The HIV epidemic is not (yet) over

An announcement from Australian scientists, epidemiologists and community sector representatives this week states that the AIDS is no longer a public health issue in Australia. Thirty-three years of collaborative activism, forward thinking public health policy, innovation and investment in scientific advancement and a healthcare industry committed to involving people living with HIV in their healthcare, combined with the huge impact of effective antiretroviral drugs have meant that the number of Australians diagnosed with AIDS has dwindled.

To properly grasp the impact of this announcement, there are two issues that need to be very clear.

• The distinction between HIV and AIDS
• The announcement refers specifically to Australia, where the circumstances are quite different from those in other parts of the world.

Why HIV is different from AIDS

The Human Immunodeficiency Virus (HIV) is the infectious agent that causes AIDS (Acquired Immune Deficiency Syndrome). HIV is a virus carried in the blood and other bodily fluids such as semen and vaginal secretions. HIV is passed on through activities involving exchange of these fluids – for example during sexual activity, the use of shared needles or the use of contaminated blood products. There are very effective treatments available for HIV, and when taken properly and consistently, treatment allows people diagnosed with HIV to live largely normal, healthy lives, even though treatment never completely removes HIV from the body.

AIDS is the syndrome (a group of symptoms) that occurs after long term, untreated HIV infection. HIV infects critical cells of the immune system, predominantly white blood cells called CD4 helper T cells. If left untreated, people living with HIV experience a severe drop in the number of these CD4 T cells, and lose the immune response needed to ward off even the most common infections. This is what was so frighteningly common in the early days of the epidemic, and which is not often seen in Australia any more. AIDS occurs in advanced HIV infection, and can be prevented if treatment is given consistently and early enough to preserve and restore immunity.

The Australian context

Australia’s response to HIV has been world class. A rational and sound public health policy in the early days of the epidemic, combined with ongoing collaborative efforts have led to the current situation where relatively small numbers of new HIV infections are diagnosed in Australia and very few people are diagnosed with AIDS. This response has involved policy makers, clinicians, scientists and researchers and critically, HIV positive people. Australia’s response has been envied around the world, and forms a model of best practice in public health. Populations such as sex workers, injecting drug users and gay men have been engaged and involved in developing programs to encourage HIV testing, access to treatment and harm minimisation. While stigma and discrimination do exist in Australian society, HIV testing and HIV treatment are widely available and publicly funded.

This context is very different from many other countries where there are variations from the Australian context in pretty much every parameter – government involvement may be patchy, engagement with affected communities may not exist, tackling stigma may be stifled by morality, access to testing and treatment may be complex and expensive, the infected populations may be diverse and the magnitude of infection on a shocking scale.

Even in Australia, there are vulnerable populations who are less well served by the current response. HIV diagnoses in Aboriginal and Torres Strait Islander people are on the increase, and a significant proportion of new infections are diagnosed ‘late’, when immune damage has already occurred. Young people (especially young women) are also being diagnosed at an alarming rate.

What you need to know

A very particular set of circumstances has led to a powerful (but not perfect) response to HIV in Australia. The vast majority of HIV positive people know their status and are on effective treatment, and are therefore prevented from developing AIDS. This situation, however, is not the case in most countries around the world. AIDS may be a rarity in Australia, but it is certainly not a rarity in the world, and until testing, treatment and a possible cure are available across the globe, claims of the ‘end of AIDS’ are frankly misleading.

Read the press release here.

AIDS HIV public health