Priorities for preventing a concentrated HIV epidemic among Aboriginal Australians

Priorities for preventing a concentrated HIV epidemic among Aboriginal and Torres Strait Islander Australians

James S Ward, Karen Hawke and Rebecca J Guy
Med J Aust 2018; 209 (1): 56. || doi: 10.5694/mja17.01071
Published online: 2 July 2018
Greater efforts are required to prevent human immunodeficiency virus infection (HIV) escalating among Aboriginal and Torres Strait Islander Australians. Recently released national data highlight a 33% increase in new HIV diagnosis rates among Aboriginal and Torres Strait Islander people, from 4.8 per 100 000 population in 2012 to 6.4 per 100 000 population in 2016. In the same period, newly diagnosed HIV rates among Australian-born non-Indigenous people decreased by 22% (from 3.7 per 100 000 population in 2012 to 2.9 per 100 000 population in 2016).

Community-level changes in condom use and uptake of HIV PrEP by gay and bisexual men in Melbourne and Sydney

Lancet HIV (2018). Published online 06 June 2018. doi: 10.1016/S2352-301830072-9.

Abstract:

Background

Pre-exposure prophylaxis (PrEP) has been rapidly rolled out in large, publicly funded implementation projects in Victoria and New South Wales, Australia. Using behavioural surveillance of gay and bisexual men, we analysed the uptake and effect of PrEP, particularly on condom use by gay and bisexual men not using PrEP.

Methods

We collected data from the Melbourne and Sydney Gay Community Periodic Surveys (GCPS), cross-sectional surveys of adult gay and bisexual men in Melbourne, VIC, and Sydney, NSW. Recruitment occurred at gay venues or events and online. Eligible participants were 18 years or older (face-to-face recruitment) or 16 years or older (online recruitment), identified as male (including transgender participants who identified as male); and having had sex with a man in the past 5 years or identified as gay or bisexual, or both. Using multivariate logistic regression, we assessed trends in condom use, condomless anal intercourse with casual partners (CAIC), and PrEP use by gay and bisexual men, controlling for sample variation over time.

Findings

Between Jan 1, 2013, and March 31, 2017, 27 011 participants completed questionnaires in the Melbourne (n=13 051) and Sydney (n=13 960) GCPS. 16 827 reported sex with casual male partners in the 6 months before survey and were included in these analyses. In 2013, 26 (1%) of 2692 men reported CAIC and were HIV-negative and using PrEP, compared with 167 (5%) of 3660 men in 2016 and 652 (16%) of 4018 men in 2017 (p<0·0001). Consistent condom use was reported by 1360 (46%) of 2692 men in 2013, 1523 (42%) of 3660 men in 2016, and 1229 (31%) of 4018 men in 2017 (p<0·0001). In 2013, 800 (30%) of 2692 men who were HIV-negative or untested and not on PrEP reported CAIC, compared with 1118 (31%) of 3660 men in 2016, and 1166 (29%) of 4018 in 2017 (non-significant trend).

Interpretation

A rapid increase in PrEP use by gay and bisexual men in Melbourne and Sydney was accompanied by an equally rapid decrease in consistent condom use. Other jurisdictions should consider the potential for community-level increases in CAIC when modelling the introduction of PrEP and in monitoring its effect.

New evidence supports HIV screening in young adulthood

Science Daily, December 19, 2017

A new study suggests that the most beneficial age for a one-time screening HIV test of the general population would be age 25.

The report — led by researchers at Massachusetts General Hospital  working with the U.S. Centers for Disease Control and Prevention (CDC) and the Massachusetts Department of Public Health — will be published in the Journal of Adolescent Health and has been issued online.

Smoking Highly Dangerous for HIV-Positive Patients

Specialty Pharmacy Times,  Tuesday, October 17, 2017

Patients with HIV who smoke may have an increased risk of lung cancer mortality compared with the risk of dying from HIV, according to a new study published by JAMA Internal Medicine. 

These findings suggest that healthcare providers should strongly advocate for smoking cessation and cancer screening for patients with HIV.

The abstract concludes with: Those PLWH who adhere to ART but smoke are substantially more likely to die from lung cancer than from AIDS-related causes.

 

The updated 2017 ASHM HIV pre-exposure prophylaxis (PrEP) Guidelines

Journal of Virus Eradication, 2017; 3: 168–184

Daily use of co-formulated tenofovir and emtricitabine for HIV pre-exposure prophylaxis (PrEP) by populations at high risk of HIV infection is now recommended in guidelines from the United States, Europe and Australia and globally through the 2015 WHO guidelines. 

These 2017 Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine‘s (ASHM) PrEP Guidelines are an updated adaptation of the 2014 US Centers for Disease Control‘s PrEP guidelines and are designed to:

    • Support the prescription of PrEP using forms of coformulated tenofovir and emtricitabine that have been registered in Australia by the Therapeutic Goods Administration and other bioequivalent generic drugs that are available in Australia through self-importation, private prescription or Australian PrEP clinical trials
    • Assist clinicians in the evaluation of patients who are seeking PrEP
    • Assist clinicians in commencing and monitoring patients on PrEP including PrEP dosing schedules, management of side-effects and toxicity, use of PrEP in pregnancy and in chronic hepatitis B infection and how to cease PrEP

Daily PrEP with co-formulated tenofovir and emtricitabine, used continuously or for shorter periods of time, is recommended in these guidelines as a key HIV-prevention option for men who have sex with men (MSM), transgender men and women, heterosexual men and women, and people who inject drugs (PWID) at substantial risk of HIV acquisition.

Sex without fear – ​my experiment with ​the HIV-prevention drug PrEP

The Guardian, Thursday 22 June 2017 

When I first heard about the HIV-prevention drug PrEP – pre-exposure prophylaxis – I had mixed feelings.  It remains controversial even among readers of the gay magazine Attitude. “Why should my taxes pay for these sluts to have bareback sex?” is a typical comment. But I was worried that my reaction was the result of anti-gay conditioning, being brought up to think that I didn’t deserve the same rights as the rest of society, and I wanted to challenge this by taking the drug for three months to find out more.