Rebecca Benson peers into the near future and assesses the hot issues and key challenges ahead.
- Easier drug collection
From 1 July, people living with HIV will be able to pick up their HIV medications from community chemists. If you live in an inner city it’s likely that you’ll be able to collect your drugs on the spot with little fuss. However, those living in regional Australia may find collection more problematic and will more than likely have to drop off a script and pick up the meds a few days later.
To accommodate the changes it’s expected chemists will extend dispensing hours — some may even open seven days a week. Others may be able to provide a free delivery service. (Be assured that HIV medications are packaged discreetly.)
Whilst having more choice as to where you collect your meds is undoubtedly a good thing, there are some legitimate concerns — particularly around privacy, especially in small towns. If you have any worries, talk to your pharmacist.
- PrEP trials
All eyes will be on the Australian PrEP trials this year. There are currently three ongoing: the PRELUDE study in NSW; the VicPrEP study in Melbourne; and the QPrEP study in Queensland. The aim of the trials is to explore the acceptability, feasibility, uptake and impact of taking Truvada as an HIV pre-exposure prophylaxis.
Overseas studies have shown encouraging results: in trial after trial, Truvada — a single pill combining tenofovir and emtricitabine — has been found to be highly effective in reducing the risk of HIV transmission. It is expected the Australian trials will deliver similar results which will in turn, no doubt, lead to urgent calls for Truvada to be licensed for use as PrEP here.
- Testing, testing
Last year, more than 40 rapid testing sites operating across Australia successfully attracted people who had never tested for HIV before. There are two different kinds of test: one collects oral fluids; the other involves a finger prick. In an effort to trace the estimated 7,000 cases of undiagnosed HIV, expect an increased roll-out of rapid testing sites over the course of the year.
2014 saw restrictions lifted on HIV self-testing kits. Already available in the US and given the go-ahead in the UK, the kits — likened to home pregnancy tests — will make HIV testing more accessible, particularly for Australians living in remote communities. It is hoped that the first DIY kits will be made available in Australia sometime this year.
- New treatments
Recently approved by the Therapeutic Goods Administration, Triumeq becomes the fourth single tablet regimen available to people living with HIV in Australia. It contains three medications: dolutegravir, abacavir and lamivudine. A decision by the Pharmaceutical Benefits Advisory Committee to list Triumeq on the PBS is expected within the coming months.
Cobicistat (or COBI) is a new ‘booster’ drug also awaiting PBS listing. It is currently being considered as a potential alternative to ritonavir in other HIV-drug combinations. While similar to ritonavir in composition, COBI has a much better side-effect profile. It also has fewer HIV-drug interactions than ritonavir. However, COBI has been found to adversely interact with drugs to treat erectile dysfunction such as Viagra. It may also increase levels of amphetamines including ecstasy, cocaine, speed and meth.
- Section 19A
Responding to community advocacy, the LNP Victorian government last year announced its intention to “amend” Section 19A of the Crimes Act 1958. Section 19A establishes the criminal offence (punishable by up to 25 years’ imprisonment) of “intentionally causing a very serious disease” — “very serious disease” is exclusively specified to mean HIV infection. It is expected that sometime this year the new Labor government in Victoria will come good on its pre-election promise by repealing Section 19A altogether.
It’s getting on close to 30 years since the Grim Reaper sent men, women and children hurtling down the bowling alley of death. Back in the day, it was understandable for people to be scared of AIDS: little was known about the disease, aside from the fact it was a killer.
But for some time now, developments in treatment have ensured that people living with HIV are living well and living longer. Not only that, as major international studies have found — providing a positive person is on treatment and maintaining an undetectable viral load — there is almost zero risk of HIV transmission.
Yet stigma still persists. A New Zealand survey found that 47% of respondents said they would be uncomfortable sharing a home with someone living with HIV; 56% said they would feel uncomfortable having food prepared for them by someone living with HIV; while 87% of people were uncomfortable having sexual contact with someone living with HIV.
It is 2015 — way beyond time for attitudes to have changed and for the wider population to have become aware of the facts about HIV. It should be regarded no differently to any other manageable chronic condition. To coin a phrase: ENUF.
- Ending HIV
The key goal of the Australian National HIV Strategy is to increase efforts to realise the virtual elimination of HIV transmission by 2020. This target has been endorsed by every state and territory health minister.
A crucial step towards achieving the aim is to hit the interim target of reducing sexual transmission of HIV by 50% this year. Another important target is to have 90% of people with HIV on treatment as soon as possible. Australia has led the way in locking in such targets — 2015 is the year in which achievements must match expectations.