Australia has conquered AIDS, but not HIV

Antiretroviral drugs have cut AIDS deaths in Australia, though public education efforts haven’t eliminated HIV transmission.

Nathan Makan (CC BY-NC-ND 2.0)

Australia has conquered AIDS, but not HIV

Australia’s AIDS epidemic is over, and the country could virtually eliminate HIV infections by 2020, according to an announcement released today by a team of researchers and community experts ahead of the 21st International AIDS Conference, set to begin next Sunday in Durban, South Africa.

“The AIDS public health threat has morphed into an HIV prevention challenge,” says medical epidemiologist Andrew Grulich, head of the HIV Epidemiology and Prevention Program at the Kirby Institute for infection and immunity in society, which leads Australia’s national surveillance of HIV/AIDS and is based at the University of New South Wales (UNSW) in Sydney.

Grulich adds that Australia “compares favorably" to a handful of countries such as Denmark that have reined in HIV infections and effectively eliminated AIDS deaths. A paper in The Lancet Infectious Diseases last May reported that the HIV infection rate among Danish gay men is only 0.14% a year, or one in 700. That rate approaches the one per 1000 incidence rate the World Health Organization has set as the threshold for eventually eliminating the HIV epidemic. Although 1000 Australians are diagnosed with HIV every year, effective and accessible therapies mean that few people progress to AIDS, according to the announcement from Grulich and his colleagues at five organizations. Along with the Kirby Institute, participating bodies are the Australian Federation of AIDS Organisations, the Peter Doherty Institute, Pacific Friends of The Global Fund, and the National Association of People with HIV Australia (NAPWHA).

However, the researchers warn that too many people are still becoming infected with HIV and a diagnosis often comes quite late, after the virus has started causing illness. Consequently, they are calling for a long-term strategy to stop HIV from spreading. That strategy must target “vulnerable communities,” including women, isolated gay men, and non-English speakers, says Cipri Martinez, president of NAPWHA in Sydney.

Though welcoming the end of the “AIDS epidemic,” UNSW social policy expert Susan Kippax cautions that the “HIV epidemic” is not over. She adds that over the past decade HIV diagnoses have increased 13%. “We need to be careful about our language,” she argues. Many people do not distinguish between HIV and AIDS, and may incorrectly believe that prevention is no longer critical, she says.

Still, Kippax agrees with Grulich and company that the near zero AIDS diagnoses is the culmination of a 33-year response spanning science, medicine, and community outreach that began soon after HIV arrived in Australia. They also attribute the decline of AIDS to the nation’s universal health care system, which provides affordable, effective, and well-tolerated treatments for HIV infection.

Pre-exposure prophylaxis (PrEP)—medication taken daily to prevent HIV infection—has also been particularly significant, says Peter Doherty Institute Director Sharon Lewin, an infectious diseases physician in Melbourne, Australia. PrEP has been approved for use in Australia, and is being made available in trials in Sydney, Melbourne, and Brisbane. PrEP is currently being considered for funding under Australia’s Pharmaceutical Benefits Scheme, which subsidizes medicines for the general public.