Lots of discussion over the last couple of days about the recently released annual surveillance report for HIV, which shows a big jump in the number of HIV notifications for the last year, especially in NSW. Obviously any rise in HIV is concerning and I’ll leave it to the experts to debate the likely causes of that rise, but as I have previously argued, a seemingly important measure of the infection rate remains unreported.
Three years ago, I argued that HIV infections aren’t going up, they’re going down – if you consider that the number of new infections must be a function of the number of people living with HIV, the picture over the last few years is starkly different. I’ve updated the data from that post in the chart below (click it for a larger version):
The pink line on the chart shows the number of new diagnoses per 100 people living with HIV, based on the Kirby Institute data. There has been a noticeable increase in that measure over the last year but this follows a long period of decline from a high in 2002 of 6.29 to a low in 2011 of 4.60 (incidence per 100 PLHIV).
My argument here is that, whenever an HIV infection occurs, one HIV-positive person is the source of that infection, and as the number of people living in the community with HIV rises, some rise in the total number of new infections is inevitable. The picture over the last few years shows that rise has been lower than would be predicted by the increase in the HIV-positive population alone, which I think is a strong sign that HIV prevention efforts have been working.
The increase in the last 12 months – from 4.60 to 4.87 (incidence per 100 PLHIV) – represents a 6 percent rise in infections, and while that’s lower than the 10 percent rise in the raw numbers, it’s definitely worrying. But it’s a single data point and we won’t know for a year or two if that is the beginning of a sustained rise or just a blip in the trend.
It’s understandable that researchers, government and the media are troubled by the annual jump in new infections (and it has been an annual event for many years now) but, as long as positive people are remaining healthy and sexually active, at least part of that rise is directly explained by the increase in the population of people who are available to be the source of new infections.
The usual caveats apply: I am neither an epidemiologist nor a statistician, and the only data I have to work with is that published in the surveillance reports. Happy to be corrected on any of the data or to be (politely) disagreed with as to my interpretation of it.
This is a bit of an experiment. Seeing as how I rarely write anything for the blog these days, I’m going to try to do a weekly post with lots of links to interesting things I’ve noticed during the week, a bit of personal narrative and maybe a photo or two.
I came home from university on Monday feeling rather brilliant after getting my two major essays back, both with ‘A’ grades. Then I read this blog post by Daniel Reeders and this review by Dion Kagan and I realised I was just an old duffer again. Daniel’s insightful analysis of a real-world encounter with HIV stigma, and Dion’s brilliant synthesis of multiple streams of nostalgia and documentary-making, put my first-year legal blatherings in their rightful place. Thanks to Dion I now have the terms ‘melancholic disavowal’ and ‘traumatic unremembering’ at my disposal.
Still on the subject of stigma, last week I had the opportunity to talk about the stigma that is increasingly apparent around hepatitis C virus infection among HIV-positive gay men, at a public forum hosted by Living Positive Victoria. I recently came across Gareth Owen‘s 2008 paper ‘An “elephant in the Room”? Stigma and Hepatitis C Transmission Among HIV‐positive “serosorting” Gay Men’ that examined this issue and I used some material from that paper in my talk. One sample quote:
‘The hep C situation on the scene is much like HIV was in the early days, so guys will avoid having sex with other guys who they definitely know have hep C. Though they tend to assume that guys don’t have hep C if it isn’t mentioned.’
I also used some anonymised quotes from a prominent serosorting/bareback hookup site to support my observations – I found dozens of texts like ‘not on here to get hep c guys so please be upfront about it’ and ‘I’m Hep C neg and not really into putting that at risk, being poz is enough as it is.’
It’s impossible to ignore the obvious parallels with similar statements made by HIV-negative guys about HIV.
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.
Best-selling Australian author Bryce Courtenay has apologised for his use of the term ‘innocent’ to describe people with medically-acquired HIV/AIDS.
After the publication of his book April Fool’s Day in 1993, Courtenay was criticised for describing his haemophiliac son, Damon, as an innocent victim of AIDS.
In an interview broadcast on ABC Radio National’s Breakfast program this morning, Courtenay said:
The word ‘innocent’ was unfortunate, it really was. It was never used in the book and I think I used it once. People had a — certainly, homosexual people — had a right to be angry. But the net result of April Fool’s Day was the most important book I think I’ve ever written and had it not been for Damon saying, “Dad, you have to tell the world that it’s not a punishment from God; it’s a virus,” I may never have written the book. […]
But yes, for anybody I offended with the word ‘innocent’ I humbly apologise because we’ve come a long way since.
It’s good that Courtenay has finally acknowledged his mistake, albeit 17 years after the outcry it caused. While no compassionate person could fail to sympathise with Courtenay’s grief at losing his 24-year-old son, separating people with AIDS into ‘innocent’ and ‘guilty’ victims is plainly offensive, as it suggests some people with the virus deserved to get it, or are culpable for the ‘innocents’ infection. Language like this led to increased stigma among gay men, who were blamed for the spread of HIV at the very time they were taking the lead in combating and containing it.
The Australian Federation of AIDS Organisations publishes a media guide that explains why the term ‘innocent victim’ is offensive:
‘Innocent victims’ is usually used to describe children with HIV, or people with medically-acquired HIV infection. It implies that people infected in other ways are guilty of some wrong-doing and deserved to be infected with HIV. This feeds stigma and discrimination and should be avoided.
Courtenay, who is 79, has announced that he has terminal cancer and that his current book will be his last.
(Hat tip: Daniel Reeders)
New South Wales has a new Public Health Act starting today, with a small but important change in the way the Act deals with HIV.
The revised Act was passed by the previous Labor government, but has been waiting for gazettal for the last two years. NSW is one of two states in Australia (the other is Tasmania) that legally mandate HIV disclosure before sex, and the changes to the Act provide a new defence to prosecution for non-disclosure if the HIV-positive person can show they took ‘reasonable precautions’ to prevent transmission.
The Bouverie Centre’s Jennifer Power on the Queensland government’s HIV prevention efforts:
The government argues that de-funding QAHC was a response to rising HIV rates — evidence of QAHC’s lack of effectiveness — not an anti-gay agenda. But it would be a concern if HIV prevention in Queensland was to become more conservative, with little acknowledgement of the needs or interests of gay men.
Australia is known as a world leader in HIV prevention largely because the federal government at the time had the foresight to see that community-led organisations such as QAHC were best placed to deliver targeted HIV prevention campaigns to the communities most at risk.
As a follow-up from my previous post, take a look at this amazing campaign coming out of Vancouver. Unlike the Queensland campaign, this effort is open and honest about the reality of living with HIV today. It presents HIV testing as a personally and socially worthwhile thing to do, and situates that action within a broader framework of ultimately stopping HIV.
Australian HIV organisations can’t even make up their mind whether or not to accept the evidence about treatments as prevention, while the rest of the world embraces our first real chance to actually end HIV infections with innovative campaigns like this.
With all the talk about how our HIV response will look at the 2014 International AIDS Conference in Melbourne, this video shows just how far behind the curve we are.
The Grim Reaper TV advertisement has cast a shadow over the HIV response since it was first aired more than a quarter century ago. The original ad, with its foreboding “Always use a condom — always” tagline and grim predictions that AIDS could “kill more Australians than World War Two,” has often been credited with raising awareness of HIV in Australia. It’s also been rightly criticised for having the unintended consequence of increasing stigma around HIV and towards gay men.
Those surreal bowling reapers were supposed to represent death, but too many people read them as representing gay men, hurling a deadly virus at the innocent women and kids at the end of the alley. The ad fed into a climate of fear and hysteria and generated a great deal of hateful commentary towards gay men and those living with HIV, who were seen as the diseased vectors of a plague that at the time seemed certain to sweep through the ‘innocent victims’ of the heterosexual community.
Despite its many failings, we’ve never quite shaken off Mister Grim and his bowling buddies. The ad is so widely believed to have been a smashing success that barely a year has gone by in the last quarter century when some ill-informed government minister or pundit calls for a ‘new grim reaper campaign’ to scare people into behaving more sensibly. Luckily, to date those calls have been largely resisted.
All that changed this last weekend with the launch of We Shouldn’t Be Making This Advert, a new TV advertisement from the Queensland government, the first evidence we’ve seen of its new ‘in-house’ approach to HIV prevention following the shock de-funding of the Queensland Association for Healthy Communities. And there, proud as punch, is our old friend Grimsby, not looking a day older despite the intervening decades, ready to scare us all back into using condoms.
“The law can seem remote, arcane, the stuff of specialists. But it isn’t, because for those of us who live in democracies, the law begins with us,” says Shereen El-Feki, vice-chair of the Global Commission on HIV and the Law, in this TED talk.
The talk is a very fine summary of the issues around HIV criminalisation and its unintended effects. The comments below the video, alas, show how far we have to go.