As the COVID-19 pandemic rages on, a milestone in another global health crisis on Wednesday risked going unnoticed.
1 December marks World AIDS Day and 40 years since HIV, which is the cause of AIDS, was first discovered in the United States.
The unforgiving virus has since taken the lives of an estimated 39 million people worldwide and about 8,000 people in Australia.
For the public health experts, doctors, nurses and families who were on the frontline when a deadly, mysterious disease began killing young men in 1981, it’s a time they’ll never forget.
Professor Bill Bowtell was working as a public health advisor in Sydney and told SBS News there was initially very little information about what HIV was.
“In 1981, we didn't have instantaneous worldwide social media,” he said.
Bill Bowtell was an architect of Australia’s successful response to HIV/AIDS. Source: SBS News
“So the ominous first signs of a completely new infectious disease came in dribs and drabs to Australia through the television stations, the gay press, and so on.”
Australia reported its first cases of HIV one year later, in 1982, and recorded its first death the following year.
Professor Bowtell remembers the panic that gripped the gay community as more and more people were diagnosed.
“It became apparent that young gay men in Sydney and elsewhere in Australia were turning up right at death's door with a disease that nobody had seen before,” he said.
But Australia would be lauded for its relatively swift response, implementing effective, albeit controversial, public health campaigns including the Grim Reaper advertisement, which Professor Bowtell helped create.
He has since been credited as being instrumental in Australia’s successful response to HIV.
Australia's Grim Reaper ad campaign in 1987. Source: SBS News
Four decades on, and there’s much to celebrate. HIV can be managed with antiretroviral treatment that is available as a single daily pill.
But while Professor Bowtell said the 40th anniversary marks significant progress, there is still a long way to go.
HIV today
The number of people diagnosed with HIV in Australia is at an all-time low. That’s according to new data released by The Kirby Institute at UNSW Sydney which found there were 633 new diagnoses of HIV in 2020, a decline of 30 per cent since 2019.
“In Australia, a rich country, we’ve got the treatments and our rates of HIV infection are very small now, thankfully,” Professor Bowtell said.
“But that's not the case in the rest of the world. The HIV virus doesn't understand international borders, it just gets on with replicating.”
According to the United Nations AIDS organisation, while new HIV infections have reduced by 50 per cent since their peak in 1997, 1.5 million people were still newly infected in 2020. Women and girls account for half of those.
Professor Bowtell said it comes as no surprise that Sub-Saharan Africa, which is home to nearly 70 per cent of people living with HIV, has also become a COVID-19 epicentre.
He draws a parallel between the unequal access to HIV treatments between the developed and the developing world and the current struggle for COVID-19 vaccine equity.
“The big lesson with HIV is we've got to get those treatments out to the entire world, and that's the big lesson of COVID,” he said.
“We've just got to get real about this, we've got to devote the money, the time, the effort and the political will to dramatically change the outlook for these diseases and we've got to do it right now. Otherwise, we will go through this cycle and the world is not able to cope with repeated viral assaults like this and then be terribly surprised when the virus mutates.”
Living with HIV
For Melbourne man Richard Keane, who was diagnosed with HIV as a 19-year-old in 1989, improving the life outcomes for HIV positive people, both in Australia and abroad, has become his life’s work.
He’s now the CEO of the non-for-profit organisation Living Positive Victoria and wants to stamp out the stigma attached to the diagnosis.
“It was a really hard environment as a young person, and as a young gay man to come out into that kind of environment and some of the negative aspects around it caused me to internalise and not listen to the messages that were there at the time,” he said.
Mr Keane has managed his HIV for more than 32 years, taking “just one pill a day”. He’s had what’s called an ‘undetectable viral load’ for more than a decade, meaning he can’t pass HIV onto anyone else.
Richard Keane, CEO of Living Positive Victoria, has lived with HIV for 32 years. Source: SBS News
“It is easier to live with HIV today, it certainly is not a life-threatening condition in our local Australian context today, but it's still life-changing for people who get a diagnosis,” he said.
Through his work, Mr Keane engages with the community to make sure everyone is supported through their journey and is particularly passionate about improving in-language messaging in Australia.
“More than half the diagnoses [in Australia] are from people born overseas,” he said.
“They might come from high HIV prevalence countries or places with low testing rates, so we must continue to work in that space.”
Dr Sarah Garner, a medical microbiologist from Dorevitch Pathology, who has worked in the HIV research space for over a decade, said the low number of diagnoses in Australia is thanks to a combination of prevention measures, and high uptake of effective treatment strategies and preventative medicine, known as PrEP.
“We now have great combination antiretroviral therapy available. From about a decade ago, most people with HIV can take one tablet a day now to control their HIV which is really wonderful,” she said.
But Dr Garner said there are still diagnoses slipping through the cracks.
Nearly half of people diagnosed last year in Australia were considered ‘late diagnoses’ meaning they’d been living with the infection for four or more years without knowing it.
“We still have [HIV positive] people turning up at the hospital that are really sick. And for a lot of those people when they're admitted to hospital, they may have three or four other conditions that need to be treated,” she said.
Dr Garner said she fears the number of late diagnoses could climb because of the COVID-19 pandemic. Between July 2019 and September 2021, there was a 33 per cent drop in HIV tests performed in Australian pathology labs.
“I think people aren't going to their GPs as much as they were before the pandemic, there were difficulties getting appointments, people had to do telehealth, and I think also, everyone really has had so much else to worry about,” she said.
Chris Williams, the co-founder of PrEP’d For Change, one of Australia’s largest online communities for people looking to protect themselves from HIV said “there is still a long way to go” when it comes to educating people about HIV and potential treatments.
Chris Williams runs the online community PrEP'd For Change. Source: SBS News
Mr Williams, who uses PrEP himself, said it changed his life.
“It wasn’t really until PrEP came along that it enabled me the opportunity to connect and have intimacy without fear of HIV, so that's been momentous for me. “
“Even with these technologies at the moment it's still not enough to be able to make sure that everybody feels confident to opt into using one of those strategies to protect themselves against HIV,” Mr Williams said.
Mr Williams is a supporter of the Agenda 2025 campaign that aims to end HIV transmission in Australia in four years. Backed by the nation’s top HIV clinicians, researchers and community leaders, it’s calling on bipartisan government support to make it a reality.
Greens Leader Adam Bandt said his party fully supports the initiative.
“We are on the verge of virtually eliminating HIV transmission in Australia in the next four years,” he said.
He is calling on the government to commit $53 million to help fund organisations, remove out-of-pocket costs for HIV testing and treatment regardless of visa status and fund education programs.
“Spending $53 million a year to virtually end HIV transmission in Australia in the next four years is not only affordable, it's money very well spent,” he said.
On Wednesday, the Morrison Government announced more than $50 million in new funding to extend access to HIV treatment in Australia and to support activities that will support the health and mental wellbeing of people living with blood-borne viruses and sexually transmissible infections.
