positiveliving FOR PEOPLE LIVING WITH AND AFFECTED BY HIV | WINTER 2015
S E L B A T C E T E D N U THE
“One of the key challenges for the government in the early days of AIDS is to keep the population calm.” THE
HIV-positive people with undetectable viral loads say proactively keeping the virus under control through treatment makes them feel empowered. They feel as if they are keeping the arch-enemy at bay – much like a superhero. PAGE 6
One of the most widely used antiretrovirals
Tenofovir Jacob Boehme talks about Blood on the Dance Floor
has been re-formulated. Why the upgrade?
positiveliving ISSN 1033-1788 EDITOR Christopher Kelly
David Menadue Vicky Fisher CONTRIBUTORS Daniel Brace, Jake Kendall, David Menadue, Dr Louise Owen DESIGN Stevie Bee Design ASSOCIATE EDITOR PROOFREADER
COVER IMAGE XX
TIPS ON HOW TO WARD OFF THE FLU PAGE 15
ABC OF HIV PAGES 7-9
Why does the medical use of cannabis remain illegal in Australia? PAGE 5
what’syourproblem? PAGE 10
Should I test for syphilis?
Free subscriptions are available to HIV-positive people living in Australia who prefer to receive Positive Living by mail. To subscribe, visit napwha.org.au or call 1800 259 666. CONTRIBUTIONS Contributions are welcome. In some cases, payment may be available for material we use. Contact the Editor EMAIL: firstname.lastname@example.org 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: September 2015 SUBSCRIPTIONS
n 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. n 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. n The content of Positive Living is not intended as a substitute for professional advice.
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thenews from the editor Readers with keen eyes will have noticed that the masthead strapline has been re-worded. It’s gone from reading “For people living with HIV” to “For people living with and affected by HIV”. So why the change? Well, for starters, to acknowledge that Positive Living isn’t read exclusively by people living with HIV. It’s also read by the friends, families and lovers of PLHIV — all of whom, in some way, are also affected by the virus. Another reason for the change is, by encouraging a more inclusive readership, it’s hoped a greater number of people will get to understand the science of HIV — that with effective treatment a positive person becomes virtually non-infectious; that there is less risk of HIV transmission from a positive person on treatment with an undetectable viral load than someone whose status is unknown. The more people in the regular population understanding this, the sooner we can dispel the stigma surrounding HIV. The sooner we lose the stigma, the more people will be willing to test for HIV. The more testing, the more treating and the more positive people becoming undetectable (see page 6). Testing and treating are the key to ending HIV. Christopher Kelly
Men not testing often enough There’s good news and bad news: more men who have sex with men (MSM) are testing for HIV — but not often enough. According to findings from the Burnet Institute, only about 50 percent of MSM who had been screened for HIV repeated the test within 12 months. (It is advised that men with multiple partners or who engage in condomless sex should test for HIV and other STIs every three months.) Announcing the results of the six-year study, Dr Mark Stoove said: “If [MSM] don’t test again for 12 months, they spend that time in the community putting their partners at risk. If someone presents regularly, that time is reduced and allows people to practise risk-reduction strategies.”
START finds clear evidence A major international trial coordinated by the Kirby Institute at UNSW has been halted ahead of schedule after results provided “rock solid evidence” that immediate treatment of HIV has “a highly significant benefit” for people infected with the virus. The Strategic Timing of AntiRetroviral Treatment (START) study findings will have “global implications for the treatment of people living with HIV”, said coordinating investigator Professor Sean Emery. “As a result of this trial we now know that treatment at all stages of disease extends survival and prevents serious complications in people with HIV infection,” he added. Current international guidelines generally recommend PLHIV start treatment when their CD4 count falls below 500. The
the START study from START study its beginning in 2009, corroborates earlier with former executive evidence justifying director Jo Watson treatment at higher serving on the counts. “Many international researchers, clinicians coordinating group. and advocates have “Once again, through held this view,” said our participation in Robert Mitchell, START, Australia has president of the Treatment at all shown remarkable National Association leadership in of People with HIV stages of the global HIV research,” said Australia (NAPWHA), disease extends Mitchell. “but the evidence to Carried out at 215 support it came survival and sites in 35 countries, mostly from smaller prevents serious START is the first studies and expert opinion. It was argued complications in study to examine the that we lacked a large, people with HIV. initiation of antiretroviral therapy definitive, randomised – Sean Emery (ART) for HIV-positive clinical study to prove individuals with the early treatment normal CD4 counts (500-plus). strategy. So START has provided The study enrolled 4,685 that.” NAPWHA has been involved in participants who had never taken
ART before. One half of participants began treatment immediately, while the other half commenced treatment once their count fell to 350. Interim analysis shows the risk of serious AIDS events, and deaths due to non-AIDS events including major cardiovascular episodes, renal and liver disease, and cancer was reduced by more than 50 percent among the early treatment cohort compared to those in the deferred group. All study participants will now be offered treatment and will continue to be followed in the next stage of the study which is expected to conclude in 2016. “We would like to thank the thousands of HIV-positive participants who have contributed to a finding that will impact treatment guidelines around the world,” said Emery.
Uncertainty for HIV sector Almost $1 billion is to be cut from health programs as part of savings revealed in last month’s Budget — more than half of which will come from the Health Flexible Funds allocation. One of these funds — the Communicable Disease and Service Improvement Grants Fund — provides the bulk of health promotion funding for the HIV sector. Flexible fund grants are made
to national peak bodies such as the National Association of People with HIV Australia (NAPWHA) and the Australian Federation of AIDS Organisations (AFAO). Both bodies have a 12month extension to expire in June 2016, with no certainty after that. “The lack of certainty distracts organisations such as ours from our long-term work,” said
NAPWHA executive director Aaron Cogle. “It also diminishes our focus on meeting the targets of the National Strategy.” Dr Brian Owler of the Australian Medical Association (AMA) said it is crucial that organisations such as NAPWHA and AFAO are able to plan for the future. “We need to see certainty around where the cuts will be made, how they are going to be
applied,” he said. Labor health spokeswoman Catherine King said the cuts will have a profound effect on the people reliant on NGOs. “It will have a direct impact,” she said. “These [grants] fund the important organisations that the HIV/AIDS community has been working with for many decades. We will literally see those groups defunded.”
Community dispensing about to begin From 1 July, HIV treatments can be picked up from local chemists (HIV medicines have historically been dispensed from hospital pharmacies). PLHIV will still be able to access their meds from hospital pharmacies if they wish; however, the changes will provide greater flexibility and convenience as — unlike hospital pharmacies — community chemists are often open in the evenings and over the
weekends. There will also be options for PLHIV to arrange for the delivery of their meds online (only scripts dated 1 July or after can be processed). People are advised to plan ahead to renew scripts so as to allow time for the pharmacist to order stock,
especially those living in an outer suburban, regional or rural area. As the HIV drugs remain highly specialised (s100), not all chemists will choose to dispense them, so it is important people
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check with the pharmacist first. And in a survey conducted by the National Association of People with HIV Australia (NAPWHA), 72 percent of PLHIV signalled a preference for collecting their treatments from a community chemist. However, the NAPWHA survey also found that 70 percent of respondents expressed some concern about their HIV status being known to their local pharmacy.
thenews Positive Life SA defunded After serving the HIV community for 21 years, Positive Life SA (PLSA) is to be defunded by the South Australian government. A public tender process was initiated late last year for new contracts to service the HIV community in SA, and PLSA failed in its bid. “Following a competitive tender process, preferred suppliers were identified,” said an SA Health press release. The Victorian AIDS Council (VAC) and SHine SA are to jointly take over the state’s HIV/STI prevention program. In response, PLSA president Geoff Hood has called on VAC to withdraw from “the illogical consortium partnership” with SHine. “Positive Life SA must receive the necessary funding to enable it to continue its current model of best practice support to PLHIV,” said Hood. PLSA has launched an online petition in an attempt to persuade the SA government to reverse its decision and reinstate $400,000 in funding. It states: “PLSA is unique. It is the only funded organisation in SA driven by HIV-positive people. This SA Health decision silences the voices of the HIV community in South Australia.” The defunding of PLSA is due to take effect on 30 June.
Better than the real thing new materials would have the same properties as rubber, but with a nicer feel,” said team leader Robert Gorkin. The researchers now plan to conduct biometric testing to measure the body’s response to the condoms. “If you make them so pleasurable that people can’t wait to put them on, then more people will use them, and we can hopefully stop the spread of disease,” said Gorkin. “It’s as simple as that.”
One of the most common complaints about condoms is that they decrease the pleasure of intercourse. But maybe not for much longer. Scientists at the University of Wollongong are busy developing the condom of the future — one that self-lubricates, delivers Viagra, and even conducts electricity. Rather than latex, the team has been experimenting with hydrogel material which — although strong and durable — can be made to feel like human tissue. “We had an idea that these
Gorkin and colleague testing the flexibility of hydrogel
HIV speeds ageing Left untreated, HIV causes changes to cellular DNA comparable to 14 years of ageing, according to findings. DNA extracted from the blood cells of treatmentnaïve HIV-positive men aged between 20 and 56 were compared with those of HIV-negative men. Researchers at the UCLA AIDS Institute and Centre for AIDS Research discovered that the positive cohort seemed to be 14 years older than their
chronological age. “This number is in line with both anecdotal and published data suggesting that treated HIVinfected adults can develop the diseases of ageing approximately a decade earlier than their uninfected peers,” said one of the study’s senior authors. “These results are an important first step to finding potential therapeutic approaches to mitigate the effects of both HIV and ageing.”
Annual blood test sufficient, says study An annual CD4 count may be adequate, say scientists, for people doing well on treatment. A study has shown that the probability of a decline in CD4 cell count to below 200 in people with a suppressed viral load did not differ according to whether they were monitored annually or every six months. “This suggests,” said the researchers, “that less frequent CD4 measurement does not miss important immunological events in patients with viral suppression.
Men with HIV get drunk quicker!
Self-testing kit on sale in UK Dubbed “the world’s most accurate HIV self-test”, the first legally approved DIY HIV test kit has gone on sale in the UK allowing people to get a result in 15 minutes. Manufactured by BioSure and retailing online for £29.95 ($60), the HIV self-test has, it is claimed, a 99.7 percent accuracy rate. Experts advise, however, that any positive results be confirmed by a healthcare professional. Detecting antibodies from a small drop of blood, it is hoped the single-use, disposable kit
(pictured) will help normalise HIV testing and reduce some of the 26,000 people estimated to have undiagnosed HIV in the UK.
“Knowing your HIV status is critical,” said BioSure founder Brigette Bard. “The launch of this product will empower people to discreetly test themselves when it is convenient to them and in a place where they feel comfortable.” The introduction of hometesting kits in the UK highlights the lack of availability of such a product in Australia. Although the Therapuetic Goods Administration lifted restrictions on the sale of home-testing products last year, as yet, no manufacturer has applied to supply such a kit.
Annual CD4 monitoring in virally suppressed patients with a baseline CD4 of 250 may be sufficient for clinical management.”
Men living with HIV need fewer drinks than negative men to feel the effects of alcohol, according to a new study. “People who have HIV infection have a lower tolerance for alcohol than similar people without HIV,” said Professor Amy Justice of Yale University. Yale researchers studied data on more than 2,600 men. They
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analysed survey responses from both HIV-positive and HIV-negative participants. Researchers also compared reactions of HIV-positive men with detectable viral loads with those of positive men with undetectable viral loads (UVL). Those with an unsuppressed virus were more sensitive to the effects of alcohol than both HIV-positive men with UVL and the negative cohort.
Mandatory testing for BBVs
High time for change
As Christopher Kelly reports, in SA and WA people can be forcibly tested for HIV.
Marijuana’s therapeutic properties are well documented, so why — asks Jake Kendall — does the medical use of cannabis remain illegal in Australia?
Although police are routinely blood tested should they become exposed to ‘biological material’, legislation now exists in SA and WA forcing people who assault police to be screened for bloodborne viruses (BBVs). The so-called ‘spitters and biters’ laws have been introduced to provide police with ‘peace of mind’. But an assailant testing positive for HIV does not establish that an officer has contracted the virus. Conversely, a negative result is not a conclusive all-clear. Leaving aside for the moment that such powers further stigmatise PLHIV, these laws also highlight an ignorance of how HIV is transmitted: saliva is not among the bodily fluids through which HIV is transmissible. As for contracting HIV from a bite, the risk is negligible: among the large number of police who have been exposed to such an assault, there is not a single recorded case of HIV transmission through this means in Australia. Then there is the small matter of civil liberties to consider. HIV testing exceeds the legal boundaries of ‘examining’ a person and clearly constitutes an infringement of human rights. And what if a person resists being tested? Are they to be held indefinitely until a court orders them to comply? Details are sketchy. Worryingly, a precedent seems to have been set. The Police Association of NSW has recently called for powers to force anyone who ‘transmits’ a bodily fluid to an emergency worker to be tested for infectious diseases — including HIV. Such laws risk taking us back to the dark ages when PLHIV were perceived to be a danger to society.
In 2014, a 59-year-old South Australian man with leukaemia was sentenced to two years’ jail for growing cannabis. He’d received the sentence as he had ‘previous form’, having been caught growing the plant sometime before to help his wife endure the side effects of chemotherapy for her lymphoma. That a man in such an obviously desperate situation can be made a criminal exposes the ludicrousness of the law. And the law — across all Australian jurisdictions — says it is illegal to possess, grow, sell and use cannabis (penalties vary from state to state). But are things about to change? NSW, Victoria and Queensland are moving towards clinical trials for the medical use of cannabis. A move in the right direction you’d think. But advocates remain unimpressed, saying trials are a waste of time — the science is already in, with medical watchdogs in Europe and the US backing the evidence. And the evidence shows that marijuana is effective in treating people with a variety of medical conditions including cancer, multiple sclerosis, migraine, glaucoma, anorexia, arthritis, epilepsy, Parkinson’s disease, Alzheimer’s disease, hepatitis C and HIV/AIDS. Cannabis has medicinal uses for treating muscle spasms, chronic pain, sleep disorders, and nausea; it also acts as an appetite stimulant in patients with weight loss due to cancer or HIV. For people living with HIV, cannabis is particularly helpful in alleviating peripheral neuropathy (nerve damage). Marijuana is regarded as acceptably safe to take with generally — not unpleasant
— mild side-effects. Australia is way behind on this. Marijuana is legally available for medical use in about 20 countries, including Portugal, Spain, Israel, Holland, Finland, Germany, Canada and the Czech Republic. In the US, it is legal in 23 states. Patients simply fill out an application form, provide a signed statement from a GP, pay a fee and collect their cannabis from a dispenser (there are even marijuana vending machines in operation). It seems particularly ridiculous that medicinal marijuana remains illegal in Australia when other drugs taken recreationally — such as ketamine, cocaine and amphetamine — are often used to assist people in a medical setting. But perceptions are changing and support is growing. A new survey by Palliative Care Australia
finds 67 percent of respondents back the use of medical cannabis. In December last year, the NSW government introduced regulations allowing terminally ill people who sign up to a register to carry 15 grams of marijuana without fear of prosecution. In Victoria, premier Daniel Andrews has said he is keen for medical marijuana to be made available to “a limited and select group of patients”. Federally, the Greens have introduced the Regulator of Medicinal Cannabis Bill 2014 to the Senate. If passed, it would make medical marijuana available to people who need it. An independent regulator would be responsible for licensing the growing, manufacturing and distribution of medicinal cannabis. Greens leader, Dr Richard Di
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“Medical cannabis should be made available without delay.” Greens leader Dr Richard Di Natale
Natale, said marijuana’s efficacy is well established and it should be approved for medical use immediately. “Medical cannabis should be made available for those conditions where it has been proven to be effective now, without delay, without trial,” he said. For cannabis to be approved for medical use in Australia, an application needs to be put to the Therapeutic Goods Administration (TGA) with supporting evidence of its quality, safety and efficacy. Di Natale is pressuring the TGA to create a special category for marijuana so that the drug can be accessed with a doctor’s prescription (the TGA currently lists cannabis as a prohibited substance). It’s not just the progressives calling for reform. The Greens’ bill — due to be debated soon — has broad support. Even Tony Abbott is in favour of marijuana for medical purposes. "I have no problem with the medical use of cannabis, just as I have no problem with the medical use of opiates," he said. The Australian Medical Association backs the use of marijuana for medical reasons in principle, but has warned against the legalisation of the raw dope plant and has urged that only fully-tested cannabis-based medicines be considered for use. Troy Lang, director of AusCann — whose company has become the first in Australia to be granted a licence to grow and export medical marijunana — thinks legalisation is inevitable. “Things are moving so quickly,” he said. “Once people find out [marijuana] provides relief for loved ones, they are going to stop at nothing to get it.” Desperate Australians are already stopping at nothing and, until there is a change in the law, they’re risking jail in the process.
S E L B A T C E T E D THE UN atment, PLHIV le viral load through tre tab tec de un an ing ain by maint nadue reports. The science is sound: alth of others. David Me he the t tec pro t bu h own healt not only bolster their
F ‘THE UNDETECTABLES’ SOUND LIKE A BUNCH OF SUPERHEROES, WORKING SILENTLY TO CHANGE THE WORLD FOR THE BETTER, THEN MAYBE — WHEN PUT IN THE CONTEXT OF A DESIRE TO REDUCE HIV TRANSMISSIONS — THAT'S KIND OF WHAT THEY ARE. The Australian HIV Observational Database estimates that between 85 percent and 95 percent of people living with HIV who are on treatment have an undetectable viral load (less than 20 copies of the virus in a millimetre of their blood). Becoming undetectable means the drugs have stopped the virus replicating. Most people living with HIV usually get to undetectable within three to six months of starting treatment. If a person’s viral load hasn’t become undetectable within that period, their HIV medication is usually reviewed. Some people, despite their best efforts, may not get an undetectable viral load (UVL) for
some time — if at all. This is not something to get overly concerned about as long as the general blood results are good. However, people with a detectable viral load may need to be extra vigilant to ensure they don’t pass on the virus. Those people able to achieve a UVL have a better chance of sustaining good health. Research presented at the Conference on Retroviruses and Opportunistic Infections in Seattle in February suggests that the earlier a person with HIV is able to get on treatment and reach a UVL, the more able they are to maintain higher CD4 counts over time. The HIV is also less likely to become resistant to treatment if a person is undetectable. Apart from the obvious advantages to a positive person’s own health, being undetectable greatly reduces the risk of onward transmission of HIV. Several international studies (such as HTPN 052 and the ongoing PARTNER study) back the science. Indeed, earlier this year,
preliminary findings from an Australian study — Opposites Attract — confirmed that treatment as prevention works. Conducted by the Kirby Institute at UNSW, the study monitored serodiscordant gay couples (positive-negative) for an average period of 12 months. Out of 6,000 acts of condomless anal sex, zero HIV transmissions were reported. “Essentially, what we are seeing among the gay couples enrolled in Opposites Attract is that HIV transmission is quite unlikely when someone’s viral load is undetectable,” said chief investigator Andrew Grulich. “In fact, no HIV-negative man in the study has contracted HIV from his positive partner.” Those in serodiscordant relationships experience a real sense of relief about the significant reduction in infectivity that comes with a positive partner’s undetectable status. If the negative partner is also taking the pre-exposure prophylaxis drug Truvada, then
the risk of HIV transmission becomes infinitesimal. However, couples engaging in condomless sex need to be mindful of the risk of contracting a sexually transmitted infection (STI). A positive person’s viral load will increase a little in the presence of an STI, potentially making a negative partner more vulnerable to HIV. Dr Nick Medland, a clinician at the Melbourne Sexual Health Centre, sees a lot of newly diagnosed clients. Medland says he has noticed a marked change in the numbers of people with HIV wanting to begin treatment as soon as possible, specifically with the aim of achieving a UVL. “Five years or so ago, many doctors would be hesitant to start people on treatments early after diagnosis,” said Medland. “It was thought advisable to let people take time to adjust to their HIV status, to think about whether they are ready to commit to taking treatments — which they may have to do every day for the rest of their lives.” (This is still
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true for some people and no one should be rushed into the process.) “These days, however, I have patients who ask in the same consultation when I have given them their positive diagnosis, if they can start treatment,” said Medland. “They have often already talked to their friends with HIV about how they are handling their medications and, as the side-effects are minimal for most people these days, they want to start as early as possible." And there is no longer a barrier against doing so. Last year, the Australian government changed the PBS guidelines for HIV antiretrovirals so that anyone who wishes to start treatment can do so any time they want, irrespective of their CD4 count. Anecdotally, HIV-positive people with undetectable viral loads say proactively keeping the virus under control through treatment makes them feel empowered. They feel as if they are keeping the arch-enemy at bay — much like a superhero.
hiv AN AUSTRALIAN STORY AIDS
In the middle of 1981, an innocuous article appears in the Sydney Star Observer mentioning an unidentified illness affecting gay men in New York and San Francisco. Nobody knows what it is or what has caused it. Or, for that matter, what to call it (it initially goes by the acronym GRID — gay-related immune deficiency). It becomes known as Acquired Immune Deficiency Syndrome — AIDS. The first Australian case is notified at St Vincent’s Hospital, Sydney in October 1982. Australia’s first AIDS-related death occurs nine months later at Prince Henry’s Hospital, Melbourne.
Australia quickly mobilises a national collaboration of governments, clinicians, researchers, community advocates and activists, policymakers, public health experts and
— crucially — people with HIV. “We were respected for our knowledge of what was happening in the epidemic and what needed to be done,” says Bill O’Loughlin, who has been living with HIV since 1982. The active involvement of people living with HIV (PLHIV) proves crucial to the Australian response.
Bipartisanism NEAL BLEWETT AND PETER BAUME TOOK A COOPERATIVE APPROACH
As does the bipartisan approach adopted by political rivals Labor health minister Neal Blewett and shadow counterpart Peter
ACT UP D-DAY ON THE STEPS OF FLINDERS ST STATION, MELBOURNE, 6 JUNE 1991 Baume. Blewett takes the lead on policy while Baume backs him up. “Peter Baume played a major role,” remembers Blewett. “He kept the recalcitrants on his side very much in line.”
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Various communities start to pull together for a political response to HIV and, in 1983, AIDS Action Committees form across the country (later to become AIDS Councils). Organisations providing practical support are established, such as the Bobby Goldsmith Foundation (set up in NSW in 1984) and the David Williams Fund (formed in Victoria in 1986). ACT UP (AIDS Coalition to Unleash Power) also emerges, protesting the delay in getting the few drugs available to those
in desperate need. Pressure from the organisation — including a series of ‘die-ins’ — leads to a change in the rules allowing people to import unlicensed medication for personal use. “Histories of HIV often make heroes of doctors and governments, and ignore the key role played early in the epidemic by communities at risk,” says Ross Duffin, former AIDS educator and activist.
from kissing and hugging, or by sharing a water bubbler — or a toilet seat. “It was a scary and volatile time in the public’s understanding of the virus,” says David Menadue, who was diagnosed in 1984. In an effort to
Infections With their immune systems severely weakened, AIDS patients display a vulnerability to opportunistic infections such as pneumocystis pneumonia (PCP), mycobacterium avium complex (MAC) and cytomegalovirus (CMV). “People would get mysterious conditions we had never heard of before,” says Menadue, “and the reality of AIDS became clear.”
Drug use Australia A STILL FROM THE 1987 ‘GRIM REAPER’ introduces a TV CAMPAIGN pioneering needle and syringe program for injecting drug users; counter the ignorance, the the scheme is rapidly rolled out government decides to run a across the country. With only 1.9 public awareness campaign. percent of HIV infections in Australia attributable to injecting drug use (IDU), the initiative has proven extremely effective. In It features a television contrast, the US has an IDU HIV commercial portraying the Grim infection rate of 20 percent. Reaper knocking down men, women and children like nine pins. Although later credited as helping to successfully manage It’s not long before it’s discovered Australia’s response to HIV, the ad proves controversial, as it is that a retrovirus is the cause of seen to contribute to the stigma AIDS. It is named the human surrounding people living with immunodeficiency virus — HIV. HIV/AIDS. “We could see the But while the cause of AIDS has point of the campaign,” says been identified, there is no cure, Menadue, “but we knew and no treatment. And in it would increase people’s Australia between 1984 and midfears about people with 1985 there is a 540 percent HIV as much as their increase in HIV infections. fears about the virus.” “This period was one of the toughest times being involved in HIV care,” says Mark Bloch, who has been working in the sector since 1983. “Many of those who One of the key challenges became positive in the peak for the government is to period of the mid-1980s were keep the population calm. becoming sick. There were so “Medical science in many ways many lives cruelly cut short so was baffled in those early years,” young.” As the ’80s end, death says Blewett. “It had all the rates skyrocket. ingredients of a mass hysteria and some of the press encouraged that with ‘we’re all going to die’ sort of thing.” “Some public health officials, Fear of the unknown leads to media commentators, and the mass misinformation, with people inevitable religious right believing they can catch AIDS attempted to regulate and contain people with HIV,” says Menadue. It is suggested that the details of everyone diagnosed HIV be compulsorily notified to the authorities — including addresses. In 1984, Adelaide’s Advertiser runs the headline: “Place AIDS victims in quarantine”.
Criminal law is used to prosecute people for potential exposure and transmission of HIV. Regulation varies across Australia. “Criminalisation of HIV exposure and transmission were often determined by opinion rather than evidence,” says Anne Mijch, who co-established Victoria’s first HIV/AIDs service in the 1980s. “A number of vulnerable individuals were caught in vendettas and incarcerated.” This connection between HIV and the law exacerbates the stigma and discrimination already associated with people living with the virus.
Hospital in Sydney and Prince Henry’s Hospital in Melbourne with purplish-black blotches on their skin. “People would put make-up on to try and hide the KS lesions on their face,” says Bloch. “It was very painful to see friends and patients change from looking well to rapidly going downhill, wasting away.”
Candlelight memorials become an integral part of honouring and remembering those who have died of the disease. The first is held in 1985 when two men stand silently with lit candles in Melbourne’s city square. In 1988, the Australian AIDS Memorial Quilt is established and publicly displayed for the first time on 1
gay man, “1996 will always be the ‘protease moment’ — the year that the advent of effective treatment for HIV was announced.” The extensive uptake of HAART in Australia — highly active antiretroviral therapy (a combination of drugs that include protease inhibitors), brings, for the first time, real hope that the worst is over. “I had begun my first triple treatment. The impact was immediate and extraordinary,” says Andrew Kirk, living with HIV since 1984. “The dream that I had wished for, for so many years, had arrived.”
With the development of new, more effective treatments, rather than a terminal illness, HIV
Kincumber Eve van Grafhorst (BELOW LEFT) is one of the first Australian children to become infected with HIV via a blood transfusion. Eve is at the centre of a media storm in 1985 when she is banned from her kindy in Kincumber, NSW, amid fears she might infect other children. She is allowed to attend providing she wears a face mask. However, the van Grafhorst family are eventually hounded out of their home and resettle in New Zealand where Eve later dies, aged 11.
Lesions Kaposi’s sarcoma (KS) — a relatively benign cancer that tends to occur in older people — becomes synonymous with AIDS in the early 1980s, so much so it is dubbed the ‘gay cancer’. “There was a story in the Sydney Morning Herald describing a ‘gay cancer’,” says Duffin. “We constructed a lot of hilarity about the notion that cancers had a sexual preference and dismissed the story as trash.” AIDS patients begin to present themselves at St Vincent’s
CANBERRA, MAY 2015: CANDLELIGHT MEMORIALS STILL EXIST TODAY December (designated World AIDS Day the year before). “The establishment of these AIDS memorials served an important service,” says John Rule, editor of Through our Eyes — a publication charting Australia’s HIV response. “The stigma surrounding HIV/AIDS meant there was no formal recognition of HIV/AIDS as a national tragedy, nor were there moves to commemorate formally those who had died from the virus in a manner that often occurs following events such as natural disasters or wars.”
Ninety-six “In the annals of AIDS,” says Geoff Honnor, an HIV-positive
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becomes a manageable condition and positive people find themselves living longer. “People with HIV weren’t meant to live this long,” says 72-year-old Barry McKay, diagnosed in 1988. “Now PLHIV are being put in aged-care homes!” But ageing with HIV presents its own unique challenges with evidence suggesting many
positive adults are ageing prematurely and developing multiple chronic illnesses typically seen in the very old — such as cardiovascular disease,
themselves as having any particular rights or identity. We were a silent part of the epidemic until a few brave people started to speak up and change things.”
The babies’ deaths lead, in March 1985, to Australia becoming one of the first countries in the world to adopt universal blood screening procedures for HIV. Gay men are automatically outlawed from donating blood.
kidney disease, cancer, diabetes, osteoporosis, and neurocognitive disorders. “Things accelerate and explode a bit with HIV,” says McKay.
Plague At the height of the AIDS epidemic, gay men are routinely persecuted; the disease is coined the ‘Gay Plague’ — a term the press seize upon. A moral panic ensues and gay men are blamed for bringing AIDS upon themselves. AIDS is the “wrath of God”. GAY becomes an acronym for “Got AIDS yet?” There emerges a clear distinction between innocent AIDS patients (those who medically acquire the disease) and the guilty — gay men. In 1984, Brisbane’s Daily Sun runs a story sympathising with a haemophiliac husband who transmitted HIV to his wife and unborn son. “What makes this case even sadder,” writes the author, “is that the mother and father are decent folk. They did not contract the disease through the kind of sexual lifestyle most people rightly avoid.”
Queensland babies Four babies in Queensland die from contaminated blood transfusions in 1984. The tragedy heightens the fear of AIDS and inflames anti-gay rhetoric when it is discovered the blood donor is a gay man. The fact he did not know he had the virus (antibody testing for HIV isn’t introduced in Australia until 1985) does nothing to quell the antagonism.
The ’80s and ’90s see a series of high-profile AIDS-related deaths. Hollywood leading man Rock Hudson is the first celebrity to publicly announce that he has AIDS shortly before succumbing to the disease in October 1985. Queen front man Freddie Mercury, pianist Liberace, Russian ballet dancer Rudolph Nureyev and Australian entertainer Peter Allen are also mourned by fans.
ROCK HUDSON: THE FIRST MAJOR CELEBRITY TO DECLARE HE WAS HIV
Silence = Death Originating from ACT UP New York, ‘Silence = Death’ becomes internationally recognised as a popular slogan of the AIDS era. It protests both taboos around discussion of safe sex and the unwillingness of some to resist societal injustice and government indifference. “Few people wanted to publicly admit that they were HIV-positive in such a hostile environment,” says Menadue. “People with the virus didn’t see
Today, effective treatment means HIV is no longer a death sentence. And studies show PLHIV who maintain an undetectable viral load present little risk of transmitting the virus onto a negative partner. “What we are seeing,” says Andrew Grulich, an epidemiologist who has worked in HIV research for more than 20 years, “is treatment as prevention (TasP) works.”
Unprotected sex For more than 30 years, condoms remain at the forefront of Australia’s HIV prevention strategy. Recent studies, however, seem to suggest gay men have tired of the message. The Annual Report of Trends of Behaviour 2013 found that over the past decade the number of gay men having condomless sex in Australia has grown — especially among the under-25s. And results from Queensland’s Gay Community Periodic Survey released in March this year found 41 percent of men reporting condomless sex with casual hook-ups. Rather than complacency — as has been suggested — this trend perhaps reflects the variety of safe-sex options available to gay men today.
Virology Much has been discovered about the human immunodeficiency virus over the past 30 years. Unfortunately, a medical cure remains a long way off. A ‘functional cure’, however — where HIV is suppressed to such
an extent that it no longer warrants treatment — seems more likely. “A functional cure may be closer than thought, at least for some,” says Professor Sharon Lewin, one of Australia’s leading HIV scientists. “Certainly, very early antiretroviral therapy (ART) can profoundly reduce the size of the viral reservoir, but much work is still needed to understand and eventually eliminate long-term reservoirs that persist on ART.”
diagnoses since national notifications were introduced. Since then, year-on-year, HIV diagnoses have been gradually increasing. Today, they remain at a 20-year high with 1,236 cases recorded in 2013. By 31 December 2013, 35,287 cases of HIV have been diagnosed in Australia since 1982.
Zidovudine Otherwise known as AZT, zidovudine becomes the first HIV treatment available for use in Australia. “The promise of AZT was ultimately a let-down,” says Duffin. “At the doses used, it
Various treatment developments (such as HAART and single-tablet regimens) have made headlines over the TRUVADA: years. Today, all the talk is of Truvada. In THE LATEST trial after trial, when TREATMENT used as a pre-exposure BREAKTHROUGH prophylaxis (PrEP), Truvada proves to be highly effective in reducing the risk of transmission of HIV. There are currently three Australian PrEP trials underway. If results echo trials overseas, Truvada as PrEP could be available here by April produced considerable side-effect 2016 — if not before. problems and HIV was able to quickly develop resistance.” With a plethora of drug regimens available, the HIV In July 2014, Melbourne hosts the landscape today is vastly different to that of the ’80s.Thanks to the 20th International AIDS development of effective ART, Conference. With more than PLHIV are now living well and 16,000 delegates from 200 living longer with a life countries converging on the expectancy close to that of the banks of the Yarra River, AIDS general population. 2014 is the largest health “Today, we actually have the conference ever held in Australia. scientific knowledge and potent, At the conference a pledge is well-tolerated treatments to give made — by every state us the opportunity to and territory health revolutionise treatment and minister — to prevention of HIV,” says Bill eliminate all new HIV Whittaker — one of the transmissions in Australia by the architects of Australia’s response end of 2020. to AIDS. “We have made enormous progress. So much so, that the prospect of an AIDS-free generation is for the first time The annual number of Australian HIV diagnoses peaks at more than being contemplated.” An ambition simply unimaginable 2,000 in 1987. After which, rates thirty years ago . . . of infection begin to decline. And in 1999, Australia records its lowest annual number of HIV
The ABC of HIV includes extracts from Through our Eyes — Thirty years of people living with HIV responding to the HIV and AIDS epidemics in Australia. The book is available at Hares and Hyenas in Melbourne, and The Bookshop in Sydney.
WE’VE TEN COPIES TO GIVEAWAY. TO WIN ONE, ANSWER THIS QUESTION:
What year saw a significant turning point in the treatment of HIV? Send your answer to The Editor, Positive Living, PO Box 917, Newtown NSW 2042
positiveliving l 9 l WINTER 2015
DOCTOR LOUISE ANSWERS YOUR QUESTIONS
what’syourproblem? syphilis, aside from the risk of transmission to others, is, in people living with HIV, it can behave in unusal ways and serious side effects may present earlier than in the regular population. Untreated syphilis may cause neurological damage or liver function abnormalities. So if you are seeing a number of sexual partners, the bottom line is: get screened regularly for STIs. That means urine, throat and anal swabs for chlamydia and gonorrhea; and a blood test for syphilis — even if you show no symptoms.
Tuan from Sydney writes: A sexual partner has tested positive for syphilis. I’ve no symptoms — what should I do? Dr Louise replies: Thanks for your question, Tuan. First a few facts about syphilis: syphilis is a sexually transmitted infection (STI) caused by the Treponema pallidum bacteria. Syphilis is transmitted by close skin-to-skin contact. This includes oral, vaginal and anal sex, and close contact with someone in the early stages of syphilis. If not diagnosed and treated appropriately, it can have serious outcomes. There are various stages of infection. The first stage, ‘chancre’, is usually a painless ulcer or sore that appears at the site of infection. So the site of contact determines where the sores will appear e.g. on the penis; in the anus or perianal region; on the lip; in the throat; even the fingers. This may go unnoticed and the syphilis will progress to the secondary phase. Phase two may include skin rash, which may show on the trunk, hands and feet. Fatigue, swollen glands and general tiredness may also present at this stage.
Should I test for syphilis?
Keep your questions under 100 words and email them to email@example.com.
Many other conditions mimic syphilis symptoms, so it’s about being alert to the possibility and getting screened. Remember, even if you’re using condoms for anal sex, syphilis can still be transmitted via oral sex or close contact — so it’s important to test regularly. The gold standard test is a blood test. It can take a few months after infection to become
positive, so if there is an ongoing risk of infection then it’s best to have this test two or three times a year. There is an online tool — checkyourrisk.org.au — that assesses your sexual risks (anonymously) and makes suggestions for the types of tests you should have. Syphilis is easily cured with penicillin — ideally an injection.
The length of treatment depends at what stage the syphilis is at. You should wait at least a week after treatment before having sex. Testing and treating sexual contacts is really important, so get them to see their doctor or use the ‘let them know’ website (letthemknow.org.au) to assist with contact tracing. The problem with undiagnosed
n 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.
Tenofovir: now better than ever! One of the most widely used antiretroviral drugs — tenofovir — has been re-formulated. So why the upgrade? Well, the original tenofovir (tenofovir disoproxil fumarate — or TDF) has been found, in some cases, to cause renal problems. The new compound, dubbed TAF (tenofovir alafenamide), better targets the immune cells, which allows for reduced dosing — meaning less toxicity. (TAFs dose is 10 percent of TDFs.) TDF — available in its own right as Viread, or found in single-tablet combos Atripla, Eviplera and Stribild — has also been associated with a small amount of bone loss (but this is usually within the first 12
months and not unique to TDF). So for people who have osteoporosis or who are already experiencing some renal dysfunction, TAF may be an alternative option. Your doctor will advise if a treatment change is required. Ongoing research suggests people whose virus has built some resistance to TDF may have a better outcome with TAF instead — good news, considering tenofovir is the backbone drug for so many people living with HIV. As for side-effects, TAF has reported mild-to-moderate reactions including nausea, bloating, diarrhoea and headache.
In a nutshell: TAF offers equal effectiveness, but with less toxicity.
TRUVADA 2.0 Gilead has applied to the US Food and Drug Administration for approval of a new version of
Truvada. The upgraded compound replaces tenofovir disoproxil fumarate (TDF) with tenofovir alafenamide (TAF). As already mentioned, TAF has a more favourable side-effect profile than TDF. The application is backed by phase III clinical trials in which the improved formulation proved noninferior in its ability to suppress HIV. However, Gilead has not filed for approval of the new Truvada as a preexposure prophylaxis as there have been no clinical trials of the
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tablet for that purpose. The drug — which will go under a new name — is only intended for use with other antiretrovirals to treat HIV in people age 12 or older.
TRIUMEQ ADDED TO PBS The new single-tablet regimen (STR) Triumeq has been added to the Pharmaceutical Benefits Scheme. Developed by ViiV Healthcare, Triumeq has been found to be a highly effective, well-tolerated, easy-to-use antiretroviral drug. As the name suggests, Triumeq contains three medications: 600mg abacavir, 300mg lamivudine and 50mg of dolutegravir. It is the fourth STR available in Australia and is the only one not to contain tenofovir.
Jacob Boehme is many things: dancer, choreographer, writer, puppeteer, community arts practitioner. He’s also indigenous, gay and HIV. He spoke to Daniel Brace. he first thing to notice about Jacob Boehme, is how softly spoken he is. In fact, I have to ask him to lean into the microphone so it can pick up his voice. He obliges with a smile. “I wasn’t sure anyone would want to see performance about HIV. There’s been a resurgence of work recently, especially around AIDS 2014,” he murmurs. “But I was surprised, excited actually, that the first showing was packed out and people stayed for a long time afterwards talking and reacting. That was a good sign.” He’s talking about his latest production: Blood on the Dance Floor. It’s a visceral work utilising dance, theatre and the spoken word to tell a powerful story — one that draws on Boehme’s experiences as an indigenous gay man living with HIV. It’s a story, he explains, that began in Sydney when a close friend, another indigenous dancer, was diagnosed HIV. “He hanged himself shortly after. That was my first experience of HIV face-to-face — ‘OK, so you get HIV and then you kill yourself’. When I was diagnosed, I thought of my friend and had to do some reach-out to my ancestors to help overcome the feelings of stigma and shame.” Boehme was diagnosed with HIV in 1998, and his decision to develop Blood on the Dance Floor happened to coincide with the 15th anniversary of his diagnosis, his 40th birthday and the 30th anniversary of HIV in Australia. In all of this, Boehme felt there were some dramatic undertones to explore through dance. For Boehme, dance is about the connectedness to country; of traditional story-telling, dreaming and lore. Having trained performing Western dance, it was indigenous dance that Boehme felt a burning desire to connect to. “It’s through learning the traditional dance that your lore, your place, your belonging is taught to you. And from that place of belonging we can share our own stories as well.” Boehme grew up “a proud Westie” in Newport, Melbourne. His father was a Narangga and Kaurna man from South Australia;
the inin the
PHOTOS BY DORINE BLAISE. COURTESY OF ILBIJERRI THEATRE COMPANY.
Blood positiveliving l 11 l WINTER 2015
his mother from Anglo-Australian stock. “My earliest memory of there being an issue was when my baby sister started primary school. She started crying when I walked her home. When I asked her what was wrong, she told me they were calling her names, making fun of her Aboriginality. “They hadn’t picked up on me, because I looked more like them. ‘You don’t look Aboriginal’; ‘You’re too smart to be an Aboriginal’ — that’s what the kids would say. 25 years later and I’m not so sure much has changed; mention HIV to gay guys today and they reach for the garlic and the cross.” A constant flow of aunties and uncles from Boehme father’s side of the family kept the boy engaged with his indigenous heritage, but it wasn’t until he started university that local elders guided him toward what was to become his life’s passion — dance. “There is a history of dance-men and women in my family, so this kind of storytelling is in my blood.” Blood on the Dance Floor combines traditional art forms and disciplines rarely seen successfully in Western theatre in Australia. “I’ve taken the work right back to my foundations, which is in ceremony. I’m trying to reconstruct our ceremonies now for a contemporary theatre audience with a topic that certainly wasn’t around for my ancestors.” Boehme’s experience of being HIV-positive is something he says everyone can relate to. “It’s about having secret identities within us, falling in love, of being courageous, of blood and legacy, and memories we all hold in our blood, through our ancestors. Everyone — black or white or any colour — has the memories of our ancestors in our DNA, in our blood. HIV isn’t going to take these away, but it is going to make them more precious.” Blood on the Dance Floor has been burning in Boehme for a while — since 2012. And, he admits, the production very nearly became his swansong. “I thought, I’m going to create a solo work and bow out at the age of 40, as a flabby slut. And I was being dramatic at 39, saying: ‘I’m going to do my last dance work ever!’ But it’s turned out to be an autobiographical story that shows no signs of ending any time soon.” Blood on the Dance Floor formally premieres at the Melbourne Indigenous Arts Festival in 2016.
Negative people taking control As David Crawford reports, for the first time, the emphasis is on HIV-negative people to safeguard their sexual health rather than placing the onus of responsibility on PLHIV. HIV-negative men are having new conversations with their sexual-health providers and GPs about the once-a-day preexposure prophylaxis (PrEP) pill, Truvada. Like HIV-positive people, they too are being proactive in finding new ways to block and prevent HIV. If you’re considering accessing and taking PrEP, you’ll find an article I’ve written on positivelife.org.au about this exciting new development in HIV prevention. Now more than ever, this new era of ending HIV calls for knowing your HIV status, getting regular STI and BBV check-ups from your healthcare providers, and starting a new dialogue with your sexual partners. To assess your risks for HIV in a given set of circumstances and parameters, check out: knowtherisk.org.au. To learn more about PrEP and your access options, there’s an information sheet you can download at http://bit.ly/PrepPaper. David Crawford is treatments officer for Positive Life NSW
Poz gay men and meth use Lance Feeney calls for a more enlightened discourse on the use of methamphetamine in the gay community — particularly among HIVpositive gay men. Accessing mainstream media, one might be forgiven for believing that methamphetamine and its pernicious and corrosive social influences are carrying us inexorably towards madness, badness and chaos. The recent run of sensationalist stories have done nothing to foster enlightened debate and spectacularly fail to understand the complex reasons why people use meth and other party drugs. In an effort to counter the
one-sided hysteria, I recently interviewed four HIV-positive gay men for a ‘real-world’ article about meth use. The men were aged from their mid-30s to early 50s. Against stereotype, all are employed and hold down senior positions in various sectors. All were remarkably candid about their meth use and how it fits
into their lives; they spoke particularly of their motivations and their harm- and riskreduction strategies to mitigate HIV, HCV and HBV transmission. The article — which can be viewed at positivelife.org.au — attracted a number of supportive responses and stimulated an energised discussion, which has
produced positive interactions within our community. It is important to keep the conversation alive around drug use and harm reduction, particularly amongst the body positive. We need to combat stigma, secrecy and the power of shame within our communities. In the interests of improving support and knowledge around meth and injecting drug use (and to find out how people are accessing harm-minimisation services), NSW Users and AIDS Association (NUAA) and Positive Life NSW are running a survey for people who use meth in NSW. If you’d like to contribute to this survey please visit http://bit.ly/methuse Lance Feeney is senior policy analyst for Positive Life NSW
DARE to check what’s up down under! SPANC — the Study of the Prevention of Anal Cancer — has been extended and is recruiting men who have sex with men, living in Sydney, aged 35 years or older, not taking anti-coagulant medicine (aspirin is ok), and never been diagnosed with anal cancer. SPANC is particularly interested in enrolling people living with HIV so they can track the prevalence of anal human papilloma virus (HPV) infection. Most sexually active adults get at least one variety of HPV in their
lifetime, and for HIVpositive gay men this is a near-universal infection. While most guys clear HPV from their body within a one- to two-year period, some specific varieties can contribute to the development of cancer. One easy way to screen anal health regularly is to talk with your GP about a digital ano-rectal examination (DARE). You’ll be able to incorporate a quick anal check as part of your
regular STI check-up. It’s particularly important for HIVpositive men to have a DARE yearly. Anal cancers always respond
to treatment better if diagnosed early, so it’s really important to be aware of any anal symptoms early on. If you haven’t tested positive to HPV, have a conversation with your GP or your sexual health/HIV care provider about your vaccination options. While the HPV vaccine hasn’t been approved under the Pharmaceutical Benefits Scheme (PBS), it is available to adults as a private prescription. A very useful, informative website is thebottomline.org.au.
PositiveLifeNSW 414 Elizabeth Street Surry Hills 2010 | ) (02) 9206 2177 or 1800 245 677 | ø positivelife.org.au positiveliving l 12 l WINTER 2015
Taking the lead A community program seeks to nurture the leader in all of us. Sebastian Robinson reports. The day I was diagnosed HIVpositive — Valentine’s Day 2014 — I ran into a friend. Upon my frantic disclosure, he smiled, hugged me tight and said: “Welcome to the family, we lost a generation of radicals and creatives, and now we’re not dying anymore and it’s your job to burn bright.” Prior to being diagnosed, I had pondered much on what exactly defines a leader. Certainly since my diagnosis I have become acutely aware of the necessity for leadership and that this thing called ‘leadership’ isn’t necessarily appointed or awarded. What I’ve come to understand is, if you’re aware enough, spaces
will present themselves for filling. These spaces and holes are everywhere, waiting for the right person to fill the role — not just CEOs, religious idols, or mythical figures but ordinary people like you and me. There were 12 of us at a retreat north of Sydney, on the banks of the Hawkesbury River for Australia’s third PLDI workshop (for those unfamiliar
together for the first time, a gentleman — an elder of the virus, so to speak — raised a question: “Who are you to call me a leader?”. I smiled to myself. Of course, a leader can be any one of us. A leader can be me and a leader can be you. We are led daily by ourselves; I know I am led to make a difference. I don’t always know what that difference is, but it
Sebastian Robinson at a PLDI retreat
with the acronym it stands for Positive Leadership Development Institute). As we grouped
Originating in Canada and piloted in Australia in 2013, the PLDI program is designed for people living with HIV (PLHIV) that either already have, or show potential to be, leaders within their community. PLDI is a joint program for positive people in partnership with 22 other organisations from the HIV/AIDS, health and business sectors. The purpose of PLDI Australia is to engage a new generation of leaders so that positive people continue playing a central and vital role in the HIV response. If you’d like to participate in a PLDI workshop contact firstname.lastname@example.org
informs the activities I undertake daily. Sometimes I feel ineffectual, but nobody’s perfect. Leadership is a matter of perspective, and depends on the way we view our lives; those who are leaders and those who are followers change from home, work, and social settings but every setting has a leader and every leader can fill a role and make a difference. PLDI was an enlivening experience. We’re at a point in the HIV epidemic now where the living are beginning to outnumber the dead. We are alive and with that comes the responsibility to live fully. We need leaders to nurture, encourage and develop others so that our community continues to thrive. It was a privilege to be at the PLDI retreat and all leaders — past, present and future — should have the opportunity to attend.
Wheels in motion to repeal 19A As Rebecca Benson reports, Victorian premier Daniel Andrews has come good on his pre-election promise to repeal 19A. After much lobbying by the HIV sector, the Victorian government has introduced legislation to repeal Section 19A of Victoria’s Crimes Act. Introduced in the early 1990s, the contentious law made it an offence to intentionally infect another person with a “very serious disease” — defined exclusively to mean HIV. The offence carried a jail term of 25
years. The law’s intended purpose — for which it was never used — was to prevent criminals using a blood-filled syringe as a weapon. Announcing the news, Victoria’s attorney general Martin Pakula said: “Section 19A of the Crimes Act is an anachronistic law, it unfairly stigmatises people with HIV and gives the impression they’re a danger to the community — and they’re not.” The #Repeal19A campaign was spearheaded by the Victorian AIDS Council (VAC) and Living Positive Victoria during last year’s International AIDS Conference in Melbourne. It was
argued that the law needs to treat HIV transmission as a public health issue, not a criminal justice issue. The campaign drew commitments from political leaders as they headed into November’s state election — including Victorian premier Daniel Andrews. The Andrews government has come good on this pledge and
the decision to repeal 19A has been welcomed by community representatives. “Research around the world shows this is the right way to combat HIV,” said Paul Kidd, chair of the HIV Legal Working Group. “Our organisations strongly believe the Public Health and Wellbeing Act provides the best way to deal with allegations of risky behaviour — keeping the public safe and protecting human rights.” VAC CEO Simon Ruth described the move as a “vital step forward” in destigmatising people living with HIV. “Repealing 19A will allow us to combat the stigma experienced
by PLHIV and to continue our work in HIV prevention,” he said. By abolishing 19A, a barrier to people getting tested and treated for HIV will have been removed. “We know it’s a deterrent to testing,” said Brent Allan of Living Positive Victoria. “Around the world where laws like this are repealed, testing rates increase.” On 5 May, the Liberal-National opposition announced it would support the repeal bill, guaranteeing its passage through both houses of parliament. The HIV Legal Working Group will now continue its focus on prosecutorial guidelines to minimise the use of the criminal law in HIV cases.
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positiveliving l 13 l WINTER 2015
Queensland gets PrEPared PrEP will soon be available under trial conditions in Queensland. Reactions from a recent community forum suggest there won’t be a shortage of willing participants. Scott Brown was there. There’s been a lot of talk in Queensland over the last 12 months about the upcoming QPrEP trial (commencement begins June/July). And a recent community forum entitled ‘Let’s talk about PrEP’ (pre-exposure prophylaxis) further highlighted the significant community interest in the topic. More than 70 people attended the event at the HIV Foundation Queensland (HIVFQ) headquarters in Fortitude Valley, many keen to ask questions and discuss the issues around PrEP. An expert panel of local GPs and clinicians joined facilitator Heath Paynter from the Victorian AIDS Council (VAC) to present the latest science. Speakers such as
The QPP team at the PrEP forum Dr Andrew Redmond and Dr Fiona Bisshop spoke about the importance of raising community awareness about PrEP, and the benefits it can have for HIV prevention — particularly in the gay community. The QPrEP trial is an initiative of the HIVFQ and is funded by Queensland Health. It is one of three trials being held in Australia and it will have seven sites around the state: two in
Brisbane, and one each in Cairns, the Gold Coast, Ipswich, the Sunshine Coast and Townsville. Cairns Sexual Health (CSH) is leading the research team and Simon Doyle-Adams, nurse unit manager at CSH, was on the panel to explain how the trial will work. At present, QPrEP has 50 places available — although if the interest and funding is there, researchers will look into the possibility of expanding the
number of participants. Not everyone is eligible though, the research team will be looking particularly for men who have sex with men (MSM) who reside in Queensland and who have had condomless sex with casual partners in the last 12 months (overseas studies have shown PrEP to be a highly effective HIV prevention tool for people undertaking high-risk sexual behaviour). Places will be
granted on a first come, first served basis. For people who miss out on being part of the trial, HIVFQ has prepared a ‘PrEP Access Factsheet’. The factsheet lists step-by-step instructions on how to order generic PrEP online from an overseas supplier (go to hivfoundation.org.au). The Brisbane community forum follows similar events held in Sydney and Melbourne; it was the first major update to be presented to the community on QPrEP. People appeared to express much interest in the trial and it’s great to know that guys who are most at risk — MSM who don’t always (or ever) use condoms — are keen to test PrEP. If you were unable to attend the forum, the entire evening was recorded and is available for viewing online at the HIVFQ YouTube channel. Another forum is due to be held later in the year, so if you or anyone you know may be interested in attending, it is worth being added to the HIVFQ contact list. Email: email@example.com.
Rapid success in HIV testing Since QPP’s rapid-testing program was rolled out six months ago, it has proved to be a paragon of government-community collaboration. Jime Lemoire reports. RAPID, Brisbane’s communitybased HIV testing service has completed its 500th test since its launch in January, exceeding all expectations and removing significant barriers to testing.
The testing offered by RAPID is a completely peer-based service staffed by trained community members employed by QPP. All are skilled to understand the risk of HIV transmission in the community, and have the experience to know how to create a respectful space for testing and how to stimulate discussions on how to reduce HIV risk more generally. It is important for the community to have a range of testing options available to them;
some people will go to a GP or sexual health clinic, but others may prefer the peer model offered by RAPID. Indeed, our messaging to the community has been hugely successful in reaching out to those people who are not in a testing routine or who do not like attending sexual health appointments. RAPID offers a safe place to get tested for HIV and syphilis without any judgement about sexual behaviour or injecting practices. Since its launch,
RAPID has expanded its outreach service to include testing at all four sex-on-premises venues in Brisbane for men who have sex with men, with more than 200 tests carried out so far via outreach. QPP executive officer Simon O’Connor said RAPID is a shining example of what can be achieved with a strong partnership between government and community. “QPP is very proud of what we have been able to achieve with RAPID,” he said.
“Increased access to testing is a core pillar of the Queensland HIV strategy and RAPID has provided a muchneeded expansion of testing options for the community here in Brisbane.” And RAPID will continue to broaden its reach: planning is underway for a Gold Coast program later this year. Jime Lemoire is manager of RAPID
queensland positive people | 21 Manilla Street East Brisbane 4169 | )07 3013 5555 or 1800 636 241 | ø qpp.net.au positiveliving l 14 l WINTER 2015
— Wake gingerly FOR AVOIDING THE FLU n Minimise contamination: use a knuckle to rub your eye; cough or sneeze into the crook of your elbow; and wash your hands often. n Try to relax: people who are stressed are twice as likely to get sick. n Leave some windows open, just a crack — circulating air chases the bugs away. n Change or wash your hand towels every few days. n Lower the heat in your home — an overheated environment is the perfect breeding ground for a flu virus.
For an immunity boost first-thing, you couldn’t do much better than start the day with a cup of hot water with fresh lemon and ginger. Don’t be deceived by the simplicity: this winter warmer will provide you with a hefty dose of antioxidants, vitamin C, and other immunity-boosting compounds. Just grate one teaspoon of fresh ginger into 300 grams of water and add the juice of two lemon slices. It’ll activate and cleanse your entire system, and set you up for the day.
Laws that treat people living with HIV or those at greatest risk with respect start with the way that we treat them ourselves: as equals. If we are going to stop the spread of HIV in our lifetime, then that is the change we need to spread. Shereen El Feki, journalist and author
THE MAGIC OF MUSHROOMS Mushrooms tend to get overlooked as a health food. Perhaps because — unlike more ostentatious foods such as kale and quinoa — mushies tend to shy away from the limelight, preferring, instead, to stay in the dark. Yet for all their humbleness, mushrooms possess mighty powers. They contain selenium and beta glucan — both of which strengthen the immune system by stimulating white blood cells. Shitake, maitake and reishi pack the biggest immunity punch, with experts recommending up to 25 grams a day for maximum benefits. So go on, make room for a mushroom! positiveliving l 15 l WINTER 2015
of sexually active adults will contract a sexually transmitted infection (STI) at some point. However, most won’t notice, as more than
of all people who contract an STI don’t show any symptoms.
calendar2015 june 13
ACON invites positive gay men to share their stories through multimedia. Come along to a free sixweek digital publishing course at the Powerhouse Museum, Sydney. Contact mymates@ acon.org.au for more details
Living Positive Victoria hosts The Winter BBQ. Enjoy great food, beverages and door prizes in a safe and friendly environment. DT’s Hotel, 164 Church Street, Richmond, Melbourne From 1-5pm )(03) 9863 8733
Queensland Positive People (QPP) hosts Planet Positive — a social event for HIV-positive people and their friends at the Shafston Hotel, Shafston Avenue, Kangaroo Point, Queensland. From 6pm til late Contact QPP )07 3013 5555 for more information
The Northern Territory AIDS & Hepatitis Council (NTAHC) presents Eat, Indulge, Connect — a food event for HIVpositive people, their partners, friends and family. NTAHC, 46 Woods Street, Darwin From 5-8pm
Positive Living ACT hosts a Peer Support Dinner. Westlund House, 16 Gordon Street, Acton, ACT 2601. Starts 6pm
Phoenix — a weekend workshop for heterosexual men recently diagnosed HIVpositive. Running until Sunday, the Melbourne workshop provides a safe, confidential and supportive space in which to learn strategies for managing and making sense of HIV. Contact Straight Arrows )(03) 9863 9414
Pozhet hosts an informal lunch where positive people can learn more about HIV treatments and health management. Partners welcome. Western Suburbs Haven, Blacktown. From 11.30am-3pm Susan )1800 812 404
You’re invited to a special fundraising screening of the British hit comedy Pride at the Deckchair Cinema, Darwin. Starts 6pm Contact NTAHC )(08) 8944 7777
tasCAHRD is hosting a coffee arvo for positive people. Free drinks and nibbles, plus informal and friendly peer support. 319 Liverpool Street, Hobart. From 2-4pm )(03) 6234 1242
The United Nations International Day of the World’s Indigenous Peoples is observed each year to promote and protect the rights of the world’s indigenous population.
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More than 400 delegates from 160 LGBTI organisations will gather at the National Convention Centre, Canberra for Health in Difference 2015 — a three-day conference specifically designed to address the health of LGBTI communities. )02 6257 2855
Pozhet is hosting a Women’s Day at Redfern Health Centre, 103-105 Redfern Street, Redfern, Sydney. It is open to all positive women, female partners and family members. From 11am-3pm )1800 812 404