Tagged with HIV

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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It’s not true, is it?

HIV-positive shirt

The International AIDS Conference is starting in Melbourne in a few days. I’m in a convenience store , wearing this T-shirt that says ‘HIV Positive’. There’s music playing, in a language I don’t understand.

“I like the music,” I tell the clerk.

“You probably can’t understand what she’s saying. It’s in Persian – Farsi.”

I hand over my purchases.

“It’s not true, is it?” he says, pointing to my T-shirt as I pay.

“Yes, it is true.” He makes a screwed-up smile, unsure whether I’m pulling his leg. A moment of silence. “Really?”

I tell him about the AIDS conference, and something about the importance of positive people being visible. Another moment of silence.

“You know, when I tell people I’m from Iran, they make assumptions about me, too. It’s good to meet you, my friend.” He shakes my hand and I leave.

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A blunt instrument

The following article about HIV criminalisation, by David Mejia Canales and me, was originally published on the Law Institute of Victoria Young Lawyers’ Blog last week. (Yes I have been published on a ‘young lawyers’ blog – I am aware that is amusing on several levels). 


The International AIDS Conference will be held in Melbourne in July. The conference, one of the largest in the world, attracts tens of thousands of activists, politicians, scientists, doctors and a diverse group of community members affected by HIV.

With the world’s eyes on Melbourne during the conference, it’s timely that we revisit our criminal laws with regards to HIV transmission.

Did you know that s 19A of the Victorian Crimes Act is the only law in any Australian jurisdiction that specifically criminalises the transmission of HIV?  The maximum penalty under the section is 25 years’ imprisonment – equivalent to armed robbery or aggravated crimes of violence.

Section 19A was introduced in 1993 to placate community fears of robberies with HIV-infected blood-filled syringes, but no HIV-positive person has ever been convicted of such a crime. Instead, the law has only ever been used for allegations of sexual transmission.

So is s 19A a good law? It’s only produced one conviction in 20 years (and this was for attempt); it was intended to be used to punish robbers armed with HIV laden syringes but has only been used to lay charges against people who have allegedly transmitted HIV through sex.

This is not to say that intentional transmission of a serious disease like HIV should not be a crime – there’s no doubt it should. But other sections of the Crimes Act are capable of being used should such a scenario occur. Not only that, we have public health processes that can be triggered when HIV transmission occurs, and which are focused on achieving positive behaviour change rather than punishing past wrongs.

In theory, s 19A was intended to protect the public, but what happens in practice is it acts as a disincentive to knowing your HIV status while reinforcing perceptions that people living with HIV are dangerous or malicious. This does no one any good.

Laws don’t exist in a vacuum.  You probably didn’t learn about s 19A at law school, and you definitely didn’t learn about the incredible social baggage a discussion about HIV and transmission brings.

Here are four things you can do today to know more about the fascinating junction of law, human rights and HIV:

  • Register for Beyond Blame: Challenging HIV Criminalisation, an International AIDS Conference affiliated event about the criminalisation of HIV, not just in Victoria but around the world. The event is free to attend but you must register. Keynote speaker: Hon Michael Kirby. Registrations here: http://beyondblame.eventbrite.com.au
  • Contact organisations like Living Positive Victoria or the Victorian AIDS Council, they can organise speakers or information sessions for you or your organisation to understand HIV and the human rights issues surrounding it. www.vicaids.asn.au and www.livingpositivevictoria.org.au
  • Take part in the hundreds of events during the International AIDS Conference, for more details: www.aids2014.org
  • Consider volunteering or donating to the HIV/AIDS Legal Centre, a community legal centre assisting HIV positive Victorians. For details: http://www.vac.org.au/plc-legal-assistance

What do you think? Is it possible to have a constructive discussion about HIV and decriminalisation of HIV without the fear and hysteria that usually comes with discussions about HIV?

About the authors: David Mejia-Canales is a lawyer and Vice President of the Victorian AIDS Council. Paul Kidd is an HIV activist, current law student at La Trobe University and the Chair of the HIV Legal Working Group at Living Positive Victoria.

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How HIV criminalisation harms prevention, wrecks lives and doesn’t stop a single infection


My op-ed in this week’s Star Observer:

Criminal law processes have been criticised internationally because they provide a disincentive to knowing your HIV status – instead of protecting people from HIV, they actually have a negative impact on prevention. In September, UNAIDS recommended that criminal prosecutions should only occur where HIV transmission actually occurs and where it can be shown that the accused intended to transmit HIV. The report also condemned the use of laws that criminalise non-disclosure of HIV status, such as those in NSW and Tasmania, and HIV-specific criminal laws, such as Victoria’s section 19A.

Read the full article on the Star Observer website.

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HIV infections are going up – or are they?

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):

HIV infections 2000-2012

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.

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The week: 25 May

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.

Selfie, 21 May

Selfie, 21 May

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 ‘žnot 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.

Continue reading

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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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Bryce Courtenay: ‘I’m sorry’

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)

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Public Health Act 2010 (NSW) starts today

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.

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