way. Positive Women Victoria required to lead and to worldwide would be years and were not penetrative at all. AFAO also points out the recommends that all positive advocate. that it will possibly be not for He also quoted two other following social and ethical women have intercourse with Two community twenty years or another studies (Kaisner in a trial in arguments against the use of a condom, to speakers then gave us generation that the benefit San Francisco and Bachbinder circumcision programs for ensure the non transmission examples of how they are will be felt — assuming new (4)) in gay men that did not any population: of HIV to their partner as leading in their own babies are circumcised, find a correlation between !#A partially effective well as for her own protection countries. Frika Chia from anyway. circumcision and a protective technology may adversely against STIs and Indonesia spoke about the superinfections. difficulties getting HIV on “Some women who her government’s agenda – are in a stable with things like the relationship find tsunami, earthquakes, there are times poverty and other illnesses when it is more to compete for attention. difficult to adhere With pressure from HIV to condom use,” groups such as her own said Director Dawn assisting, there is now Wilcock. “These widespread access to times include when treatments in Jakarta but she and her partner not elsewhere in the are negotiating country. Second and third pregnancy and also line treatments are scarce where a partner everywhere. Frika sees the may ‘risk’ need for greater unprotected sex due international solidarity to not wanting to with other PLWHA groups use condoms. to keep governments aware While these of the plight of people with research results HIV. may appeal to some Maura Elaripe Mea HIV-positive from Igat Hope (an HIV- women who are in positive advocacy group) in these situations and Papua New Guinea (PNG) who also have an finished the session with a undetectable viral moving account of how load, circumcision HIV is destroying whole should not be seen levels of the productive as an alternative workforce there, safe sex method. particularly amongst the Counselling can 20 to 35-year-olds. Some also help couples were taking others to court resolve these issues for giving them HIV: it is safely.” still regarded as a great stigma to have the disease In a poster presented at benefit. Further research affect condom use and 1 G. W. Dowsett and in PNG. She the Conference, Bridget would need to be done to see negotiation; M.Couch, Reproductive acknowledged that Haire, Biomedical Policy if a gay male partner who was !#Partial efficacy is a Health Matters 2007: 15 agencies like the World Analyst with the Australian active only gained any difficult concept to (29):33-44 Health Organisation were Federation of AIDS protective benefit if their communicate to obtain 2 Have you heard about the now providing funds for Organisations wrote of the passive partner was HIV- informed consent; benefits of circumcision?, The antivirals but the rollout concern that a roll-out of positive. !#Risk behaviour may Gilgal Society, London, 2006 has been so slow and many circumcision programs could A study by Guanira from increase as a result of 3 B. Haire, Ethical Issues in are still dying. Maura is amount to a cultural Asocicion Cicil Impacta Salud perceived invulnerability to HIV Transmission, Australian speaking out though, with transformation of certain y Educacion in Lima, Peru (5) infection; Federation of AIDS her own politicians and on societies and there would on men who have sex with !#Women aged 15-24 are Organisations international stages, to need to be acceptability men in the Andes region of at the greatest risk of HIV 4 J. Bachbinder et al, Sexual keep attention on PNG’s studies to see if this is South America found men acquisition and risk, nitrate inhalant use and situation. feasible. (3) “A major ethical who came from larger cities, circumcision and male circumcision associated The final moment in my challenge is whether health were more educated and who circumcision programs will with HIV seroconversion in future gazing happened for education systems in the were largely insertive sexual not reduce infections in men who have sex with men me when I spoke to a drug countries expected to benefit partners were more willing to women directly for at least in the United States, JAIDS, company representative from the intervention have have circumcision for 10-20 years; 2005, 39 (1), 82-9 about what he foresaw in the capacity to communicate prevention purposes. His !#Circumcision may 5 J. Guanira et al, How willing ten years’ time. “There is a the complex message about research did find a concern reduce women’s ability to are gay men to “cut off” the possibility of a monthly partial efficacy and how this on the part of those negotiate condom use; epidemic? Asocicion Civil injection for all your impacts on individual risk,” interviewed that their sex !#Circumcision is a Impacta Salud y Educacion in antivirals by then. How she writes. partners would be more likely complex cultural practice; Lima, Peru would you like that idea?” PositiveLiving " 7 HIV TESTING INCREASING ACCESS AND UPTAKE AND PROTECTING

HUMANShifts in policy relating to HIV testing raises questions about RIGHTS how we balance public health and human rights priorities. BY SERENA MAWULISA

ne ‘hot button’ positive people, unaware of concern. It is understood He emphasized the “right to the industrialized world, in issue their status don’t have access that some of the reasons life and the right to health” as particular with a two-thirds internationally, to treatments. There is also people have avoided testing well as the importance of reduction in perinatal has been the the belief that undiagnosed have included stigma and medical ethics. He mentioned (mother to child) WHO (World positive people may be more risks of violence. The that doing the right thing in a transmission rates. Health likely to infect others. PITC is emphasis on testing before medical sense required basing De Cock spoke about the Organisation)/ seen as a way of increasing counseling is treated with decisions on evidence, and advent of combination ART in UNAIDS (The access to HIV testing, and alarm by critics who also that the Hippocratic notion of 1996, and the beneficial JointO United Nations knowledge of one’s HIV status worry that PITC may be “do no harm” isn’t impacts, however that the Programme on HIV/AIDS) is seen as a basic human another form of mandatory compatible with “inaction in developing world continued to shift from the voluntary right. testing in some settings. the face of threats with lag behind. He mentioned the counselling and testing However, there is a range An IAS session, entitled potential remedies.” Dr De 2003 WHO document “The programs (VCT) to provider of ethical issues connected to “HIV Testing – Increasing Cock went on to say that Right to Know” endorsing in provider-initiated testing PITC. Indeed, HIV testing has Access, Increasing Uptake, licensing of the HIV serologic ‘opt-out’ HIV testing, and and counselling (PITC). The always been an ethical and Protecting Human test occurred to prevent large warned that the move towards PITC by WHO minefield, with the fight for Rights,” with a panel of numbers of people from “consequences of lack of and UNAIDS has been due to anonymous testing, the prominent speakers, explored donating blood in order to knowledge of sera status are indications that more than debates about mandatory some of the public health and learn their HIV status. This measurable in failed 80% of people living with HIV testing, either generally, or human rights issues raised by resulted in the introduction of prevention, disease and in low and middle-income targeted groups identified as this policy direction. the voluntary counseling and death” and that “ample data countries do not know that ‘high-risk’, before wide uptake Dr Kevin De Cock, an testing model, with an show poor treatment they are infected. The of voluntary counseling and infectious disease specialist, emphasis on consent, and outcomes when ART is concern is that the low testing. Many see PITC as a who is the director of the confidentiality. By the early initiated late.” Dr De Cock uptake of voluntary HIV move away from the VCT WHO Department of 1990s, the VCT model had reminded us that in 2005, testing globally means that model, and this is viewed with HIV/AIDS, was first to speak. changed the face of HIV in only 14% of patients with PositiveLiving " 8 tuberculosis had received an connected “xenophobia, to stigma, and to introduce different than our earlier New York State, there is a HIV test, and therefore racism, homophobia, denial, any provider initiated practice of targeted testing revised two-part consent “What does it mean under ignorance and fear” screening for HIV with full where we focused our testing form and signed informed such circumstances to speak After such a new approach patient participation and activities only on certain consent is currently still of universal access?” to an epidemic, such as respect for the patient’s people perceived to be a high required. “Importantly, they Dr De Cock framed his promoting behaviour fundamental human dignity risk. We also recommended also doubled the number of discussion of PICT by stating modification, as suggested by and human rights. In short, opt-out screening, which is people who were diagnosed that in resource-poor social scientists in the early stepping up testing has to occur performing an HIV test after with HIV passing through countries, HIV related days of HIV, the desire to in proportion with stepping notifying the patient that the their institution from mortality was overall about move back to the familiar up legal and social measures test would be done, giving approximately 700 people a 2.5 times higher than in realm of medicine is to combat or address stigma.” them the opportunity to ask year to between 1,500 and industrialised nations. understandable. However, the The third panelist, Bernard questions, and the option to 1,600 people a year at the Dr De Cock pointed out rights-based approach and Branson, is from the Division decline and that consent current time with this that PICT should not be harm reduction strategies of HIV/AIDS Prevention at would be inferred unless the expanded testing.” coercive or construed as have been successful in the Centers for Disease patient declined.” The CDC In comparison, San mandatory, and should never controlling the spread of HIV. Control (CDC) in the United recommendations call for a Francisco Public Health had a occur without the patients Justice Kirby mentioned the States. Dr. Branson has been routine screening for all directive that required signed consent and without linkage Australian response, hailed as the key initiator of CDC’s persons aged 13 to 64 in informed consent, and that to appropriate services. highly effective, which activities surrounding new health care settings, this consent be documented Decisions about testing included decriminalising technologies for HIV testing, regardless of perceived risk. on the request form sent to should always be in the best homosexuality, reforming sex including rapid HIV tests. Dr. In settings with ‘low or the laboratory. When the first interest of the patient, and work laws, established clean Branson discussed unknown prevalence’, the draft of the CDC’s consultation, and adaptation needle programs, enacted implementing U.S. testing recommendation is “that recommendations was of policies to local conditions anti-discrimination legislation policy. Dr Branson began by screening be initiated and if disseminated in 2006, San are essential. Dr De Cock and promoted condom reviewing the primary the yield from screening is Francisco Public Health discussed weighing up the awareness, including in schools, features of the US epidemic. less than one infected person changed their requirement for need to prevent all of which led to a decrease An estimated 1 – 1.2 million per 1,000 screened, then signed informed consent so “discrimination and stigma” in HIV transmission rates. against “the unforgiving However, most countries outcomes of undiagnosed have said that they cannot or progressive HIV disease and will not introduce these preventable transmission” He measures, and one of the finished by stating that WHO results of cultural and and UNAIDS strongly endorse religious opposition to harm expansion of client-initiated reduction approaches has HIV testing and the two been the diversion of HIV approaches should not be related funds to the seen as in conflict. promotion of the ABC model Justice Michael Kirby was (Abstinence, Be faithful, use appointed to the Australian Condoms) Kirby criticised High Court in February 1996. “the incapacity of the United Since 2004 he has been a Nations machinery to member of the UNAIDS demand and secure strategies Global Reference Panel on that are essential to treat the HIV/AIDS and Human Rights. epidemic of stigma” and the Justice Kirby began by hoping lack of justification for that this session sent a “clear inaction by many politicians message repudiating the and bureaucrats “given the suggested conflict between the rapid accumulation of human rights and the medical knowledge about this approach to the AIDS epidemic and the effective pandemic.” He mentioned strategies that work against that although there was a it.” vital part for medical science Justice Kirby cautioned in the fight against HIV, and that widespread testing wasn’t that antiretroviral drugs have going to be a cure to all the Anthony Fauci, director of the US National Institute of Allergy and Infectious given enormous benefit to problems associated with HIV. Diseases, speaking at the opening ceremony for IAS in Sydney in July 2007 many positive people, there That testing in isolation was no cure, or vaccine, and “produces no benefit.” At the people in the United States continued screening would that a separate consent was none available in the time when increasing are HIV-positive, and about not be warranted.” no longer required, thus HIV foreseeable future. Under criminalisation of HIV one quarter are unaware of Dr Branson stressed that testing was added to the these circumstances, medical transmission is occurring, their status. There is an “screening must be voluntary, regular lab requisition. In science as well as social PITC can expose those tested estimated 40,000 new that all patients must be comparing rates of testing science “even occasionally the to risks of conviction; Kirby infections in the US annually. informed, orally or in writing, before and after the change, law” had a role to play. pointed out that “the Over the last decade, 40% of that HIV testing is planned rates increased in health Justice Kirby warned Hippocratic oaths . . . and the people develop AIDS within and will be performed unless clinics and in the public against the ‘remedicalisation’ fundamental notions of the first year of being they decline, and that like the health hospital. Also, of the epidemic. Since the health care ethics . . . demand diagnosed with HIV. WHO recommendations, it is numbers of HIV diagnoses advent of ART there was affirmative patient consent to In September 2006, CDC essential to arrange access to increased from an average of potential pressure to move significant medical procedures, published revised care, prevention and support 20.6 positive tests per month away from a rights-based of which HIV tests are recommendations for HIV services for patients with before to 30.6 HIV-positive approach. That “AIDS is not, certainly one.” Justice Kirby testing of adults, adolescents positive HIV test results.” tests after the change, “which and probably never will be a urged increasing prevention and pregnant women in Dr Branson reviewed provided some at least neutral medical condition. efforts, or “all the tests in the health care settings, due to initial results of these ecologic evidence that it did Indeed there are still two world and all the pills we can research indicating that many recommendations. The Health make a difference whether or epidemics, the epidemic of offer will not keep pace with HIV-positive people were and Hospital Corporation of not you required this separate the virus and the epidemic of the oncoming avalanche of passing through health care New York City, the largest document.” stigma. We can reduce both, seroconversions.” He spoke of settings in the United States healthcare provider to Dr Branson also looked at but for this we have to tackle the need to tackle while remaining undiagnosed, impoverished people, emergency department HIV them both and at the same discrimination with “exactly despite multiple visits. increased testing from their testing programs. In the Cook time.” We were reminded the same and even greater The recommendations baseline of approximately County Hospital in Chicago in that medical science had yet energy than we tackle testing suggest screening or 50,000 tests per year in 2003 2003, where screening was to propose an answer to and treatment, to adopt the performing routine HIV to 2005, by nearly 70% to initiated and 62 percent of stigma, and the resulting sometimes uncongenial but testing for all people in a conduct 132,000 tests a year social isolation, and the essential measures to respond defined population. “This was in the fiscal year 2006. In CONTINUED PAGE 10

PositiveLiving " 9 CONTINUED FROM PAGE 9 Mthembu mentioned that HIV. Is it not stigmatizing me reduced counseling, that PITC had been introduced even further?” people may avoid clinics for people accepted HIV testing. before VCT had been Also questioned was the fear of testing, and that there Positive Because rapid testing was evaluated, and that one of the assumption that increased may be an increase in testing- used, 98 percent received problems with PITC, is that HIV testing would lead to related partner violence. their test result. Initially, while it talks about the ability increased treatment, care and Dr Weiser compared two Living 3,300 patients were screened. of the patient to opt-out of support. “Where I live in large scale population-based ISSN 1033-1788 Eighty-three, or 2.5 percent testing, it ignores the power Southern Africa, there are studies, one conducted in late of the people coming to this imbalances between service reports that less than 50 2004, 11 months after the EDITOR Serena Mawulisa emergency department were providers and service users. percent of people needing introduction of PITC, and the ([email protected]) found to be HIV-positive. 80 “We know from the work treatment do not have access second conducted in 2006, ASSOCIATE EDITOR David Menadue percent of them entered HIV we’ve been doing around the to such treatment. We still both looking at attitudes CONTRIBUTORS care in the median of 18 days world and the Gender AIDS see AIDS deaths at alarming towards this policy. At the Kellie Kendrick, Paul Kidd, after receiving their test Forum are with us on this, numbers, and these are time of the 2004 study, 54 Suzanne Lau Gooey, result. Approximately half that women, particularly HIV- people who have tested more percent of participants had David Menadue had no identified risk factors positive women see than a decade ago . . . They heard of routine testing. After DESIGN Stevie Bee Design and 57 percent had never healthcare provision centers are not dying because they a brief explanation of the Positive Living is a publication been tested for HIV before. In as places of powerlessness. were never tested. They died policy, 81 percent said that of the National Association of George Washington University They report that they lose because they do not have they were very much or People Living with HIV/AIDS. Hospital in Washington, D.C., their power the minute they access to adequate treatment extremely in favor of routine opt-out screening was think about going to clinics. and care.” Promise Mthembu testing, and 8 percent said conducted between September Then we ask, how then is this spoke of the HIV test as a they were somewhat in favor and December 2006, as well woman expected to make a “double-edged sword” and the of the policy. Only 15 percent as surveying patients to decision of opting out of an concern that the global of participants tested had Positive Living is published examine attitudes to testing. HIV test?” response has ignored the tested by routine testing. four times a year. Our next Of over 600 patients She also stated that potential of HIV testing or a In comparison, data from edition will be published in interviewed, 70 percent who patients may feel pressured to positive diagnosis to increase the 2006 study found December 2007. accepted the test, patients take up the option of testing, women’s vulnerability to increasing awareness of Positive Living is distributed were asked about Emergency to avoid the risk of violence. She spoke of the routine testing, with 79 with assistance from Departments as a setting for stigmatisation or not having known risks of post-test percent having heard of the testing. “73 percent of the access to services in health violence against women, and policy. 94 percent of those patients either agreed or care settings. “What this all the lack of social support for surveyed where in favor of strongly agreed that the means is that this testing that HIV-positive women. routine testing. “Some of the emergency department was a has been introduced is being Mthembu called for WHO to most notable findings have good place to perform forced upon people. It is live up to agreements in been successes in uptake of emergency department testing and treatment. Finally, testing, and 84 percent of it looks like people are being patients said that they would PEOPLE ARE NOT DYING BECAUSE diagnosed at earlier stages of recommend that a friend get disease. For example, the Subscriptions an HIV test if they went to THEY WERE NEVER TESTED. proportion of patients testing Free subscriptions are available the same emergency positive with CD4 counts less to HIV-positive people living in department.” THEY’RE DYING BECAUSE THEY DO than 100 decreased from 49 Australia who prefer to receive Dr Branson concluded by percent in 2003 to 34 percent Positive Living by mail. To subscribe, visit our website or saying “We’re encouraging all NOT HAVE ACCESS TO ADEQUATE in early 2006. While we can’t call 1800 259 666. of our programs to poll these infer a causal connection patients to find out what TREATMENT AND CARE. here, two years after the Contributions people perceive in addition to policy was introduced, nearly Contributions are welcome. In what the providers and CDC 80 percent of HIV positive some cases, payment may be perceive. In summary, we PROMISE MTHEMBU pregnant women were available for material we use. think there’s an urgent need receiving PMTCT Contact the Editor. to increase the proportion of therefore compromising the relation to human rights in interventions.” This is the persons who are aware of people’s rights to choose how health. “We are concerned highest anywhere in Africa. ADDRESS CORRESPONDENCE TO: their HIV infection. With and when to be treated in that the hunger for statistics “There has also been an over Positive Living streamlined programs, we healthcare settings, and it also and numbers is compromising fourfold increase in ART PO Box 917 Newtown 2042 find that more patients are undermines the people’s the rights in this area, and we uptake, with nearly 85,000 TEL: (02) 8588 0300 tested, more HIV infections rights to their body’s call for rights first please.” individuals on treatment by FREECALL: 1800 259 666 are diagnosed, and that most integrity.” Mthembu Dr Sheri Weiser, an March 2007. Please note that FAX: (02) 9565 4860 patients approve of HIV challenged the view that “if assistant professor of there were likely many factors EMAIL: [email protected] screening.” you expand HIV testing, you medicine in the Division of that contributed to the high WEB: www.napwa.org.au Promise Mthembu is an stand to reduce the rate of Infectious Disease in the treatment uptake in ! Positive Living is a newspaper HIV/AIDS activist from South HIV infection.” She asked Center for AIDS Prevention Botswana. Available evidence for all people living with HIV/AIDS in Africa, who currently works how this was to occur, and Studies at the University of suggests that people don’t Australia. Contributions are for the International where the evidence was to California in San Francisco, seem to be avoiding clinics for welcomed, but inclusion is subject to editorial discretion and Community of Women Living support this view. She also who discussed the testing fear of testing.” However, is not automatic. The deadline is with HIV and AIDS as Global questioned how increasing experience in Botswana, the “concerns were raised about 14 days before publication date. Advocacy Officer for Sexual testing would reduce stigma. first country in Africa to the quality of informed Receipt of manuscripts, letters, and Reproductive Rights. “Is this expanded HIV testing introduce a national policy of consent and confidentiality. photographs or other materials She’s lived with HIV for the not full of stigma anyway? PITC. Botswana, a high- Also, the majority of people will be understood to be past seven years, and is Who gets targeted for this prevalence country, was the felt they could not refuse the permission to publish, unless the contrary is clearly indicated. passionate about issues sort of testing? Is it not those first in Africa to introduce a test. Without more careful ! Material in Positive Living does concerning young people with who are perceived to have the program of widespread access monitoring of the process, we not necessarily reflect the opinion HIV. She spoke in particular HIV virus? . . . And I’m to free antiretroviral therapy. don’t have enough definitive of NAPWA except where about issues for HIV-positive thinking of a scenario where I In 2004, Botswana was data on the real impacts of specifically indicated. Any women as they relate to HIV go to the clinic today and I get introduced a national policy the policy.” reference in this publication to any testing. She stated, “The offered this HIV test where of provider initiated testing, a This session made clear person, corporation or group should not be taken to imply biggest question we have is it’s said that I might wish to response to slow enrollment that dilemmas relating to anything about the actual conduct, that who should be making a opt out, and then I go back to in treatment. Key features balancing health and rights health status or personality of that decision about a person my communities to say hello include the right to decline concerns in relation to HIV person, corporation or group. All getting tested for HIV? And – I was at the clinic today and the test, shortened pre-test are ongoing ones, particularly material in Positive Living is copy- our human rights codes I was offered an HIV test. information sessions and a in resource-poor settings. right and may not be reproduced inform us that an HIV test What sort of response am I to stated goal of informed consent. Concerns relating to provider- in any form without the prior permission of the publishers. should be an individual’s expect from my communities? PLWHA groups and human initated testing and counseling ! The content of this publication choice and decision, people Because the very fact that I’ve rights organisations raised continue to be raised on the is not intended as a substitute for should decide whether or not been offered a test does concerns that testing could be international stage. professional advice. they want to take an HIV test.” suggests that I might have coercive, that there would be

PositiveLiving " 10 Health ministers meet on BRIEFS reckless endangerment The Blood Borne Virus and Sexually no evidence that States and public health system and police but Parallels between HIV disease Transmitted Infections Sub- Territories introducing provisions that referrals to police be only progression and the aging process committee (an inter-governmental requiring disclosure of HIV status those individuals where a charge With improved antiretroviral therapy increasing the body, previously known as to prospective sexual partners will could be brought of “intent to cause life expectancy of HIV-positive people by decades ‘IGCHARD’) have been working to be effective in preventing HIV serious harm”—not those who might in developed nations, the impact of HIV on the develop nationally consistent transmission, and may indeed be charged with “recklessness” or aging process is becoming a concern as guidelines for management of HIV- undermine prevention efforts. “”negligence” who should be researchers attempt to determine whether positive people who place others at The report recommendations covered by public health dementia, heart disease and cancer – will occur risk of infection. Associate were accepted by the Australian authorities. Finally, protocols sooner or more frequently in HIV-positive people Professor Robert Griew of the Health Minister’s Council meeting should be drawn up between the as they age. School of Public Health and (composed of the Federal Health Police and Health Departments. In a plenary presentation at the Fourth IAS Community Medicine at the Minister and State/Territory Health The Commonwealth Conference on HIV Pathogenesis, Treatment and University of NSW who recently Ministers and advisers) on July 27. Department of Health and Ageing Prevention, in Sydney, it was noted that prevalence reviewed NSW guidelines, has been The Health Ministers agreed has also initiated a review, intended of HIV is increasing in older age groups with a commissioned to work on this with the reports recommendation to be independent of existing third of all adults who are HIV-positive 55 years or project, conducting a review of that states and territories continue structures for responding to HIV. over in the UK. Life expectancy is improving year relevant guidelines produced by to rely on public health (rather Professor John McNeil, Head of the by year, thanks to improved ART, but in addition individual state and territory health than criminal law) approaches Department of Epidemiology and departments. Associate Professor where possible also that there be a Preventive Medicine at Monash to longer life there is also an increase in new Griew’s report stated that there is closer relationship between the University, is leading the review. seroconversions into older age groups. The relationships between aging, HIV and the potential effects of ART are complex ones. Diseases of aging can be more common HIV- positive people, such as cancer, heart disease Criminal HIV transmission and dementia, and people living with HIV who are also affected by these conditions also experience a decreased life expectancy. booklet launched HIV can affect molecular mechanisms, which are linked to the aging process, including NAM, A community-based cases), explains how HIV can be There is concern that the interfering with removal of dead cells in the body organisation located in the UK, transmitted, and outlines why prosecutions have added to stigma and processes of cell redundancy after multiple whose website aidsmap.com posts scientific evidence cannot prove experienced by HIV-positive people cell divisions. There appears to be strong parallels daily news relating to HIV, have HIV transmission between in the UK. between the aging process and HIV progression, produced a new publication, a individuals. Criminal HIV Transmission has and future research into aging and HIV may booklet called Criminal HIV There have been more than a been produced as a response to inform our understanding of age-related diseases Transmission. Written by Edwin J dozen criminal prosecutions in widespread ignorance about HIV in general. – AIDS Map Bernard, the editor of NAM’s relation to transmission of HIV in within the criminal justice system, monthly newsletter, AIDS Wales and England since 2003. In and is aimed at people working in Treatment Update, it provides some two cases over the last year, all levels of this system. For more Increase in incidence of basic facts about HIV (which have defendants were found not guilty information contact: non-AIDS defining cancers been overlooked in many of the after using scientific evidence. [email protected] among Positive people The data from two cohort studies indicate that non-AIDS-defining cancers are occurring with greater frequency in HIV-positive people than in Don’t miss an issue – subscribe now. the wider population. The findings of two large US cohorts presented as a poster to the recent Positive Living is Australia’s national newsmagazine for people living with HIV/ AIDS. We International AIDS Society Conference on HIV cover the latest treatments news, events of importance, living with HIV and HIV-related Pathogenesis, Treatment and Prevention in arts and culture.The best way to make sure you never miss an issue of PL is to subscribe – Sydney revealed that the incidence of the AIDS- defining cancers, Kaposi’s sarcoma and non- subscriptions are free of charge, confidential and mailed out in a plain envelope. Hodgkin’s lymphoma has declined significantly Just fill out the form at right, call us on 1800 259 666, or visit www.napwa.org.au since the introduction of effective HIV treatment, however the incidence of non-AIDS-defining Privacy statement: NAPWA collects the information on this form solely for the purpose of delivering your malignancies, such as anal cancer, Hodgkin’s subscription to PL.The information you provide is securely stored and not passed on to any other party, lymphoma, liver cancer, lung cancer, melanoma, except as required to provide you with your subscription. A more detailed privacy statement can be found oropharyngeal cancer (cancer that develops in on our website (www.napwa.org.au). the part of the throat just behind the mouth, called the oropharynx), and, colorectal cancer. Of the nine most common cancers in the USA, only ! Yes – I’d like a free subscription to PositiveLiving. prostate cancer and breast cancer did not occur more frequently in people living with HIV than the NAME general US population. The researchers suggested that this is ORGANISATION (IF APPLICABLE) because “prolonged exposure to viral oncogene, moderate immune suppression, and genomic POSTAL ADDRESS instability could result in impaired cancer surveillance and the subsequent development of STATE POSTCODE DAYTIME TELEPHONE tumours.” They noted that some of these non-AIDS- EMAIL ADDRESS defining cancers are preventable, and also call for ! I am a person living with or affected by HIV the evaluation of screening programmes designed ! I work in the HIV sector to detect pre-cancerous anal lesions. The ! incidence of some of these cancers could be I’d like ______copies for my organisation for distribution to people living with HIV reduced if doctors advised their patients against MAIL COUPON TO: NAPWA, PO Box 917 Newtown NSW 2042 or fax to (02) 9565 4860. smoking and undertook routine screening for cervical and colorectal cancer. – AIDS Map

PositiveLiving " 11 NATIONAL coordinators + client support workers. $#National Association of People Services incl. mental health, diet, Living With HIV/AIDS (NAPWA) support to diverse social groups. PLWHABroadsheet % 1300 785 853 % 02 8568 0300 or 1800 259 666 ! % ! www.napwa.org.au Brisbane 3421 2841 $#Australian Federation of AIDS Heterosexuals (M) Freecall $#Positive Counselling Free ! Cairns % 4051 1028 Organisations (AFAO) counselling for positive straight people counselling for individuals, couples, ! Townsville % 4721 1384 % 02 9557 9399 ! www.afao.org.au + partners. Women’s officer avail. friends or family infected or affected by ! Sunshine Coast % 5441 1222 $#Australian Hepatitis Council Annual calendar of activities. HIV/Hep C. %#9530 2311 (Fri only). ! Gold Coast % 5576 8366 %#02 6232 4257 % 1800 812 404 ! www.pozhet.org.au $#Education and Resource Centre $#Hepatitis C Council of Qld ! www.hepatitisaustralia.com $#The Sanctuary (V) Complementary (HIV and Hepatitis) at the Alfred (HCCQ) (M) Education, support, info, therapies, massage, shiatsu, yoga Community resources on HIV, hepatitis, advocacy, counselling. % 3236 0610 NEW SOUTH WALES Area code (02) % 9515 6142 2 STDs, health research. % 9276 6993 or 1800 648 491 (country) $#PLWH/A (NSW) (M) (V) Advocacy, $#North AIDS Supported accomm. $#Inform Victoria Services directory ! www.hepatitisc.asn.au publications, speakers’ bureau, events. for PLWHA + carers. Info, day centre for plwha. Suite 5, 94 Oxford St Darlinghurst. at Myrtle Place (M–F 9.30–4.30 or by ! www.inform.webcentral.com.au WESTERN AUSTRALIA Area code (08) %#9361 6011 or 1800 245 677 arrangement). Lunch, social activities, $#Country AIDS Network Victoria $#HIV/AIDS Peer Advisory ! www.plwha.org.au massage, counselling. For monthly % 5443 8355 & [email protected] Network (HAPAN) (M) PLWHA $#ACON (M) (V) HIV prevention, health calendar % 9929 4288 $#Hepatitis C Council of Victoria group, meets once a month. % Cipri promotion, advocacy, care+support for $#Pozwest (Western Sydney) % 9380 4644 (country 1800 703 003) 9482 0000 & [email protected] plwhas, gays, lesbians, ATSI, IDU, sex Support for heterosexual men, women ! www.hepcvic.org.au $#WA AIDS Council (WAAC) (M) workers. 9 Commonwealth St Surry + partners. % 1800 812 404 or The $#Hepatitis C Helpline (V) Phone (V) Support, counselling, treatments Hills % 9206 2000 / 1800 063 060 Haven % 9672 3600 counselling, info, referral. % 9349 1111. info, complementary therapies ! www.acon.org.au $#The Haven (Western Sydney) Hep C positive volunteers welcome – (massage, Reiki, acupuncture, pranic ! Treatments Info 1800 816 518 Social support, convalescent + respite full training given. healing), retreats, forums, workshops, ! Counselling 1800 647 750 care. Meals, massage, classes, cheap peer support, education, women’s ! Positive Women 9206 2015 groceries, workshops, internet access. SOUTH AUSTRALIA Area code (08) project, newly-diagnosed program. ! Western Sydney 9204 2400 % 9672 3600 $#PLWHA (SA) – Positive Living 664 Murray St West Perth. ! Hunter 4927 6808 $#Blue Mountains PLWHA Drop-in Centre (M) (V) For plwha and closely % 9482 0000 ! www.waaids.com ! Illawarra 4226 1163 Centre 2 Station St, Katoomba. Peer affected. Counselling, treatments + $#The Living Centre (HIV/AIDS ! Northern Rivers 6622 1555 / support, meals. % 4782 2119 2 other HIV info, medical/dental, transport, Pastoral Care) Peer, social and 1800 633 637 $#MacKillop Centre (Hunter) legal advice, health+wellness activities outreach support % 9470 4931 ! Mid-North Coast 6584 0943 Training + development. % 4968 8788. (Fri lunches, community food store), $#Hepatitis Council of WA % 9227 $#Community Support Network $#Karumah (Newcastle) Social + complementary therapies (massage, 9800 (general enquiries) 9328 8538 (CSN) (V) Transport + practical home peer support for plwhas, carers, friends, aromatherapy, spiritual healing), Positive (support, info) 1800 800 070 (WA help for plwhas. family. Lunch Tue + Thu, monthly BBQ. Speakers Bureau, individual + sector country) ! www.hepatitiswa.com.au ! Sydney % 9206 2031. % 4940 8393 2 advocacy. 16 Malwa St Glandore ! West Syd/Blue Mtns % 4734 3887. $#Positive Support Network % 8293 3700 ! www.hivsa.org.au TASMANIA Area code (03) ! Hunter/Mid Nth Coast % 4927 6808. (Central Coast) Support+referral M-F $#AIDS Council of South Australia $#Tasmanian Council on AIDS, ! Illawarra % 4226 1163 10am-3.30pm % 4323 2905 (ACSA) (M) (V) Counselling, financial Hepatitis and Related Diseases ! CSN volunteers (training provided) & [email protected]. com.au + practical assistance, individual (TasCAHRD) (V) 319 Liverpool St % 9206 2038 $#Hepatitis C Council of NSW Hep advocacy. 64 Fullarton Rd Norwood Hobart % 6234 1242 or 1800 005 $#Ankali (V) Volunteer support for C Helpline % 9332 1599 % 8334 1611 / 1800 888 559 900 ! www.tascahrd.org.au plwhas, partners, family, friends. (NSW country 1800 803 990) ! www.acsa.org.au $#Sexual Health Service Referrals, counselling. % 9332 9742 ! www.hepatitisc.org.au $#Adelaide Diocesan AIDS Centre 60 Collins St Hobart % 6233 8691 $#Positive Living Centre Sydney (PLC) 33 Wakefield St Adelaide. Home care, (M) (V) Regular programs, social events, VICTORIA Area code (03) counselling, financial help, acomm., ACT Area code (02) meals, info, referrals, care coordination, $#People Living with HIV/AIDS loss+adjustment Thurs lunches $#PLWHA/ACT (M) (V) Social drop- complementary therapies, internet, re- Victoria (PLWHA Vic) (M) (V) Support, % 8241 7022 in centre at Rainbow Room, Westlund skilling, art classes. Tue–Sat 10–4, 703 advocacy, representation. Speakers’ $#Cheltenham Place (Adelaide House. Free internet, holistic bodywork, Bourke St Surry Hills % 9699 8756 bureau, treatments officer newsletter, Diocesan AIDS Centre) Short-term positive speaker’s bureau, women’s $#Luncheon Club (V) Free lunch social groups. 6 Claremont St accomm., (social respite; early group, financial help, social networks, (Mon 12–4) for people living with and South Yarra % 9865 6772 discharge from hospital; accomm. for advocacy, referral, support, counselling, affected by HIV. Luncheon Club Larder ! www.plwhavictoria.org.au rural visitors) Admission based on info, dietician’s clinic+ workshops. (Mon/ Wed 12–4) Free food, $#Victorian AIDS Council/Gay assessed needs. % 8272 8799 16 Gordon St Acton % 6257 4985 essentials for plwhas struggling on the Men’s Health Centre (VAC/GMHC) $#HIV Women’s Project Peer & [email protected] DSP. 77 Kellick St Waterloo (M) (V) 6 Claremont St, South Yarra support group, info, advocacy. $#AIDS Action Council of the ACT % 8399 3220 or 0416 040 074 ! % 9865 6700 ! www.vicaids.asn.au 64 Pennington Tce North Adelaide (M) (V) Information, referral, support. luncheonclub.org.au $#Positive Living Centre Free tea/ % 8239 9600 &#[email protected] Westlund House, 16 Gordon St, Acton $#Bobby Goldsmith Foundation coffee/brunch, complementary ! www.whs.sa.gov.au % 6257 2855 ! www.aidsaction.org.au (BGF) (V) Financial help with essential therapies, massage, naturopathy, yoga, $#Mosaic Counselling Confidential, $#Peer Support Network Weekly bills, no interest loans, financial low-cost meals, food pantry, emergency free service for people affected by HIV social + educational night for plwhas. counselling, support with study, financial relief, peer support, youth or hep C. % 8245 8100 Free dinner. Tue 6-8pm % 6257 2855 employment, accom. % 9283 8666 or program, legal centre, social/educational/ ! www.cope.edu.au $#ACT Hepatitis C Council 1800 651 011 ! www.bgf.org.au self-development courses + activities, $#Hepatitis C Council of SA % 6253 9999 or HepLine 1300 301 383 $#Positive Futures Project Support community support, outreach, computer/ % 8362 8443 (country 1800 021 133) ! www.acthepc.org for people returning to work or study, internet training, fitness classes. ! www.hepccouncilsa.asn.au volunteering, alternatives to paid work. 51 Commercial Road Prahran. NORTHERN TERRITORY Area code (08) % 9283 8666 or 1800 651 011 % 9863 0444 / 1800 134 840 QUEENSLAND Area code (07) $#PLWHA/NT (M) PO Box 2826 ! www.bgf.org.au $#The Centre Clinic Community health $#Queensland Positive People Inc Darwin 0801 % Mark Halton or $#HIV/AIDS Legal Centre Free HIV- service for plwha + LGBT community (QPP) (M) (V) Peer support, advocacy, Kath MacDonald 8941 1711 related legal services. Wills, super, but open to all. Rear 77 Fitzroy St info. 21 Manilla St East Brisbane $#NT AIDS and Hepatitis Council immigration, discrimination St Kilda % 9525 5866 % 1800 636 241 & [email protected] (NTAHC) 46 Woods St Darwin 0800 % 9206 2060 or 1800 063 060 $#AIDS Housing Action Group ! www.qpp.org.au % 8941 1711 ! www.ntahc.org.au ! www.halc.org.au State-wide confidential housing $#Queensland Association for ! Alice Springs % 8953 3172 $#Multicultural HIV/AIDS + service. % 9417 4311 or 1800 674 311 Healthy Communities (QAHC) (M) $#Men’s Line Confidential phone Hepatitis C Service $#Positive Women Victoria (M) (V) Promotes health of lesbian, gay, support, info, referral for gay + Bilingual/bicultural support, advocacy State-wide peer support + advocacy bisexual, transgender people as well bisexual men. Sun-Tue 5.30-10.30pm for people from NESB backgrounds. for positive women. Confidential support, as sexual health and Indigenous health. % 8941 1711 or 1800 181 888 % 9515 5030 or 1800 108 098 info, advice, publications. % 9276 6918 30 Helen St Newstead 4006 $#Hep C Info Line % 8922 8007 / ! www. multiculturalhivhepc.net ! www.positivewomen.org.au & [email protected] 1800 353 755 $#Positive Central Counselling, $#Aidsline (V) Phone counselling, ! Brisbane + S-E Qld % 3017 1777 dietetics, occupational therapy, physio. info, referrals. % 9347 6099. HIV+ ! North Qld % 4051 5451 Individual + group sessions, home volunteers welcome, full training given. ! Central Qld % 5451 1118 ARE YOUR DETAILS CORRECT? visits. % 9395 0444 ! www.aidshep.org.au ! Statewide % 1800177 434 The Broadsheet lists services, $#Switched On Living Monthly info $#Straight Arrows (M) Support, $#Positive Directions (St Luke’s programs and events of interest to sessions on healthy lifestyle for plwhas, services for HIV+ heterosexuals + Nursing Service) Community-based, HIV-positive people. To enquire about friends, family, carers. % 8382 2072 families. % 9276 3792 client-centred, wellness approach to a free listing or to update your details, $#PozHet (HIV Positive ! www.straightarrows.org.au HIV/AIDS with experienced HIV care email: [email protected]

PositiveLiving " 12 KEY TO SYMBOLS % Phone ! Internet & Email 2 Limited hours (M) Membership organisation (V) Volunteer opportunities