Friday, September 29, 2017

Elton: An AIDS Free Future is Within Our Grasp

To mark the 20th anniversary of the death of Diana, Princess of Wales, and to honour her unique contribution to the fight against AIDS, I joined His Royal Highness Prince Harry this year on a trip to London Lighthouse – a former palliative care centre where many people went to die in the 1980s and 1990s.

Diana visited the Lighthouse many times, publicly and privately. It was quite literally a beacon of hope in the dark days before effective AIDS treatment and one of the few places that did not shame those living with the "gay plague" as it was then called.

Today, London Lighthouse has been re-purposed given the success of anti-retroviral therapy in preventing sickness and death. As Prince Harry and I toured its garden, which holds the ashes of many people for whom that therapy came too late, we reflected on how overjoyed Princess Diana would be to think that an AIDS-free future is now truly within our grasp.

From the beginning, the AIDS epidemic has generated unusual alliances. If I had claimed in 1982 that one of Australia's defining national achievements would come from the cooperative efforts of gay men, sex workers, and people who inject drugs, I would likely have been met with scepticism, to say the least.

Yet 35 years later, that's where Australia finds itself, with the opportunity to end HIV transmission. Australia should be proud that what brings her to this point is a triple combination strategy of courage, compassion and compromise, driven by the very people whose lives are most disrupted and traumatised by the virus.

In the early 1980s, gay activists in this country risked social ostracism and violence when they insisted on explicit advertising campaigns to encourage their peers to wear condoms. They won.

Sex workers stood up to clients and brothel owners to insist on safe sex. They won too. People who inject drugs teamed up with brave doctors to stretch legal boundaries, establishing the first clean needle exchange programs.

What underpins these acts of heroism was simple: HIV could only be prevented by convincing people to change their risky behaviour. And to do that, you had to be honest about how people behave in the real world.

Australia's early lessons now need to be applied to a new and awesome challenge: ending transmission.

Science now provides new tools that can make serious inroads in the HIV epidemic. A once-a-day pill, pre-exposure prophylaxis (PrEP), is the HIV equivalent of the contraceptive pill, and is astonishingly effective at preventing HIV.

In London, where I live, recent figures show a 32 per cent drop in new HIV cases in the city's five busiest HIV clinics in the last year. This is in large part attributed to PrEP. A PrEP trial in NSW shows equally dramatic results, driving the lowest HIV transmission rate since the epidemic began.

In both instances, patients were importing PrEP through online providers because it was not available through the public health system. I'm delighted that Britain's National Health System will now expand access to PrEP, supporting up to 10,000 patients. Australia similarly needs to make PrEP available and affordable to all who need it through the Pharmaceutical Benefits Scheme.

But PrEP is not the only exciting development in HIV prevention.

Home testing for HIV offers another advance against transmission. While the days of a three-month wait and a disapproving tone from a doctor have passed, too many people still avoid the awkwardness and delay of getting tested. Now new technology allows people to test for HIV wherever they want.

People at risk of HIV, like sexually active gay and bisexual men, need to test up to four times a year. We know that when they can do it from their own home, they test twice as often. Even among infrequent testers, the rate of testing increases five-fold.

Shame-free testing is critical to ending HIV because it means those who do test positive can get onto treatment much sooner. A person treated early for HIV can look forward to a normal life expectancy and will not transmit HIV onwards. This compelling reality underpins the work of my AIDS Foundation, which last year enabled more than 548,000 people in 15 countries to receive an HIV test.

HIV is a virus that feeds on fear, stigma, and discrimination. Since the earliest days of the epidemic, Australia has countered that with sound science and concerted action. No country is better positioned to end this epidemic. However, it won't happen on its own. We need the next generation of Australian leaders and activists to step up and make AIDS history.

- Elton via SMH

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