HIV Diagnoses Rates On The Rise For Heterosexual Australians
HIV diagnoses rates in Australia have hit a seven year low, but they're on the rise for one social group in particular: heterosexuals.
Diagnoses among heterosexuals in Australia have increased by 10 percent over the last five years, and accounted for a quarter of the 963 new diagnoses in 2017.
More worryingly, almost half (48 percent) of diagnoses among heterosexuals are late, meaning the individual has been living with HIV for four or more years. Not only does this have more serious long-term health consequences, but it makes it more likely that they've passed along the virus to somebody else.
Jane Costello has been living with HIV for 24 years, receiving a diagnosis when it was still essentially a death sentence. She was given three years to live. Her husband, from whom she had contracted the illness, was given one.
"He was mortified," Costello told ten daily. "I remember the night I came home from work and I walked into the house and he was sitting in the living room, just ashen-faced. He was grey. You can imagine [the difficulty], trying to tell the person you love that they might have contracted HIV."
It was the early 1990s, and the treatments we have in place today were not yet developed. It started presenting itself as a cough in Costello's husband, like "nothing I'd heard before". It was so bad that he could only get to sleep if he was sitting in an upright position, but despite a gamut of tests, it was months before anyone realised her husband had an AIDS-defining illness.
Stigma In AIDS And HIV Treatment
The AIDS crisis, as it became known, came to define the 1980s. As it first presented in gay and bisexual men, it was initially known as gay-related immune deficiency (GRID), and stigma and fear -- helped along by fear-mongering 'Grim Reaper' campaigns, and legislated by moralising politicians such as then-Indiana Governor Mike Pence -- did little to quell the outbreak.
Princess Diana was considered a revolutionary for her work with AIDS, opening the UK's first purpose built HIV / AIDS hospital unit and challenging public paranoia by shaking the hand of a man suffering from the illness -- without a glove.
"HIV does not make people dangerous to know, so you can shake their hands and give them a hug," she is famously quoted as saying. "Heavens knows they need it."
But HIV in 2018 is nothing like it was in the 1980s, or even the 1990s, when researchers estimate it was at its peak.
The drug pre-exposure prophylaxis (PrEP) can be taken by people more at risk in a preventative measure, and has been largely credited with a decline in new diagnoses. It was listed on the Pharmaceutical Benefits Scheme (PBS) by the Australian government in April this year.
And for people living with HIV, antiretrovial therapy can achieve a suppressed viral load, meaning that HIV is virtually undetectable, and unable to be transmitted.
In fact, Australia is one of very few countries to achieve the ambitious 90-90-90 target set by the United Nations Programme on HIV / AIDs (UNAIDS) in 2014: for 90 percent of people living with HIV to know their HIV status, for 90 percent of people diagnosed to be receiving sustained antiretroviral therapy, and for 90 percent of those people to have achieved viral suppression, and all by 2020.
If you do the maths, that means 73 percent of all HIV positive people need to have achieved viral suppression.
Australia has achieved that two years early.
The seven year low in new HIV diagnoses is largely among gay and bisexual men, according to new research from the Kirby Institute. A huge queer community-led effort means more gay and bisexual men than ever are getting regular HIV tests, and it's essentially part of the culture; the gay dating app Grindr allows users to state if they're HIV positive or negative, and if positive, if their viral load is undetectable.
But the decline has not been equal across all populations, said Dr Rebecca Guy, one of the researchers from the Kirby Institute.
There has been no decline in Indigenous populations or internationally-born men in Australia who have sex with men, with researchers stressing the need to address why these communities are not being reached.
And the rise in heterosexual diagnoses is "concerning," said Guy, which is partly due to "sub-optimal testing rates".
"Diagnoses have remained steady for a long time, accounting for about 20 percent of the 1,000 new diagnoses each year," she said. "The increase is over the last two years, but we need to be cautious about that data."
It's particularly concerning due to about half (49 percent) of heterosexuals are diagnosed four or more years after contracting the viral, which "can effect the immune system, their health, or even pass it on unknowingly."
The point is, "we're not seeing a decline. This really emphasises the need for further strategies."
'Not In My Backyard'
There's an outdated idea among heterosexuals that HIV is "not in my backyard": in other words, unless you're a man who has sex with men, or inject drugs, then it's not going to affect you.
"Our research identified that particularly with heterosexual people, stigma is a main barrier to engage with services," said Guy. "Even though they know it's confidential, the community thinks that it's gay men and drug users who are affected, it's not in our community, it's not for heterosexual men and women."
That stigma exists within the medical community as well.
Costello told ten daily that she personally knows of two women in the past five years who have sought an HIV test and been told, "Oh, you don't need that," only to later been diagnosed as HIV positive.
She also has found herself facing medical professionals who ask invasive questions about how she acquired HIV for completely irrelevant procedures -- in her case, for treating an injured knee after a fall.
"As a woman living with HIV it appears I only have two options," she said. "I'm either a sex worker or somebody who injects drugs. I am neither." And as a matter of fact, sex workers in Australia have some of the lowest rates of HIV in the world, largely due to a huge emphasis on protected sex and regular testing.
Dr James McMahon, an infectious diseases physician at both the Alfred Hospital and Monash University in Melbourne, told ten daily that it's vital for the medical community to be accepting of HIV status and support patients through diagnosis and treatment.
"It's a hard discussion to have," he said. "It's not even specific to HIV; something you might say to anyone is, have you got a good GP and do you trust them? If you have a trusting relationship with your doctor, you can talk about the more personal stuff."
Regular sexual health test doesn't include an HIV test; it's something you need to request.
"The problem we have -- particularly with heterosexuals -- is that we don't have a culture of testing," said Costello.
"This is why there is a higher proportion of heterosexuals who are diagnosed late, first of all because they don't consider themselves at a higher risk, and secondly the idea of going and asking for an HIV test doesn't occur to them.
"So you have people who are potentially living with HIV who are not aware of their status."
But while there's still incredible work to do to fight the stigma of HIV, after 24 years of living with it, Costello said that it's an extremely small part of her life.
"It's part of me, but it doesn't define me," she said. "And it doesn't say who I am."
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