Positive Living Spring 2016

positiveliving FOR PEOPLE LIVING WITH AND AFFECTED BY HIV | SPRING 2016

N O I T I D E L A I C E P S 6 1 0 2 S AID

CONFERENCE VOICES

AIDS 2016

AttenDeeS on the key tAkeAwAyS

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HIVCURE A new feature devoted to the latest cure research advances

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TIPS FOR TELLING YOUR CHILD YOU’RE POSITIVE 16

TREATMENT EVOLUTION

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MORE TOLERABLE, EASIER-TO-TAKE HIV MEDS HAVE BEEN THE PURSUIT OF RESEARCHERS FOR DECADES. NOW, TREATMENT DEVELOPMENT IS HEADING IN TWO DISTINCT DIRECTIONS.

OUT OF AFRICA

what’syourproblem?

KEEPING CHOLESTEROL IN CHECK

Heather Ellis’s book, Ubuntu, is much more than a travel memoir — it’s an amazing story of resilience, spirit and determination.

ISSN 1033-1788 EDITOr Christopher Kelly

David menadue Vicky Fisher CONTrIBuTOrS Dean Beck, David Crawford, Neil Fraser, Sharon lewin, Dr louise Owen, Thomas rasmussen, Peter Watts DESIGN Stevie Bee Design ASSOCIATE EDITOr PrOOFrEADEr

COVEr ImAGE xx

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Discovering Descovy

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Contact the Editor EmAIl: christopher@napwha.org.au all correspondence to: Positive living PO Box 917 Newtown NSW 2042 TEl: (02) 8568 0300 FrEECAll: 1800 259 666 FAx: (02) 9565 4860 WEB: napwha.org.au Positive Living is published four times a year by the National Association of People With HIV Australia and is distributed with assistance from Gilead and ViiV Healthcare. Next edition: December 2016 subscriptions

l Positive Living is a magazine for all people living with HIV in Australia. Contributions are welcomed, but inclusion is subject to editorial discretion and is not automatic. The deadline is 21 days before publication date. receipt of manuscripts, letters, photographs or other materials will be understood to be permission to publish, unless the contrary is clearly indicated. l material in Positive Living does not necessarily reflect the opinion of NAPWHA except where specifically indicated. Any reference to any person, corporation or group should not be taken to imply anything about the actual conduct, health status or personality of that person, corporation or group. All material in Positive Living is copyright and may not be reproduced in any form without the prior permission of the publishers. l The content of Positive Living is not intended as a substitute for professional advice.

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thenews

PrEP knocked back by PBAC HiV organisations expressed disappointment at the pharmaceutical benefits advisory committee’s (pbac) decision not to subsidise truvada for use as prep through the pharmaceutical benefits scheme.

The PBAC cited cost as the main reason behind its decision, describing the price submitted by manufacturer Gilead Sciences as “unacceptable”.

In response, Darryl O’Donnell, CEO of the Australian Federation of AIDS Organisations, said: “People are needlessly getting HIV while we wait for access to this prevention pill. The Australian government has made a world-

leading commitment to virtually end HIV transmission in Australia by 2020. We can do this together if we have access to the best prevention tools, of which PrEP is pivotal.”

Speaking to Out in Perth, Cipri Martinez, President of the National Association of People with HIV Australia, said it was crucial that Gilead resubmit Truvada to PBAC as soon as possible. “I encourage Gilead to go forward with a new submission — one that’s more realistic, more sustainable, and puts people before profits; and one that puts ending the epidemic before profits.”

Qld cure for HiV?

a functional cure for HiV may have been discovered in Queensland.

That’s the hope of Brisbane researchers who have created an antiviral protein that appears to ‘switch off’ the virus. The inhibitor — known as ‘Nullbasic’ — was made by mutating an existing HIV protein.

The exciting breakthrough offers a new approach to antiretroviral therapy.

Speaking to Fairfax Media, Associate Professor David Harrich (pictured above) of the Qimr berghofer medical research institute said the discovery has the potential “to treat cells in a way that turns the virus off but otherwise leaves the cell alone”. The next step, said Harrich, is to test the antiviral protein in mice. “It’s going to be a very useful research tool.” The advancement, reported in the American Society for Microbiology journal, mBio, is the result of seven years of laboratory tests. more on the cure on page 5

Gilead should make a new submission — one that’s more realistic, more sustainable, and puts people before profits; and one that puts ending the epidemic before profits. cipri martinez

The PBAC has said it would welcome another submission from Gilead, one that addressed

“the concerns about costeffectiveness and the appropriate eligible population”. For its part,

Gilead has indicated that it will take PBAC’s feedback on board and participate in a stakeholders’ meeting with healthcare professionals and advocacy groups to discuss the way forward. However, with the process now delayed for at least 18 months, the going will be slow.

In the meantime, there are a number of ways to obtain PrEP in Australia. There are large-scale PrEP programs in place: in Queensland, nsW and Victoria.

People can pay for PrEP privately within Australia, or buy a generic drug from overseas online. For more details go to prepaccessnow.

Funding cloud hangs over global response there are real fears that the aids epidemic could spiral out of control, with infection rates hitting unprecedented levels.

That’s the grim news to come out of South Africa, host country of AIDS 2016. The reason for the pessimistic forecast? Progress in the global response is stalling while funding is decreasing (donations fell last year for the first time in five years, from US$8.6bn to $7.5bn).

Around 2.5 million people contract HIV every year — 60 percent of them adolescent girls and young women.

Professor Peter Piot, former executive director of UNAIDS and Director of the London School of Hygiene and Tropical Medicine, told The Guardian: “It is as if we’re rowing in a boat with a big hole and we are just trying to take the water out,” said Professor Piot. “We’re in a big crisis with this continuing number of infections.”

Bill Gates, whose foundation has contributed multi-millions of dollars to the fight against AIDS, said the number of young people at risk of HIV in Africa

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is set to rise considerably. Speaking in Durban, Gates (pictured above) said: “If we only do as well as we have been doing, the number of people with HIV will go up even beyond its previous peak.”

Despite the gloomy outlook, new President of the International AIDS Society, Linda-Gail Bekker, remains

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upbeat. “I’m excited and optimistic for the future of the global HIV response,” she told conference delegates. “The scientific insights and programmatic responses shared at this conference provide powerful evidence that we can beat this.” However, Bekker admitted that “the work simply isn’t done”. more on pages 8 and 9

thenews

‘negligible risk’ of HiV with art HiV experts from around the world have joined together to declare that — with effective treatment — the risk of HiV transmission is “negligible”.

A statement, released by the prevention access campaign, says: “People living with HIV on [antiretroviral therapy] with an

undetectable viral load in their blood have a negligible risk of sexual transmission of HIV.” (Previously, official guidelines have maintained that HIV treatment simply minimised the risk of transmission.)

The consensus statement has received support from leading

HIV researchers, including Australia’s Dr Andrew Grulich from the Kirby Institute at UNSW and Dr Demetre Daskalakis, an infectious diseases physician from New York — the first US health official to endorse the document.

“Several strong lines of evidence indicate that consistent

viral suppression truly is HIV prevention,” said Daskalakis.

Bruce Richman, Executive Director of the Prevention Access Campaign, which led the initiative, said, “The consensus from the world’s experts is important to clarify the confusing and inaccurate

messaging about transmission risk and the benefits of treatment. Understanding that the risk from an undetectable viral load is actually negligible is transformative on many levels for people with HIV. This news can help lift decades of HIV-related stigma and discrimination.”

Self-test on nothing to report the way

PARTNER STUDY

a big fat zero. that’s the latest finding from the partner study: no linked HiV transmissions after poz/neg couples (both gay and straight) had condomless sex 58,000 times.

Released at AIDS 2016, the results provide solid evidence that when an HIV-positive person (through antiretroviral treatment — ART) maintains a suppressed viral load, sexual transmission of HIV does not occur.

These new PARTNER results include more follow-up data — early results presented at AIDS 2014 were based on 45,000 instances of condomless sex. Unlike previous studies — which compared the risk of condomless sex while on ART to not being on ART — PARTNER

was able to estimate the risks of individual sex acts. The risk for all types of sex, including condomless anal sex, was zero.

These latest PARTNER findings will reassure people living with HIV — and their negative sexual partners — that, with treatment, they can become virtually non-infectious. l read the full report here

the first over-the-counter diY HiV test may soon be available in australia.

Local company, Atomo Diagnostics, is to trial its self-test kit within the next few months so that it can submit the product to the Therapeutic Goods Administration for approval.

Providing a result in just 15 minutes, the test kit will sell in pharmacies for an estimated $15-$20.

Results from an Australian study presented at AIDS 2016 showed that easy access to DIY kits can increase testing among gay men by 100 percent (a four-fold increase was recorded among men who tested infrequently). “Self-testing has particular value for people who are at risk of HIV who may not attend clinics as much as they need to or who may not attend clinics at all,”

Associate Professor Rebecca Guy from the Kirby Institute at UNSW Australia told conference delegates.

When study participants were asked what they most liked about the self-tests, they rated being able to test themselves (92 percent); convenience (83 percent); not needing to see a doctor or visit a clinic (75 percent); being able to test when you want (74 percent); saving time (66 percent); and privacy (62 percent).

putting the focus on HiV/HcV World Hepatitis day, held on 28 July, provided an opportunity to raise awareness about HiV and hepatitis c (HcV) co-infection.

An estimated 3,000 Australians are living both with HIV and HCV. HCV is more prevalent among people with HIV than in the broader population and is a major risk for health complications in HIV-positive

people. HIV worsens hepatitis Crelated liver disease, fastens the progression to cirrhosis, and leads to higher rates of death from both liver failure and liver cancer.

But unlike HIV, HCV is curable. A simple blood test determines whether someone has HCV and new, extremely effective hepatitis treatments called direct-acting antivirals (DAA) are

available without restriction. National Association of People with HIV Australia President Cipri Martinez urges all people with HIV at risk of hepatitis C co-infection to regularly screen for HCV and, if need be, to discuss treatment with their

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doctor. “Highly effective HCV treatment has the potential to eradicate hepatitis C from HIV-positive communities,” said Martinez. l The Kirby Institute at uNSW Australia is currently recruiting

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for a study called cease, designed to control and eliminate HCV among Australia’s HIVpositive population. People with HIV/HCV co-infection in Queensland, NSW, Victoria and South Australia are invited to enrol by contacting project coordinator Arlen Wilcox on (02) 9385 9970 or email awilcox@ kirby.unsw.edu.au.

HIVCURE

Welcome to a new page devoted to the latest cure research advances.

We kick off with Professor Sharon Lewin and Thomas Rasmussen providing an overview of what we know so far . . .

These drugs are called toll-like receptor (Tlr) agonists. In monkeys, Tlr-7 agonists stimulate latently infected cells and an effective immune response. This leads to a modest reduction in infected cells.

Clinical trials are now under way in HIV-positive individuals on antiretrovirals.

ANTIRETROVIRAL THERAPY has revolutionised the lives of millions of people living with HiV. but antiretroviral therapy is not a cure. When it is stopped, the virus rebounds within a few weeks — even after many years of suppressive therapy.

THEORETICAL POSSIBILITY To date there has been just one case of a cure for HIV. This was in the context of a stem cell transplantation for leukaemia with HIV-resistant donor cells.

This is clearly not a feasible cure strategy for HIV. But what we have learnt is that the complete eradication of HIV is theoretically possible.

Other case reports have confirmed that stem cell transplantation, even from a regular stem cell donor, can drastically reduce the frequency of infected cells. But when antiretroviral therapy was subsequently discontinued, the virus still rebounded — though it took months, not weeks.

These cases demonstrate that, although reducing the frequency of latently infected cells might delay time to viral rebound, there’s a need for continued effective immune surveillance against HIV to keep whatever remains in check.

GENE THERAPY using gene therapy to either make a cell resistant to HIV or to literally remove it completely is now being actively investigated.

The initial target of gene therapy was CCr5. This same gene is missing in some rare individuals who are naturally resistant to HIV. There have been safe clinical trials of gene therapy that eliminate the CCr5 gene and make other cells resistant to HIV. But a lot of work still needs to be done to increase the numbers of gene-modified cells.

Other research, still at the stage of test-tube experiments,

OTHER INTERVENTIONS ARE NEEDED

uses gene scissors to target the virus itself. This approach might be trickier than targeting CCr5.

This is because the virus can rapidly mutate and change its genetic code so that the gene scissors no longer work.

OTHER OPTIONS There has been a substantial increase over the past decade in our understanding of where and how HIV persists when someone is on antiretroviral therapy. It is now clear that integration of the HIV genome into long-lived resting cells is a major barrier to a cure. This state is called HIV latency.

By starting antiretroviral therapy very early it is possible to substantially reduce the number of latently infected cells. This also helps preserve immune function.

Although not an option for the majority of HIV-positive individuals who are diagnosed too late, early diagnosis and treatment could be an effective strategy to maintain immune control for some people.

Several years ago, French investigators described that posttreatment control was possible in up to 15 percent of individuals treated within months of infection. The data remains a little controversial, as in other cohorts post-treatment control is far less common.

Interestingly, post-treatment control may differ in different ethnic groups. A recent report from Africa suggests that post-treatment control could occur at far higher frequencies in African populations than in Caucasian.

‘SHOCK AND KILL’ Activating the expression of HIV proteins in latently infected cells by drugs called latency-reversing agents could drive the elimination of virus-expressing cells through immune- or virus-mediated cell death. This approach is usually referred to as “shock and kill”.

A substantial body of research has helped identify latencyreversing agents that have now been tested in experimental

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clinical trials. These studies demonstrated that, although HIV expression can be induced in patients on suppressive antiretroviral therapy, this did not reduce the frequency of infected cells. In other words, shock but no kill.

PREVENTION AND BOOSTING IMMUNE RESPONSES There have been spectacular advances in the treatment of some cancers using drugs that boost the immune response.

These are called immune checkpoint blockers. These drugs reinvigorate exhausted T cells so they can move into action — against cancer cells and, in the same way, against HIV-infected cells. These drugs are now in the clinical trial stage in HIV-positive patients being treated for different cancers.

Another way to boost the immune system is to trigger a very primitive immune response designed to react to infections.

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A successful strategy is likely to need two components: reducing the amount of virus that persists on antiretroviral treatment and improving long-term immune surveillance to target any residual virus. Far more work must be done on an HIV cure in lowincome settings to better understand the effects of different HIV strains, the effects of co-infection and the impact of host genetics. lessons from other fields, particularly oncology, transplantation and fundamental immunology are all relevant to inform the next advances needed in cure research. Finally, we have to ensure that any intervention leading to a cure is cost-effective and widely available.

The implementation of combination antiretroviral therapy in the mid-1990s is still regarded as one of the most remarkable achievements in modern medicine. life-long antiretroviral therapy remains the single best option for any person with HIV. Finding a cure for HIV remains a major scientific challenge, but many believe it to be within the realm of possibility and it will hopefully play an important role in seeing an end to HIV.

l This is an edited version of an article that appeared in Spotlight, a quarterly South African health publication.

l For more cure news, visit hivcure.

hilst current treatments are generally easier to tolerate and to take than the drugs of two decades ago, there is a shift to make today’s treatments even better.

W

The most significant recent change in this endeavour has been with long-time ‘backbone’ drug, tenofovir. The old TDF recipe

on the Pharmaceutical Benefits Scheme (see page 10). Whether Odefsey will be registered here is not yet known.

The long familiar booster drug ritonavir is also now tending to be less used in preference for the new cobicistat booster. COBI, as it’s nicknamed, is appearing in a number of new formulas such as Evotaz (the new version of Reyetaz) and Prezcobix (the new version of Prezista). It’s the convenience of having to adhere to a single daily pill that is the driving force here, but Evotaz and Prezcobix are still not complete

three-active drug regimens, meaning additional drugs have to be taken with them.

Thus, a further development is in the pipeline combining Prezcobix (darunavir + cobicistat) with Descovy in a single tablet.

Another new integrase inhibitor, bictegravir (GS 9883), is well into development, and is also expected to feature in a singletablet regimen with Descovy in the not-too-distant future.

Meantime, other conventional triple-combination regimens are being revisited. Integrase inhibitor dolutegravir, for

example, is being considered in combination with lamivudine. It is also being twinned with rilpivirine (a non-nuke) in the hope that it will maintain undetectable viral load among people with long treatment histories and drug resistance (dolutegravir is a good candidate for this as it has a high barrier to resistance). Dolutegravir singledrug studies are also being conducted. These studies are ongoing, so generally, triple therapy is still the convention — especially for treatment initiation.

Dosing levels may also change in the future. A current study of the first generation integrase inhibitor raltegravir (Isentress) — currently approved as a twicedaily treatment —is being investigated for once-daily dosing.

TOWARDS GREATER HORIZONS Researchers are moving away from merely simplifying and optimising existing treatments.

Eyes are set on less frequent dosing (weekly or monthly, or possibly even less) with a new

TREATMENT EVOLUTION

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More tolerable, easier-to-take HIV meds have been the pursuit of researchers for decades. As Peter Watts reports, treatment development is presently heading in two distinct directions. is being replaced with the less troublesome TAF-based lowerdose formula, which has much less impact on kidney health and bone mineral density loss.

A number of new TAF-based treatments are — or soon will be — available, such as Genvoya (the successor to Stribild), and reformulations of Truvada and Eviplera — known as Descovy (TAF/FTC) and Odefsey (TAF/FTC/rilpivirine). While Descovy has been registered for use in Australia, it awaits listing

MONOCLONAL ANTIBODIES MAY SOON OFFER AN ALTERNATIVE TO DAILY TREATMENTS positiveliving l

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evolution of long-acting treatments that are getting close to late-stage trials.

Additionally, new drug targets (never seen before) are on the horizon. A new long-acting (small molecule) injectable integrase inhibitor — cabotegravir — combined with an injectable form of rilpivirine (Edurant), given every four weeks, will enter phase III trials later this year, with first results expected within the next two years.

The phase IIb latte-2 trial, that tested intramuscular injections given every four and eight weeks, found that a more frequent dosing schedule suppressed HIV more effectively.

This new strategy is being met with much excitement and anticipation with hopes that it may one day completely change the HIV treatment landscape.

Monoclonal antibodies may also soon become an alternative to daily antiretroviral treatments; they’re also being looked at by vaccine researchers. Neutralising antibodies are produced by immune B cells and may control (or prevent) certain HIV strains when featured in a synthesised drug format. There is also a therapeutic approach to these potential vaccine candidates.

One, Vrc01, given as an infusion, has shown particular promise combatting HIV in an early phase I study.

Other broader and more potent neutralising antibodies have also been identified with the aim of producing formulations that could be more conveniently injected. Two other therapeutic antibodies — pro140 and ibalizumab — have each recently entered late phase III trials as potential treatments.

PRO140 is a weekly injectable that blocks HIV from entry at the cell surface, preventing ongoing HIV replication. There is some concern, however, that weekly injections will not be convenient for some people with HIV (particularly if they’re to be administered in a clinical setting), but it is still considered an advance on daily treatment methods. Also, weekly injections may be better tolerated than longer-acting monthly injections as they remain in the body for relatively shorter periods, limiting higher drug concentration exposure side effects or the development of drug resistance (since levels are topped up to adequate levels more frequently between doses).

Ibalizumab requires an infusion (rather than an injection) and is currently being evaluated at doses of once every two or four weeks. Both PRO140 and ibalizumab are potentially being considered for people who may have cross-class resistance to current antiretroviral treatment.

Of course, we’ve seen an injectable antiretroviral before — Fuzeon (T20 – entry inhibitor) — but it was not long acting (injected twice daily) and its use was limited due to injection site

LEFT: THE NEW TENOFOVIR IS A LOWER-DOSE FORMULA RIGHT: DOLUTEGRAVIR HAS A HIGHER BARRIER OF RESISTANCE

reactions and other new improved ARV treatments which came along shortly after.

However, enthusiasm is high for the new longer-acting (monthly) injectables, which potentially offer a much broader and more durable application.

New classes of ARV treatments are being developed to inhibit cycles in the HIV viral replication process that have not previously been available within existing drug classes. A new class of oral drugs — called maturation inhibitors (which stop new virus particles from maturing) — are at late phase II/ III development, such as bms955176.

Although we already have one attachment inhibitor — maraviroc/Celsentri — it works less effectively when HIV uses a host immune cell receptor called X4 to gain entry into the cell.

However, a new attachment inhibitor, fostemsavir, appears to overcome this problem (stopping HIV from latching onto the R5 or X4 co-receptors blocking entry into immune cells). Celsentri works only for R5-using virus entry pathways, so fostemsavir will be a welcome new entrant.

STILL MORE IN THE PIPELINE There are a number of other drugs further back in the developmental stage that are showing exciting enhanced attributes on existing classes of drugs, such as mK-8591 (a new NRTI nuke), which may allow for weekly oral dosing. Many of these longer-acting compounds are also being evaluated for pre-exposure prophylaxis (PrEP) as part of an enhanced prevention regimen, so we will no doubt hear more about them in that context soon too.

But, of course, the discovery of a cure for HIV is our Utopia and research in that area remains a global priority. Although a number of compounds are being researched (see page 5), to-date, there have been few breakthroughs due to the unique ways in which HIV harbours and hides within the body.

So, meantime, the quest of treatment research continues on in a concerted effort to improve the quality of life for people living with HIV.

AN INJECTION EVERY TWO MONTHS COULD REPLACE THE DAILY ORAL REGIMEN positiveliving l

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COMPARED TO THE MELBOURNE CONFERENCE TWO YEARS AGO,

the Durban shindig was a relatively downbeat affair. Ahead of the opening of AIDS 2016 in South Africa in July, a report was released showing that the decline

“I’m seeing for the first time a decline in financing from donor countries,” he said. “If we continue this trend, we won’t be able to end AIDS by 2030.”

Sidibé wasn’t alone in expressing doubts over the un target. “I don’t believe ‘the end of AIDS by 2030’ is realistic,” said scientific luminary, Professor Peter Piot, former Executive Director of UNAIDS and now Director of the London School of

protectinG YounG Women a KeY Focus oF tHis Year’s conFerence

LEAVING NO ONE BEHIND Some 18,000 delegates from 180 countries descended on Durban, South Africa for the 21st International AIDS Conference. As Christopher Kelly reports, the fight against HIV is far from over.

tHousands marcH For aFFordable treatment access

in new HIV diagnoses among adults has stalled, prompting UNAIDS Executive Director Michel Sidibé to issue this warning: “If there is resurgence in new HIV infections now, the epidemic will become impossible to control.”

Sidibé also decried the fall in funding for HIV, considered essential to meeting the UN target of ending AIDS by 2030.

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Hygiene and Tropical Medicine.

“The continuing high rate of over two million new HIV infections represents a collective failure which must be addressed through intensified prevention efforts and continued investment."

Ben Plumley, of Pangaea Global AIDS, agreed that talk of the “end of AIDS” is premature.

“There’s nothing worse than hearing governments

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congratulate themselves on a job well done, when the job has only barely started,” he said. Even Bill Gates — whose foundation has ploughed hundreds of millions of dollars into the global fight against HIV/AIDS — appeared less than optimistic. “If we only do as well as we have been doing, the number of people with HIV will go up even beyond its previous peak,” he said.

It was against this backdrop that the 21st International AIDS Conference opened. Running with the theme “Access Equity Rights Now”, a core focus of AIDS 2016 was to reach out to vulnerable populations most at risk of being left behind due to discrimination and criminalisation — such as sex workers, injecting drug users and gay men.

Addressing the stigma faced by marginalised groups, UN Secretary-General Ban Ki-moon urged for the protection of the rights of all people living with HIV. “We must close the gaps that prevent people from accessing services and living with dignity,” he said. Conference Alister Sir Elton John said that without respect for human rights “all the wonderful scientific work, all the hard work on the ground from countless people all over the world will come to nothing”.

The transgender community is particularly disenfranchised. As a result, transgender men and women are a staggeringly 50 times more likely to acquire HIV than any other adults. “They are,” said Chris Beyrer, outgoing President of the International AIDS Society, “the most heavily burdened of any of the key populations” and at “the very heart of the global HIV/AIDS epidemic”.

To raise awareness, more than 400 members of the transgender community and their supporters took part in the first-ever trans preconference. Entitled “No more lip service”, the event provided a forum to explore how services can be designed and implemented to be acceptable and accessible to the transgender population. It included special sessions on human rights and gender-based violence, as well as presentations on the latest research into transgender people’s health.

UNAIDS Deputy Executive Director Luiz Loures spoke at the event, stressing the importance of involving transgender people in the global AIDS response. “Fragile communities are everywhere and

history shows that change happens when the disempowered say ‘enough is enough’. The trans world is transforming the AIDS response,” said Loures.

With HIV hitting adolescent girls and young women the hardest on the African continent, their requirements were also front and centre at AIDS 2016 with numerous sessions giving voice to the urgent need to protect and empower them against HIV. Reducing new HIV infections among young women was described as “one of the greatest challenges in Africa”— recent statistics show that 2,000 young women contract HIV every week in South Africa alone.

BUT IT WASN’T ALL GLOOM AND DOOM inside the Durban International Convention Centre. Biomedical HIV prevention, delegates were told, is experiencing a golden age and the rapid pace of PrEP was acknowledged in several presentations. “Just as the 2000 International AIDS Conference in Durban ushered in a global movement to bring life-saving HIV treatment to the developing world, I am confident we’ll look back at this conference as the dawn of the global PrEP era,” president-elect of the International AIDS Society, Linda-Gail Bekker, told delegates.

“A primary focus of this conference is moving science into practice, and nowhere is that need more urgent than for PrEP.” Treatment as prevention was also hailed a spectacular success with the latest results from the PARTNER study making world headlines when it was announced that zero HiV transmissions had been recorded after 58,000 instances of condomless sex. But as Sidibé pointed out: “The power of prevention is not being realised — the world needs to take urgent and immediate action to close the prevention gap.”

Speaking of gaps. Out of the 37 million people living with HIV worldwide, 20 million are without treatment. In response, thousands of activists took to Durban’s streets demanding affordable access for all. Among them, Australian Theo Tsipiras.

“We stood in the middle of King Dinuzulu Park surrounded by thousands of people of all ages dancing, chanting, and shouting the Apartheid-era cry: “Amandla!” (which means ‘power’) and responding, “Ngawethu!” (which means ‘is

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ours’). I was moved by the sight of people demanding treatment.

People who simply wanted their family, their friends and themselves to survive HIV. It highlighted the privilege we have of accessible HIV treatments simply because we live in Australia. I remembered the feeling I had when I stepped off the plane, asking myself, “Where would I be if I lived here with HIV? Would I be alive?”

Back at the convention centre delegates gathered in the Global Village for more than 200 activities including discussions, screenings, exhibitions, music, dance and drama. Elsewhere, science took centre stage: delegates were told about a promising large-scale vaccine trial soon to begin in South Africa.

HVtn100 will be tested on 5,400 people across four sites for three years. An earlier trial showed the vaccine to be 60 percent effective after one year (although by the end of the trial this fell to 31 percent). “We want to get it up to 60 percent and keep it there,” said Anthony Fauci, Director of the US National Institutes of Health.

There was excitement, too, over the continued development of injectable treatments that could soon replace oral regimens.

Delegates were told that one such long-acting drug combination — cabotegravir and rilpivirine, administered every four-to-six weeks — has been found to be as effective as a single daily pill.

Delegates were buoyed by researchers describing 2016 as a ‘pivotal’ year in the effort to find a cure for HIV. Several emerging strategies were presented to delegates, among them gene editing and stem-cell therapy.

Once considered aspirational, such scientific techniques now seem plausible, Françoise BarréSinoussi told delegates. “There are a number of potential therapeutic strategies that could conceivably achieve [a cure];” however, “the challenges remain substantial,” she said.

And if there was an overarching theme to AIDS 2016, that was it: despite the remarkable advances made, the challenges facing those at the forefront of the fight against HIV/AIDS remain substantial. So now is not the time to ease back, or for people to pat themselves on the back; now is the time to increase efforts and push forward. As Beyrer told delegates at the opening ceremony: “It is too soon to declare victory.”

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MUSIC AND DANCING IN THE GLOBAL VILLAGE

DOCTOR LOUISE ANSWERS YOUR QUESTIONS

what’syourproblem?

HOW DO I KEEP MY CHOLESTEROL IN CHECK? marianna from Fremantle, Wa writes: I’m just about to commence HIV treatment and — among other tests — I’ve had my cholesterol level measured. It’s quite high, how can I manage it? dr louise replies: Cholesterol is produced in the liver and also consumed as part of our diet. The aim is to reduce total cholesterol, limit any risk factors for heart disease and to remain vigilant for signs of cardiovascular disease developing. So the ideal way to manage this is to look at all the cardiovascular disease risk factors and try and minimise and manage these where possible.

Diet is an important factor in reducing cholesterol levels. This means lowering your intake of saturated and trans fats — particularly animal fats found in meat, butter, cream and cheese.

Coconut and palm oils are also high in saturated fats. High levels of trans fats can be found in anything fried and battered, pies,

ice cream, biscuits, cakes and crackers.

Try to eat foods that are high in unsaturated fats, instead, such as oily fish, nuts, seeds, legumes, vegetable oils and spreads.

Also, eat plenty of fruit, veggies and fibre. Your doctor or a dietician can give you resources with specific guidelines to assist you with your diet plan.

Aiming to maintain a healthy body weight is important, as carrying even a few extra kilos contributes to high cholesterol.

Losing just five to 10 percent of body weight can greatly improve cholesterol levels.

Regular exercise will also keep cholesterol in check. You don’t have to go crazy at the gym: a brisk walk, gardening, cycling or dancing will do — anything that raises the heart rate and breaks you out in a sweat. Regular, moderate physical exercise also helps raise high-density lipoprotein — ‘good’ cholesterol.

After a trial of healthy diet and increased exercise, the lipid tests can be repeated to see if there has been any significant improvement in levels. If cholesterol levels remain elevated, and taking into consideration other cardiovascular risks, sometimes lipid-lowering medications — such as statins — are required. They’re usually well tolerated and your doctor will check to ensure there are no interactions with your HIV medications.

Some HIV antiretroviral medications can lead to small increases in lipid measurements.

This is usually managed, however, with a healthy diet and the addition of statin medications.

Sometimes, the HIV medication regimen may be changed to try and improve things, but this is usually considered along with other factors — such as reducing the number of tablets or perhaps switching to a once-a-day regimen if that is suitable.

Keep your questions under 100 words and email them to pl@napwha.org.au. l Dr louise Owen has been working as a sexual health physician in the HIV sector since 1993. Previously a director of VAC’s Centre Clinic in melbourne, she is currently the director of the Statewide Sexual Health Services in Tasmania. Her advice is not meant to replace or refute that given by your own health practitioner, who is best placed to deal with your individual medical circumstances.

THEPILLBOX descovy (pronounced des-kohvee) is a once-a-day, fixed-dose regimen combining 200mg emtricitabine with 25mg tenofovir alafenamide — taF for short. taF is the new and improved formulation of tenofovir disoproxil fumarate — tdF. Used in much lower doses than TDF (300mg), TAF is less harsh on the body: it’s kinder on the kidneys, and also has a softer impact on the bones — both of which have become issues of concern as positive people age.

(However, the drug’s producer, Gilead, still recommends regular monitoring of bone density and kidney function in patients.)

Another selling point for the TAF component of Descovy is that, unlike TDF, TAF does not

Discovering Descovy accumulate in the blood.

It builds up inside the cells of the immune system instead. Meaning, as the immune system’s cells are attacked by HIV, the accumulation of TAF helps to protect the cells from infection. In already infected cells, TAF reduces the production of HIV when used in combination with other drugs.

The second fixed-dose pill containing TAF (after Genvoya), Descovy can be taken with or

without food and is generally well tolerated, with mild and temporary side effects — the most

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common being headache, tiredness, nausea and diarrhoea.

Rarer side effects — found in fewer than one percent of participants in clinical trials — include abdominal pain, indigestion, flatulence, rash and vomiting.

Again, these side effects are generally mild and temporary.

If you are considering Descovy

l SPrING 2016

as a treatment option, tell your doctor if you have kidney disease or liver disease — Descovy is not suitable for people living with HIV coinfected with hepatitis B as it can acutely exacerbate already existing symptoms of hep B. You will also need to tell your doctor if you’re pregnant or breastfeeding.

While Descovy has been called Truvada 2.0, Gilead has not sought approval of the drug for PrEP as there have been no clinical trials of the tablet for that purpose. Although approved by the Therapeutic Goods Administration for use alongside other antiretroviral drugs, Descovy remains unsubsidised. It will be before the Pharmaceutical Benefits Advisory Committee for approval for government subsidy in October.

dean beck: africa — why?

Heather ellis: I’d lived in Jabiru [Kakadu National Park] for all my twenties. It was an isolated existence living in a township of 3,000 people, so I just had this desire to get out there — but I didn’t know what I wanted to do.

Then one day I was sitting with friends having a few beers and out of the blue blurted out: “I’m going to ride a motorcycle across Africa.” As soon as I said it I became obsessed. This was my calling. I don’t know where it came from, but this was the thing I was meant to do in my life. db: What did you encounter?

He: The good thing with a motorcycle is you get off the travellers’ trail; with the motorcycle I could take the back roads and go to villages. Some of the villages I went through, children had never seen a white person. They would run away screaming like I was this ghost or something. That gives you an idea of how I could really get off the beaten track. When you go to a village you always ask the chief if you can sleep there for the night.

Once he says yes, you’re under the chief’s protection and nobody will hurt you.

The book is called Ubuntu, which means the bond of human kindness and sharing and helping each other and working together as a community. There’s a sense of humanness in Africa that we don’t have in the West. People walk past you in the street and people look you in the eye and acknowledge you. We don’t do that; we avoid eye contact. And that’s what I really noticed about Africa, people acknowledging you all the time.

OUT OF

AFRICA Heather Ellis’s book, Ubuntu, is much more than a travel memoir — it’s an amazing story of resilience, spirit and determination.

Here, the author and adventurer talks to Joy FM’s Dean Beck.

one time in northern Nigeria I stayed in this village and they killed a chicken and fed me — one scrawny chicken between two adults, me and half a dozen kids. db: did you ever feel threatened?

He: Because I was a woman on my own, I was always aware of my personal safety: I wouldn’t get drunk, I wouldn’t smoke marijuana because I had to keep my wits about me. But one time I was in Bamako [mali] and I had a run-in with some hustlers who

threatened to burn me, to pour petrol over me. Fortunately, a tour guide I’d met a couple of weeks before, mohammed, happened to be wandering through and suggested we stay at his friends’ house.

I could relax, so I drank a few

db: it sounds like the people were tremendously giving.

ubuntu — one woman’s motorcycle odyssey through africa by Heather ellis is published by black inc.

He: They hardly have anything at all, these are really poor people.

But they always wanted to help me and give me food. There was

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beers and smoked a little dope.

We ended up having unprotected sex. The next morning I was in denial. I thought: “No, one time?

You can’t get [HIV] from one time.” So I carried on travelling.

The grand plan was to stay in moscow for the winter. To get the russian visa I needed an HIV test . . . and it came back positive. I was diagnosed in September 1995. db: a time when antiretrovirals were barely in existence and the stigma for a [HiV-positive] woman was profound — still is.

How did you cope with that?

He: I was devastated. I thought death was inevitable. The doctor said I had about five years before I was going to get sick. So I’m thinking: “If I’ve only got five years to live, why should I go home and just wither away and die?” I thought, instead, I’d have the one last great adventure and hope for the best. db: You did get sick.

He: I was weak, I was very tired.

As I continued travelling my hair started falling out. I managed to get down to Hanoi in Vietnam and I thought: “I’ve got to get home.”

I took the next flight to Cairns and fronted up at my parents’ doorstep. They were so shocked at how I looked they I have actually asked if I had AIDS. I told them I’d survived picked up a stomach Africa, I bug. I was so scared of can survive the rejection and the shame I’d bring on my anything! family — they grew bananas in northern Queensland; it was a little farming community.

I secretly booked myself into the HIV clinic at the Cairns Base Hospital. Straightaway I was put on intravenous ArT. I had about 40 T-cells; I was riddled with PCP. Yet even when I was in the hospital bed I thought: “I will survive. I have survived Africa, I can survive anything!” listen to the full interview here.

newsouthwalesnews PositiveLifeNSW

Back into work on your terms If you’ve been out of the workforce for a while, it can be challenging to get back into employment.

As Neil Fraser reports, HIV Work Ready is here to help you to make the transition. after my positive diagnosis in 2013, like a lot of people living with HiV (plHiV), i was left with a bunch of questions and lots of things to understand. i was also battling depression and anxiety.

I quickly found that working full time wasn’t an option for me; putting my health first became my priority. However, leaving work soon led me to an all-toofamiliar situation of social isolation and withdrawal.

After taking a few years off I realised I wanted to return to work, but wanted to do this on my own terms. I started off doing voluntary work and found it

surprisingly rewarding. Not only did it allow me to break free from social isolation, I also began to form a sense of purpose. my confidence was returning and I was participating in life again. my most recent foray back into the workforce has been as the project officer for Positive life’s new HIV Work ready program. The project aims to help people find a way back into work.

Getting back into the workforce

has spent a long time living in seclusion.

Setbacks or speed humps along the way are common, and in my own journey I’ve experienced a few. I know what it’s like.

It really helps to have someone in your corner to help you get in touch with the neil Fraser right services for your needs. The challenge is how to continue to feel (paid or unpaid) can feel like an supported and maintain your overwhelming tidal wave of resilience while not being afraid change — this is especially true to take risks. I understand work after an extended period of isn’t for everyone, but I know unemployment, or after someone

isolation serves no one either.

There are a ton of services and organisations out there looking for people with a lived experience of HIV who can offer a unique perspective. If you’re interested in getting an understanding of what’s out there drop me an email: neilf@positivelife.org.au or give me a call (02) 9206 2172 or visit HiV Work ready.

HIV Work Ready is a pilot project run by Positive Life NSW in partnership with the HIV Outreach Team and sponsored by ViiV Healthcare to assist PLHIV to engage with their community and to build confidence and quality of life.

When the pic doesn’t match the profile Suicide, or ‘selfdelivery’, is shrouded in silence. But, as David Crawford explains, the most damaging myth is we shouldn’t talk about it.

When we meet up with our mates or people we care about, generally, the first question is: “How are you?”

This moment creates an opportunity for us to tune into their responses and pick up on their cues. Sometimes, what the person is saying and doing don’t always match. Things that don’t fit with the picture are important to take notice of. You might hear “I’m OK”, but you’re not seeing “I’m OK”. Or you may think: “How can

they possibly be OK with all that crap going on?” Alternatively, a friend may be isolating and

Life.mail

Subscribe to Life.mail! Positive Life’s electronic bulletin will keep you in the loop with all our news, events and opportunities delivered direct to your inbox! Subscribe here

Talkabout Online ‘Where we speak for ourselves’ is an online magazine for and by people living with HIV. If you are living with HIV in NSW and are interested in being an author in Talkabout, click here or call the Editor on 9206 2179 EmAIl editor@positivelife.org.au

avoiding because they’re just not coping.

I often raise such concerns with people I care about. I am not being judgmental and my friends often respond with honesty and appreciation when I do. Talking about problems often alleviates the intensity of

negative thoughts; it also helps someone know that you care and that they’re not alone.

If someone you know is experiencing difficulty, ask them how you can help. If you get stuck, there are support services available, including l Qlife 1800 184 527 l lifeline 13 11 14 l beyond blue l lGbtiQ support services l nsW Health emergency information

Genesis is a weekend workshop for gay men diagnosed with HIV within the last two years. It’s peer-based, which means it’s run by other gay men with HIV who can relate to the experience of a new diagnosis. You’ll learn more about looking after your health, disclosure, HIV treatments, managing your life with HIV — and more.

WHen Friday to sunday 7-9 october 2016 WHere 414 elizabeth street, surry Hills (sydney) more inFo

acon’s HiV men’s Health promotion team 9206 2025/9206 2102 or email hivliving@acon.org.au contact

tel

l read Talkabout online here

PositiveLifeNSW 414 Elizabeth Street Surry Hills 2010 | ) (02) 9206 2177 or 1800 245 677 | w positivelife.org.au positiveliving l

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victorianews LIVING POSITIVE VICTORIA AND STRAIGHT ARROWS MERGE

Stronger together in august, members of both living positive Victoria and straight arrows voted to merge into one single organisation so as to strengthen the response towards all people living with HiV in Victoria.

“Our shared vision of partnership and genuine collaboration has always been about strengthening positive voices in the community,” said living Positive Victoria President richard Keane. “Now as one organisation we are able to provide a more inclusive and comprehensive response to the issues that affect the lives of all people living with HIV in Victoria.”

The purpose of the merger is to improve service delivery to people living with HIV by streamlining administration, governance and costs of both organisations. Straight Arrows is well known for its work with those living with HIV and their families in the heterosexual community.

The programs and expert knowledge the organisation brings will enhance the current portfolio of living Positive Victoria — an organisation that represents all people living with HIV. “Our relationship with living Positive Victoria has always been

one of mutual respect and we’ve worked well together in the past,” said Straight Arrows President Jeffrey robertson.

“Coming together as one

organisation allows us to bring our knowledge and resources together to focus on the needs of the heterosexual community and their families, and strengthen the response to support all those living with, and affected by, HIV.” The merger comes out of more than two years of planning and consultation with stakeholders by the Strengthening Positive Voices working group and the board members of each organisation. Close to 60 members from both organisations voted unanimously for the organisations to unite. There will

be no name change, and the merged organisation will retain the business name “People living with HIV/AIDS Victoria” and use the trading name “living Positive Victoria” for its health promotion, peer support and advocacy services. An interim board, made up of previous living Positive Victoria and Straight Arrows board members, has already been established and will govern until a new board is voted in later this year.

With the combined resources, members can expect to see expanded and improved programs and be confident of the sustainability of the merged organisation into the future.

Paving the way toward zero HIV the Victorian prep accord stood alongside Victorian health minister Jill Hennessy (pictured below right) to launch the double Happiness campaign in June to promote the use of treatment as prevention (tasp) and pre-exposure prophylaxis (prep) to eliminate new HiV transmissions.

The accord is a partnership between living Positive Victoria and the Victorian AIDS Council, alongside grassroots PrEP organisations prepaccessnoW, Time4PrEP, PrEP’d for Change, and researchers from Vicprep “I — along with all Australian health ministers — am committed to the goal of the virtual elimination of new HIV transmissions by 2020,” said Hennessy. “PrEP and TasP are effective strategies to help us achieve that goal.”

The campaign uses Chinese symbolism for “double happiness” to promote the union of the two complementary strategies

working together: the use of antiretroviral drugs for people living with HIV to reduce the viral load to an undetectable level (TasP), and the use of antiretroviral drugs by HIV-negative people to prevent HIV transmission (PrEP).

“The use of antiretroviral therapy to manage HIV whether you have the virus or not is incredibly powerful in breaking down HIV stigma,” said Daniel mcPhail, co-founder of prep'd for change — an organisation that seeks to educate people about PrEP. “The campaign is a brilliant vehicle for the education of PrEP and TasP no matter which side of the sero-fence you're sitting on.”

In addition to providing essential information about TasP and PrEP, the double Happiness website will have information available in multiple languages including Chinese, Greek, Spanish and Vietnamese. Having information available in multiple

languages is something that marcus Chen, Senior Specialist in Sexual Health medicine at the

melbourne sexual Health centre, thinks is a great step forward.

“We know HIV affects different communities and that culture and language can sometimes present significant barriers to access health information and services,” said Chen. “Having the campaign in multiple languages is a great way to promote this twin

approach to HIV prevention across our diverse community in a positive way.”

The campaign launch consisted of a panel discussion with representatives spanning gender, age and sexual orientation, including speakers from the prepX study and individuals on TasP. members of the HIV community and allies gathered later in the evening to hear more individual stories that highlighted the need to have both of these HIV-prevention methods accessible and available to all Australians.

“It’s been great to see the community come together on this and show that it’s possible to bridge the sero-divide," said Simon ruth, CEO of the Victorian aids council. "I’m impressed every time I see how much knowledge and empathy we have in our community, and how willing people are to learn and to engage with PrEP and treatment as prevention.”

living positive victoria | Suite 1, 111 Coventry Street Southbank 3006 | )03 9863 8733 | w livingpositivevictoria.org.au

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queenslandnews

Not eligible for Medicare?

Help is at hand

currently in australia, only those people with an australian medicare card can access low-cost HiV treatment through the pharmaceutical benefits scheme (pbs). overseas visitors (legally working, studying or holidaying in australia) who are not eligible for a medicare card are required to consider other options for obtaining affordable HiV treatment.

With this in mind, QPP has produced a new factsheet outlining options and supports available for medicare ineligible people to obtain HIV treatment, as well as information on how to get ongoing medical healthcare during their stay in Queensland.

The resource explores options

and methods for obtaining cheap generic medicines online; seeking compassionate medication access sponsorship; or engaging in a clinical trial (should a trial be available in the person’s location).

For people living with HIV without medicare cards, you are not alone: QPP is available to help you to navigate your treatment and clinical care needs. QPP offers assistance and support to all people living with HIV in Queensland — whether medicare eligible or not. This service is both free and confidential.

l Further support, help and guidance is available here.

Human Rights Act for Qld? Queensland positive people has made a submission to the state’s Human rights inquiry on whether it is appropriate and desirable to legislate for a Human rights act, other than through a constitutionally entrenched model.

QPP submitted that a Queensland Human rights Act would provide assurance that all public health responses to HIV be underpinned by human rights; that where there are laws protecting human rights, people living with HIV and people at risk of HIV are better able to access HIV services and participate in prevention, care and support programs. Further, protective and enabling legal environments ensure that public health policies and frameworks are sustainable,

Helping you navigate Qpp is delivering an innovative support program called peer navigation.

Peer Navigation is an early and brief intervention program that provides information and support to those newly diagnosed or re-engaging in care. Peer Navigators deliver structured time-limited interventions that aim to foster personal resilience, improve HIV health literacy, and provide support to synthesise information and navigate the health system. Peer Navigators are trained to address the psychosocial aspects of an HIV diagnosis to help reduce shame,

stigma and isolation; and to help improve self-esteem and mood.

So who are these Peer Navigators? Well, they’re people who have navigated through their own positive diagnosis and who

represent a diverse lived experience of HIV — including people from different gender, sexual identities, age, and ethnic and cultural backgrounds.

So far, QPP has recruited and trained eight Peer Navigators for phase one of implementation across south-east Queensland. The second phase of implementation — including training and recruitment — will take place in September and October. When the program has been fully rolled out there will be 19 Peer Navigators geographically dispersed throughout the state.

reach those most impacted or most at risk, and are up to date with the contemporary scientific realities of HIV. The Queensland Human rights Inquiry tabled its final report on 30 June 2016, recommending the introduction of a Human rights

Act. However, the committee favours a model with no mechanism to challenge human rights violations. The campaign continues, with the Queensland government still yet to act on the committee’s recommendations.

We’ll keep you posted.

Treatment support for PLHIV Qpp provides case management support to plHiV who are experiencing barriers or challenges to initiating treatment, adherence, or remaining in care.

QPP’s Treatment Support Facilitators provide PlHIV with one-on-one face time so as to help with issues such as housing, mental health, substance misuse, or financial barriers that can impact living healthy with HIV. Our facilitators work with individuals to talk

through specific goals and to help develop action plans, with the aim of fostering the personal skills to effectively selfmanage HIV. QPP has Treatment Support Facilitators in various locations across the state, including rural and regional areas. To find out where your nearest Treatment Support Facilitator is located, contact QPP at the numbers below.

queensland positive people | 21 Manilla Street East Brisbane 4169 | )07 3013 5555 or 1800 636 241 | w qpp.net.au positiveliving l

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as i sit here at the 2016 International AIDS Conference in Durban, I am listening to a very high-level panel discuss the concerns about what appears to be a trend among middle-income and high-income countries: the tightening of purse strings domestically and in relation to foreign aid.

It is very concerning to know that 13 of the 14 top donors to the Global Fund have decreased their funding, including Australia. What’s even more concerning is the number of high-income countries, such as Saudi Arabia, that don't even contribute to the fund. Why is this you ask? Because saving the lives of sex workers, gay men and drug users isn't popular.

Brent, Australia

prep took a centre stage and was part of almost every presentation, though it remains only available to a privileged few. Social justice issues continue to be a struggle for sex workers and transgender men and women.

Children are still being infected with HIV and dying in parts of the world. In all, it was a humbling experience and a check on my privilege to live in San Francisco. It is easy to forget how far we’ve come and yet we have still so much more to do.

Pierre, USA

the international aids conference takes place at a time when the global AIDS response is floating around in a sea of highfalutin’ rhetoric. The challenge we face is to overthrow this rhetoric and turn it into a concrete, plain English (or plain any language) agenda about what precisely needs to be done to curtail HIV in the next phase of the global response. When 20 million people don’t have access to medicine that could save their lives, we cannot say that the AIDS epidemic is under control. We need the world to wake up because the fight against HIV is not over.

Mark, South Africa

S E C I O V E C CONFEREN

t c e fl e r s e e d n e t t a 6 1 0 2 S D I A s y a w a e k a t y e k e h t on it was clear from the conference that we have made headway in terms of HIV treatment and prevention, but we have globally lagged in equity and access to care. This year the International AIDS Conference focused on equity, access and human rights and this theme was intertwined throughout the week-long event. The conference emphasised the need to decriminalise HIV, reduce drug costs, increase access to health services, and bring marginalised groups — such as adolescents, transgendered persons and sex workers — out of the shadows and into care. In the fight against HIV, it was made clear that no-one can be left behind if we are to achieve any of our goals.

Shaun, USA

We still have over 79 countries where it is illegal to be gay, bisexual, transgender or intersex. These laws make it almost impossible for us to access HIV prevention and treatment services, which is a direct attack on our basic human rights. As a person who has experienced the discrimination that comes from being gay in my own country, I must ask the question: how far have we gone in protecting the rights of vulnerable populations? This question remains to be answered and goes even beyond the legal rights of lGBTI — it’s about the rights of sex workers, trans diverse persons, people who use drugs, and people living with HIV. All the recent scientific success we have had in the fight against HIV will come to nothing if we continue to have laws that take away the right of individuals to access life-saving care they need. We should and must do better.

i spent a lot of time trying to understand what I should take away from the conference; what lessons I needed to learn in order to be a better leader and activist. Walking around, I noticed that many of the people speaking on panels and in sessions were members of multiple diverse communities. One panel featured HIV activists, African gay men, abortion rights activists, injecting drug users, and sex workers. All of them had two things in common: they were members of communities that were in some way marginalised, and they were all united for the goals of equal human rights and the end of HIV. I realised that if we want to be part of the conversation, then we need to work better together to achieve these goals. We need to realise that there are other people and communities who struggle just as we do and that our fight is one fight.

Micheal, Nigeria

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Theo, Australia

THE

backpage

Spring has sprung!

FOR TELLING YOUR CHILD YOU’RE POSITIVE 1 Prepare them from an early age — give out information in small chunks 2 Choose a time and place free from distractions 3 Don’t make it a big deal — reassure them you’re likely to be around to nag them for many years to come!

4 Be prepared for questions, and give honest answers 5 Let your children know that it is okay for them to keep sharing thoughts and feelings Salamander Trust

spring onions are baby onions picked before their bulbs have had a chance to grow. also known as scallions, green onions, the Welsh onion, or the Japanese bunching onion, their flavour is similar to that of their mature relatives — only sweeter and milder. containing flavonoid antioxidants, minerals, vitamins and fibre, spring onions house a host of nutritional benefits: they improve bone density, stimulate the respiratory system, are good for the digestive system, help keep eyes healthy, lower blood sugar levels, and protect against infection. spring onions also add colour and crunch to stir-fries and salads.

Yellow fever

lemons are therapeutic powerhouses. they’re good for indigestion, constipation, fever, rheumatism, burns, throat infections, respiratory disorders, dental problems, high-blood pressure, and healthy hair, skin and teeth. they help prevent diabetes and reduce the risk of kidney stones and stroke. lemons also strengthen the immune system, cleanse the stomach, purify the blood, and lower body temperature. (they’re also a very effective washing agent and mosquito repellent.) eat half a lemon a day for maximum health benefits. alternatively, squeeze half a lemon into a cup of lukewarm water. positiveliving l

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QUOTEUNQUOTE

This virus has an extraordinary ability to affect wherever people are marginalised, wherever they are excluded — and that includes people whose behaviours and lifestyles and identities are criminalised and marginalised in so many societies. If we can’t include them, we can’t control HIV. Chris Beyrer, outgoing IAS President and AIDS 2016 co-chair

GOFIGURE q

South Africa has the highest number of people living with HIV in the world, with

7million

of the population affected.

UNAIDS