Understanding U=U for women living with HIV

ICASO, September 2018

Since its announcement, Undetectable equals Untransmittable (U=U) has
become a call to action to assert that when someone living with HIV has an
undetectable viral load they cannot transmit HIV. Additionally, the U=U message
is evolving to challenge notions of HIV infectivity, vulnerability and stigma.

The science behind the U=U message provides the evidence that we can reduce the anxiety related to the sexual transmission of the HIV virus with confidence.

To contribute to getting this message out, ICASO produced a Community Brief on U=U. This community brief explains why it is so important to understand what ‘U=U’ means for women. The brief documents the experiences and needs of individual women living with HIV from all over the world. Important questions still remain that need to be answered to make the U=U message relevant, understandable and more meaningful to women in their diversity.

  • Download the community brief in English here

HIV diagnoses hit seven year low: Australia’s annual HIV figures released

Kirby Institute, UNSW, Monday, 24 September 2018

Australia has recorded its lowest level of HIV diagnoses in seven years, according to a new report from the Kirby Institute at UNSW Sydney.

The report, released at the Australasian HIV&AIDS Conference in Sydney, found that there were 963 new HIV diagnoses in 2017, the lowest number since 2010.

Researchers are attributing the promising results to more people getting tested for HIV, more people living with HIV starting treatment which reduces the risk of HIV transmission to effectively zero, and an increased use of pre-exposure prophylaxis (or PrEP, an HIV prevention pill).

However, it is not all good news. According to the report, a quarter of new HIV diagnoses in 2017 were among heterosexuals, with a 10% increase in diagnoses over the past five years.

Among Aboriginal and Torres Strait Islander populations, HIV diagnoses have been increasing over the past five years, with rates almost two times higher than the Australian-born non-Indigenous population in 2017.

HIV incidence in Indigenous and non-Indigenous populations in Australia

The Lancet HIV: August 07, 2018

DOI: https://doi.org/10.1016/S2352-3018(18)30135-8

Ward, J ;McManus, H; McGregor, S;  et al.

Methods

Using the National HIV Registry at The Kirby Institute at UNSW, Sydney, NSW, Australia, we collated and analysed annual HIV notification data for 1996–2015. Patients who were not born in Australia were excluded. We calculated the rates of HIV diagnoses with annual trends in notification rates for Indigenous versus non-Indigenous Australians by demographic characteristics, exposure categories, and stage of HIV at diagnosis. For missing data, assumptions were made and verified through sensitivity analyses. Annual rate ratio (RR) and 4 year summary rate ratio (SRR) trends were calculated to determine patterns of HIV diagnosis in the two populations.

Findings

Between Jan 1, 1996, and Dec 31, 2015, 11 492 people born in Australia were reported with a diagnosis of HIV, of whom 461 (4%) were recorded as Indigenous Australians and we classified the remaining 11 031 (96%) as non-Indigenous Australians. For exposure to HIV, among Indigenous Australians a higher proportion of diagnoses occurred among women, and through injecting drug use and heterosexual sex than among non-Indigenous Australians (p<0·0001). Among Indigenous Australians, we found a significantly higher SRR of HIV diagnoses among men in the period 2012–15 than in previous periods (SRR 1·53, 95% CI 1·28–1·83; p<0·0001), and significantly higher diagnosis among Indigenous women (4·92, 4·02–6·02; p<0·0001) for the entire study period than among non-Indigenous women. Concurrently, a decrease in HIV diagnoses of 1% per annum (RR 0·99, 95% CI 0·98–0·99; p<0·0001) across the study period was seen among non-Indigenous people. Indigenous Australians were more likely to be diagnosed at an advanced stage of HIV infection than non-Indigenous Australians (20·8% vs 15·1%; p=0·0088).

Interpretation

Greater efforts should be made to include Indigenous people in prevention strategies, particularly newer biomedical interventions, such as scale up of pre-exposure prophylaxis and treatment as prevention initiatives in Australia. More involvement of Indigenous Australians in these approaches is also required to prevent widening of the gap in HIV diagnosis rates between non-Indigenous and Indigenous Australians.

 

Newly available: WHO HIV PrEP Implementation Tool Mobile App

World Health Organization, August 1, 2018

The WHO PrEP Implementation Tool App for Health Workers App is now available.

On-the-go access to the following modules from the WHO PrEP Implementation Tool:

  • Clinical: for clinicians, including physicians, nurses and clinical officers
  • Counsellors: for staff who counsel people as they consider or start taking PrEP, and support them in coping with side effects and adherence strategies
  • Pharmacists: for pharmacists and people working in pharmacies; to provide information on the medicines used in PrEP as well as storage conditions
  • Testing providers: for people who provide testing services at PrEP sites and laboratories
  • PrEP users: for people taking PrEP and people interested in taking PrEP to reduce their risk of acquiring HIV; to support them in their choice and use of PrEP.

For more information and to download app, click here 

You can also visit these two websites:

Surgeon Who Was Denied Disability Insurance for Taking PrEP Tells His Story

Earlier this year, urology resident Dr. Philip Cheng appeared on the front page of the New York Times. Here was the headline: He Took a Drug to Prevent AIDS. Then He Couldn’t Get Disability Insurance.

The piece understandably drew widespread attention, with sharp disapproval of the denial from ID specialists and public health officials. We couldn’t understand why someone adopting the recommended strategy for HIV prevention was being penalized.

In this Open Forum Infectious Diseases podcast, he tells us some more about himself and the events surrounding his decision.

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).