Nathaniel Casco is from Australia. Here he talks about the state of HIV in his home country, whose response to the disease is recognized globally as a success.
An estimated 24,731 people were living with diagnosed HIV infection in Australia at the end of 2011. Of this 16,122 people were diagnosed with HIV infection in New South Wales, Australia alone. Approximately a quarter of people living with HIV are diagnosed by a general practitioner (GP) who has not previously diagnosed HIV.
The rate of HIV diagnosis in New South Wales declined steadily from around 6.1 per 100 000 population in 2002 – 2006 to 5.3 in 2007 – 2011. In Victoria, the rate increased from 4.1 in 2003 to 5.7 in 2011, resulting in the highest rate among state and territory health jurisdictions in 2011. Increasing rates of HIV diagnosis in Queensland and Western Australia over previous years have stabilised, at around 5.0 and 4.3 per 100,000 population, respectively. Increasing HIV diagnosis rates over the period 2002 – 2011 in South Australia, Tasmania, the Northern Territory, and in the Australian Capital Territory were also reported.
The number of new HIV diagnoses in Australia in 2011 was 1,137, an increase of 8.2% over the number in 2010. The annual number of new HIV diagnoses has gradually increased over the past 12 years, from 719 diagnoses in 1999.
In the year to December 2010 there were 1,043 diagnoses of HIV infection. The HIV-positive population in Australia is made up of a large proportion of people living with manageable HIV disease.
Up to 31 December 2010, the cumulative number of HIV diagnosed infections in Australia was estimated at 30,486. By 31 December 2011, 31 645 cases of HIV infection had been diagnosed in Australia.
Between 2006 and 2010, 86% of newly acquired HIV infections were in men who have sex with men.
Of the 1327 cases of HIV infection in heterosexual contact newly diagnosed in 2007 – 2011, 60% were in people from high risk countries or their partners.
Australia’s HIV response is recognised globally as a success. National prevalence is lower than in most other comparable high-income countries.
Australia has endorsed the United Nations (UN) General Assembly Declaration of Commitment on HIV (2001) and the UN Political Declaration on HIV (2006) including commitments to universal access to HIV prevention, care, support and treatment.
Taking a human rights approach to HIV means creating a supportive social and legal environment where rights are respected and protected and the equitable right to health is fulfilled. A commitment by governments to human rights is particularly important in seeking to establish the cooperation and trust of communities that are marginalised and disadvantaged and that may be subject to legal sanction. Australia’s approach to HIV/AIDS has demonstrated the protection of human rights to be both compatible with and essential to the effective protection of public health.
Australia was a leader in the development of the 1996 International Guidelines on HIV/AIDS and Human Rights (consolidated in 2006). These were based in part on the recommendations for reform in the 1992 Final Report of the Legal Working Party on AIDS, which identified a range of legislative and regulatory measures that both supported or impeded HIV programs. Managing HIV requires continuous medication with life-long therapy and high levels of clinical monitoring, which can be a substantial cost and time burden. Difficulties exist in providing support to adhere to treatment combinations. These can be related to access and disclosure issues, particularly in rural and remote communities where disclosure is a concern.
While Australia maintains a high level of testing for HIV continuing patterns of late diagnosis suggest there is still room for improvement. The principles of informed consent and confidentiality underpin high rates of voluntary testing, and these principles remain central to managing the epidemic nationwide. An increase in the number of people who voluntarily seek HIV testing and the increased rate of testing among people at higher risk of exposure to HIV infection has resulted in the decrease of the burden of undiagnosed HIV.