Opinion: The changing tide of the HIV/AIDS epidemic
Opinion: The changing tide of the HIV/AIDS
In the last year we have witnessed a record number of new HIV diagnoses in New Zealand and no institutional or community effort seemed effective in reversing the trend. In 2016, 244 people were diagnosed with HIV, and each of the those affected, together with their families, will have to come to terms with being diagnosed with a chronic condition, despite amazing improvements in treatment and excellent medical prognosis in the vast majority of cases.
The stigma associated with HIV is still very real, and if we consider that at least 164 cases of the new infections were among gay and bisexual men, the numbers are a real concern for this community. Within this group, Asian men have made up the sharpest increase in the number of new diagnoses – from 2004-14 they represented 10.5 per cent of new infections, and now in 2017 they represent 17.6 per cent. This should urge institutions and the community to provide additional support to help them stay safe. The picture doesn’t look too optimistic – so why am I arguing it’s time for potential change?
This year marks two very important changes – the threshold for initiating funded treatment for people living with HIV has been removed. This means people who are diagnosed with HIV can start treatment straight away, as opposed to waiting until their immune system deteriorates. Starting treatment promptly has proven very beneficial for their personal health, for preventing new infections, and for keeping the overall cost of treatment down. This benefits everyone, including the taxpayer. It has now been shown people living with HIV who are effectively treated (which means that their viral load is suppressed to undetectable levels) cannot and will not transmit HIV to their sexual partners even if they have unprotected sex. This understanding has been endorsed by UNAIDS and the American Centers for Disease Control and Protection along with countless community organisations, including those in New Zealand. This is reason to celebrate. This knowledge can remove part of the stigma associated with HIV, reassure people living with HIV that they are not “infectious”, and encourage newly diagnosed people to access treatment promptly.
Another amazing piece of news is that in New Zealand pre-exposure prophylaxis (PrEP) is now very likely to receive Pharmac funding early next year, for those most at risk. The idea that taking a tablet a day can be very effective in preventing transmission of HIV empowers men to take control of their sexual health, reduce their anxiety around HIV, as well as reducing new infections. Already, more and more men who are sexually active with other men are relying on this very effective form of prevention to greatly reduce their risk of contracting HIV. At the moment, with the assistance of grassroots local and overseas organisations, sexually active men self-fund and self-supply generic medications.
Research shows the beneficial effects on mental health and general wellbeing of men who use PrEP extend beyond simply preventing HIV. It helps those who use it regain the feeling of control over their lives, and build more satisfying relationships with their partners. Initial concerns about PrEP leading to an increase in cases of other sexually transmitted infections appear unsupported by current research. I would even suggest it could reduce the number of people potentially passing on infections, as men using PrEP get screened more often and receive STI treatment more promptly.
Armed with the new tools for prevention, New Zealand does have a chance to reduce the incidence of HIV – however, that requires adequate community and institutional response to the new developments. One of the things we should not forget is to support those already living with HIV – removing institutional barriers, such as the threshold to access treatment, are just a part of the necessary change. Fighting stigma and promoting greater inclusion for those already living with HIV is something we have to actively work on to change – not only because it reduces the number of new infections, but because it is the right thing to do.
Jacek Kolodziej is a PhD student from Massey University’s School of Social Work. His thesis entitled “Beyond prevention. Why do men who have sex with men in New Zealand use pre-exposure prophylaxis (PrEP)?” aims to examine the social and cultural contexts and benefits of PrEP use.