I would like to acknowledge the traditional owners of the land on which we meet, the Gadigal people of the Eora nation, and pay my respects to their elders, past, present and future, and any Aboriginal or Torres Strait Islander people present with us today. Always was, always will be Aboriginal land.
World AIDS Day has been held internationally every year on the 1st of December since 1988 to raise awareness of HIV and AIDS, and was the first ever global health day conceived as a way of highlighting the enormity of the AIDS pandemic and the responsibility to ensure access to universal treatment, care and support for people living with HIV and AIDS.
It is an opportunity for people to unite in the fight against HIV, to show support for people living with HIV, and to provide our communities a chance to acknowledge, remember and commemorate those we have lost to the virus.
This year’s World AIDS Day falls just over 35 years after the first case of HIV/AIDS was diagnosed in Australia, and this year’s theme is the “right to health.” On that theme and something I will expand on later, I would like to highlight that World AIDS Day also launches the start of Aboriginal AIDS Awareness Week in Australia and is a time for reflection: on what we have achieved with regard to the national response to HIV, and what we still must achieve around maintaining a mobilised and galvanised HIV response, as we move toward the virtual elimination of HIV transmissions by 2020.
[click the video to listen to this 6 minute speech by Jane along with subtitles]
The 2017 Annual Surveillance Report recently released by the Kirby Institute estimates that 26,444 people were living with HIV in Australia, of whom an estimated 23,648 were diagnosed. This means that an estimated 2,796 or 11% of people living with HIV in Australia are undiagnosed and unaware they are living with HIV. In NSW it is estimated that between 12,500 and 15,000 people are living with HIV.
This year in NSW there have been the first significant reductions in HIV diagnoses for bisexual and men who have sex with men, largely due to increases in testing and treatment uptake, and a sustained engagement with health services. But this is not the same for all populations – Aboriginal and Torres Strait Islander people, those from a culturally and linguistically diverse background, and heterosexual men and women are increasingly being left behind in this messaging. Nationally, between 2012 and 2016, the HIV diagnosis rate for Aboriginal and Torres Strait Islander people was 2.2 times higher than that of the non-Indigenous Australian-born population. While almost a quarter of men who have sex with men are diagnosed late with HIV, that figure increases to 55% in heterosexuals. The proportion of HIV notifications with late diagnosis was highest in people born in Central America, sub‑Saharan Africa, and Southeast Asia.
We need to engage with people for whom this mainstream messaging is not resonating, find nuanced ways to create awareness around HIV and the importance of testing and testing regularly. It’s a sad indictment that in a developed country such as Australia there are such substantially disproportionate rates of HIV diagnosis amongst Aboriginal and Torres Strait Islander people and those from a culturally and linguistically diverse background. In short, the theme of the ‘right to health’ means that we need to ensure that no-one is left behind and everyone counts. Let’s build on the success of the reductions in HIV diagnoses so that it includes everybody at risk, across not only Sydney, but all of NSW including regional and remote areas.
The campaign reminds people that the right to health is much more than simply just access to treatment and care – the 90/90/90 targets need to have another 90 added; that of a good quality of life. Michel Sidibé, the Executive Director of UNAIDS has stated that,
“all people, regardless of their age, gender, where they live or who they love, have the right to health… No matter what their health needs are, everyone requires health solutions that are available and accessible, free from discrimination and of good quality.”
While we have made significant advances in the science around HIV, we need to refocus our efforts on education, increasing testing rates and treatment coverage, and prevention messaging. Each year in Australia around 1,000 people are diagnosed with HIV, people do not know the facts about how to protect themselves and others, and stigma and discrimination remain a reality for many people living with HIV. In our quest to end the transmission of HIV by 2020, it should be noted that for those of us living with HIV, HIV will not end on 01 January 2021. But we should use this World AIDS Day as a clarion call to join the fight to end the negative impact of HIV.
Our fight is not just about the virus however. For the more than 26,000 people living with HIV in Australia, ignorance and discrimination can still limit opportunities, preventing many from living healthy, fulfilling and happy lives. Professor Linda Gail-Bekker, a renowned clinician, scientist and past president of the International AIDS Society suggests that stigma and its knock-on effects of HIV transmission, discrimination and isolation can be reduced if three basic interventions are put in place.
Firstly, through the implementation of effective and sustained mass media campaigns and health promotion aimed at dispelling the common myths. These campaigns should involve HIV positive people as message bearers.
Secondly, normalising and promoting the interaction with HIV prevention services. What is needed here are more people openly engaging about HIV testing, treatment as prevention and PrEP.
And thirdly laws and policies that protect those living with HIV from discrimination and promote them being able to access healthcare services. These are especially important for key population groups living in countries where criminalisation disrupts public health strategies.
World AIDS Day is important because it reminds the public and government that HIV has not gone away – there is still a vital need to increase awareness, fight prejudice and improve education. This is an exciting turning point. But we need a new burst of energy to end stigma, end HIV transmission and end the isolation experienced by people living with HIV.