How Australia came close to eliminating HIV

HIV diagnoses in Australia have fallen to record lows and the country is on track to eliminate transmissions. All thanks to the legacy of Australia’s early and effective response, reports Gary Nunn from Sydney.

During the 1980s outbreak, a political friend of then Health Minister Neal Blewett told him: “Look, there are no votes in collaborating with these people.”

He was referring to gay men, sex workers and people who inject drugs, the most affected by the virus.

Australia’s exceptional response to HIV/AIDS owes much, experts say, to the politicians and other powerful people who offered these communities to be part of the response to the epidemic.

It was an extraordinary “leap of faith,” says author Nick Cook.

“Homosexuality was still illegal in some Australian states and those three groups were stigmatized as criminals; the most hated in societyCook says.

“It was also a smart move: You couldn’t see the government spending money on telling gay men how to have sex and drug addicts how to inject safely during an epidemic. But they could channel money to trusted community groups that could.”

“A model country”

As the 40th anniversary of Australia’s first HIV diagnoses approaches, two recent books detail what distinguishes the country’s lauded public health response.

cook’s book, Fighting for Our Lives (“Fighting for our lives”), traces the aforementioned collaboration. In The Eye Of The Storm (“In the Eye of the Storm”), written by three Australian academics, tells the little-known stories of individuals who volunteered in large numbers to alleviate their suffering and that of others.

By the end of the 1980s, Australia was praised by the World Health Organization (WHO) as a model of prevention for other countries to follow suit.

It was one of the few nations to prevent an epidemic among drug addicts, with rates between five to 10 times lower than some European countries and parts of the United States.

Infections among Australian sex workers were rare. In the world, 50% of patients with HIV are women. In Australia, they suppose about 10%.

“So Prime Minister Bob Hawke’s rapid introduction of syringe exchange was way ahead of most countries,” says Eamonn Murphy, deputy executive director of the UN’s UNAIDS programme.

“Involving the most affected population, especially gay men, at all stages, from design and implementation to assessment, research and funding, made the Australian response one of the most effective.”

motivated community

Cook says Australia’s isolated geography provided a “head start”: the virus came later.

There was alsoa community then coordinated and emboldened, ready to step forward. In 1978, the first march of the famous Sydney Mardi Gras protest united various groups from the LGBT community.

This created the conditions for people to volunteer in such high numbers, says Dr. Shirleene Robinson.

“The infrastructure was there: publications, connections and organizations that could be used directly against the epidemic,” says Robinson, one of the authors of “In the Eye of the Storm.”

The volunteers, many seriously ill or in great pain, provided home care for the sick and dying, promoted needle exchanges, opened helplines, produced educational resources, provided friendship and practical support.

They helped HIV/AIDS patients navigate a hostile medical system that, in previous decades, treated homosexuals as mentally ill and people who needed healing.

The Victoria State AIDS Council conducted training sessions on how to care for dying people for those who were unprepared.

“They still didn’t know how the virus was transmitted, but there was an overwhelming sense of needing to do more,” says Robinson.

The doctor makes special mention of the lesbian community, who also helped despite being a sector that was little affected. “As part of the marginalized LGBT community, they empathized,” she says.

For this reason, he asks that these volunteers be remembered more.

“They have been underrated compared to the heroic images of iconic Australian volunteers such as lifeguard surfers and firefighters. They also saved lives”.

However, there were also drawbacks. AIDS foundations were paralyzed as to how far they could lobby the governments that funded them.

In 1991, the direct action group ACT UP Australia, whose members were impatient for an early treatment drug, stormed the Ministry of Health demanding “AIDS drugs now” from then Minister Brian Howe.

Elimination in sight

At the time, the UK and US had governments whose position on HIV and gay equality had been widely characterized as hostile.

australia had a Labor government committed to a bipartisan approach to HIV/AIDS and, significantly, a conservative opposition that supported his swift action.

Eamonn Murphy says this bipartisan support continues today, meaning Australia continues to lead the world on this issue.

“Your PrEP program (the daily HIV prevention pill) is a model that we use at Onusida for other countries,” he says.

“Australia launched one of the first large-scale implementations. They put it into their pharmaceutical benefits scheme relatively early, making it free. They combined the expertise of the researchers and that of the community, rather than a hierarchical approach. You don’t see that in other public health responses.”

The results, says Murphy, speak for themselves.

“Australia is one of a handful of countries that adhere to the three 90s rule: 90% of people diagnosed; 90% of them are in treatment and the 90% have an undetectable viral loadwhich means they cannot sexually transmit the virus.”

In December, the Kirby Institute reported the lowest number of new HIV diagnoses in a year since 1984.

With 633 cases, a six-year downward trend continued, although experts believe the substantial drop of 901 diagnoses in 2019 is due to Covid-19 restrictions.

The director of sexual health for the health organization ACON, Matthew Vaughan, says there is a remarkable result in this ongoing collaboration.

“We are on our way to end HIV in New South Wales, Australia’s most populous state, by 2030.”.