Tagged with HIV prevention

Australia’s HIV transmission rate falls

New data out of the Kirby Institute shows that the rate of HIV transmission in Australia has fallen, returning to a downward trend that has been the norm for more than a decade. So why are the papers saying that HIV infections are ‘at an 20-year high‘?

As I have been arguing for several years (see this post from 2013 and this one from 2010) the use of raw diagnoses as the only measure of progress against HIV in Australia fails to take account of the reality that there are more people living with HIV every year. With a greater HIV-positive population, in any HIV prevention scenario a greater number of new diagnoses can be expected. Because this is the case, simply looking at the number of new diagnoses tends to mask the considerable success we have had in combating HIV.

Here’s a graph that shows (in pink) the ‘HIV transmission rate’ (the number of new infections recorded per 100 people living with HIV) in Australia over the last 13 years:

HIV tx rate 2013


The blue line shows the official HIV stats, and there’s no doubt they have trended upwards over the period. That’s nobody’s idea of good news, least of all mine. We want to turn that line around (and I think we will soon).

The pink line is my estimate of the HIV transmission rate. As you can see, it has actually fallen in nine out of the last 11 years and, despite a rise last year, it looks to be trending downwards. That is a good sign that, despite the rising population of PLHIV, the percentage of people who pass HIV on has been falling. That is a marker of success that is ignored by the official reports.

The use of the transmission rate as an alternative to the raw numbers isn’t just my idea: the US National HIV/AIDS Strategy uses it. The CDC uses it. Peer-reviewed epidemiological studies use it.

I am not suggesting we should ditch the reporting of the raw numbers – they are a useful and important measure. Governments and health economists care, as they should, about the numbers of people who will need medical care and support into the future. But they are less helpful when measuring the success of HIV prevention campaigns. A rise in infections doesn’t mean that prevention is failing unless the rise is greater than that which can be attributed to the increased PLHIV population. In fact, as the graph above shows, in most recent years the rise in infections is below that natural increase and that means we have had some measure of success – not that you’d know it from reading media reports or Kirby Institute press releases.

Stories headlined ‘HIV infections at a 20-year high’ suggest that, 20 years ago, things were better than they are now. They weren’t: people were dying in droves. The rate of HIV infections in 1994 was unnaturally low because a large proportion of PLHIV were seriously ill and dying. Suggesting that we have an alarming rise in new infections 20 years later, when we have twice as many people living with HIV and most of them are leading healthy, productive (and sexually active) lives is blinkered pessimism.

Disclaimer: as with my previous posts on this topic, I have to point out that I am neither an epidemiologist nor a statistician, and while my estimate is based on published data from the Kirby Institute, I don’t have access to the detailed data on which it is based. 

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How much evidence do you need?

Newly-elected AFAO vice-president Bridget Haire has a timely piece on the ABC Science website about HIV prevention technologies, calling for regulatory action to make these available in Australia.

If a person with HIV consistently takes effective anti-HIV medication, the chances of them infecting a sexual partner are close to zero. The condom, while remaining cheap, effective and sometimes convenient, is now just one part of the HIV prevention toolbox rather than the whole kit and kaboodle — in theory at least.

But in practice, access to these new forms of HIV prevention is constrained by regulatory systems, concerns about cost, and a fear of new technologies eroding the ‘condom culture’ that saw the whole scale adoption of condoms by gay men worldwide in the mid-80s, who perceived the threat of HIV, and improvised a form of protection.

Read the full article here.

Also recommended:

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Time to go home


The International AIDS Conference is drawing to a close and with it, so is my long overseas journey. Tomorrow I’m off to London, then Singapore, then Melbourne and home. I’m ready.

The conference has been amazing – there is much good work being done out there and I’ve found plenty to be inspired by, challenged by, and occasionally angered by. I’ve met some fantastic people, including this guy, this guy, this guy and lots of others who aren’t so easily linked to. Plus I’ve renewed a lot of friendships built up over previous conferences and events.

The two “big deals” out of this meeting for me are the microbicides breakthrough (of course) and the focus on criminalisation of HIV transmission/exposure, and the complex legal, ethical and public health challenges associated with that. I’ll be writing about those two for an upcoming issue of Positive Living.

As the meeting winds up, it would be easy to be dismissive of the prospects for anything to really change in the course of the HIV epidemic – to judge the event as long on talk and short on action – but I’ll suppress my usual cynicism and say that I do think these events make a difference, if only to remind those of us working in the field of how much remains to be done and how comprehensively the leaders of the world have failed to take decisive and meaningful action to save people’s lives.

We are making progress. We have new prevention technologies coming on line – the successful CAPRISA microbicide trial will be a milestone in the history of the HIV epidemic, and there is every reason to expect that research into pre-exposure prophylaxis (PrEP) and treatment-as-prevention will give us new prevention tools and the hope of a prevention paradigm that goes beyond the “just use condoms” message that I have argued is unsustainable in the long term.

Unfortunately, not a lot of this is getting through to the people who have the power to make decisions, and so often we see public policy driven by prejudice, fear and moralisation rather than evidence of what works. As Gill Greer, Director-General of IPPF, said in a session the other day, “when morality gets in the way of policy, the result is too often morbidity and mortality.”

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March for Human Rights at AIDS 2010


One of the perennial set-piece events for the International AIDS Conference is the big, colourful march through the centre of the host city demanding universal access/equal rights/new drugs/whatever the focus is on this time round. Last night’s event, marching through Vienna to Heroes’ Square, was no disappointment.

Many thousands of activists, advocates and people living with HIV made a loud, brash and joyous sight as they moved through the city. For me it’s the one moment of jubilation in a long week of scientific data and depressing news about the march of HIV in the developing world. This year we had extra cause to celebrate – the fantastic news this week about the success of a vaginal microbicide trial – and we made the most of that while working to highlight human rights issues. Will (above) decided he’d stand up for the human rights of African men’s foreskins.

Lots more photos on Flickr.

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