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The end of HIV: how do we get there?

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Treatment is now the focus of prevention

The world’s HIV research policy and advocacy community will converge in Melbourne in July for the 20th International AIDS Conference. This is the first time this particular event has been held in this country, and provides an opportunity to focus on our response to the epidemic in our region, where we are now, and how to reduce transmission to zero. Over the years, the prevailing metaphor has evolved from the Grim Reaper’s “prevention is the only cure we’ve got” to its polar opposite, “treatment as prevention”.1,2 Recent high-profile reports of “cures” provide hope that ending HIV is a possibility.35 But what is needed to ensure this goal is accessible to all?

While Australia’s clinical and public health response to HIV has ensured that we remain a low-prevalence country with a relatively concentrated epidemic, there is currently a rising rate of new infections — the highest in more than 20 years.6 To meet this challenge, state and national HIV strategies have outlined targets that aim to halve sexual transmission by 2015, with the goal of virtual elimination of transmission by 2020.7,