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Close gaps in HIV detection, treatment: AMA

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A rebound in HIV infections has underlined the need for governments to ramp up their investment in prevention programs and treatment, according to the AMA.

As more than 12,000 HIV experts, activists and carers descended on Melbourne late last month to attend the 20th International AIDS Conference, AMA President Associate Professor Brian Owler said a jump in the nation’s infection rate to its highest level in 20 years sounded a clear warning that there needed to be a change in the nation’s response to the deadly disease.

“In the face of increasing rates of HIV infection, a business-as-usual approach is not enough,” A/Professor Owler said. “Testing rates have declined, rates of unprotected sex and high-risk sexual behaviour have increased, and a significant number of those infected with HIV are not receiving treatment.”

The AMA President’s comments followed the release of a report by the University of New South Wales’ Kirby Institute, which showed there were 1235 new cases of HIV diagnosed and reported across Australia last year, virtually unchanged from 2012, when there was a 10 per cent surge in new infections to the highest level in 20 years.

The number of new infections is now 70 per cent higher than those detected in 1999, and a decline in testing rates has led to estimates that around 10,000 people with HIV do not realise they are infected, while more than a third are diagnosed late, delaying treatment and increasing the risk of transmission.

A major concern for health workers is increasing ignorance and complacency about HIV, particularly among younger men, and gaps in care which have meant up to half of those with the disease are not receiving antiretroviral treatment.

At a meeting in June, the nation’s Health Ministers committed to rejuvenating the country’s HIV effort.

In a joint statement, the Ministers committed to halving new HIV transmissions in Australia by 2015, and their “virtual elimination” by 2020.

Supporting this, the Health Department has announced that from 1 July next year patients in the community who use antiretroviral therapies will no longer have to demonstrate a link to a hospital in order to receive a publicly subsidised supply, and the authority prescription process will be streamlined.

The change means that prescribing doctors will no longer have to provide a hospital provider number.  

The nation’s Chief Medical Officer, Professor Chris Baggoley, said the country was tackling HIV as part of a broader assault on blood borne viruses.

“We understand in Australia that HIV is not addressed – cannot be addressed – in isolation from other blood borne viruses and sexually transmissible infections,” Professor Baggoley said.

He said measures to tackle HIV, hepatitis B and C and STIs had been combined and “together the strategies support a coordinated, holistic effort across all conditions. They respond to the intrinsic links through co-infections, common risk factors and priority populations”.

A/Professor Owler said the national strategies were welcome, not least because they included concrete targets that would provide impetus for action.

But he said immediate action was needed to close persistent and growing gaps in testing and access to affordable treatment.

“We urgently need an implementation action plan and government investment if we are to turn aspirational targets into a reality,” the AMA President said. “This must include a focus on reducing inequities and engaging with communities experiencing higher infection rates and poorer health outcomes.”

Former US President Bill Clinton told the AIDS Conference that advances made in the fight against HV had put the prospect of an AIDS-free generation within reach.

“The AIDS-free world that so many of you have worked to build is just over the horizon. We just need to step up the pace,” Mr Clinton said. “We are on a steady march to rid the world of AIDS.”

Hopes for improved treatment for HIV were boosted ahead of the AIDS Conference when it was revealed that two Australian patients had had their cancer and AIDS infections virtually eradicated following bone marrow transplants.

Cancer is a common complication among those with HIV, and the discovery has opened up inquiries into the use of stem cell transplants as a HIV treatment.

As medical researchers explore new and better treatments, the AMA has released its Position Statement on Sexual and Reproductive Health 2014, in which it has urged governments to do more to educate people about HIV and sexually transmitted diseases and strengthen early detection and treatment initiatives.

The Position Statement can be viewed at: position-statement/sexual-and-reproductive-health

Adrian Rollins