Sydney almost eliminates HIV transmission in global first

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Health officials have “virtually” eliminated HIV transmission in parts of Sydney that were once the epicentre of the Australian AIDS epidemic, raising hopes of conquering a disease that has killed more than 40mn.

HIV diagnoses in inner Sydney plunged 88 per cent from the 2008-2012 average to just 11 cases last year, a decline on a scale never before recorded in a former AIDS hotspot.

The results are adding to evidence that existing prevention strategies, including testing and pre-exposure drugs, are highly effective when implemented correctly.

“Rapid progress towards ending AIDS is possible. If trends continue, several countries in several global regions will reach the [UN] goal of a 90 per cent HIV incidence reduction by 2030,” the researchers wrote.

While rates decreased in New South Wales and Australia overall, the decline was “extraordinary” in inner Sydney, where a large proportion of men who have sex with men resided, said Andrew Grulich, a professor of HIV epidemiology at the country’s Kirby Institute.

Darryl O’Donnell, chief executive of NSW-based HIV advocacy group Health Equity Matters, said the prospect of eliminating transmission was an “astonishing” one for anyone that lived through the “horror years” of the AIDS crisis. 

“What we are starting to grasp in Australia is that we could end this epidemic,” he said.

The reduction was achieved, Grulich said, because of a community-centred approach that included high rates of testing, prompt treatment of those who tested positive, and increased use of pre-exposure prophylaxis, a drug regimen that prevented the risk of contracting the virus by 99 per cent.

“People should be acting on [this evidence],” he said.

HIV treatment enables those living with the virus to lead long and healthy lives. But only a few instances of complete cure, or HIV eradication, have been documented in patients, and no vaccine is yet available.

Some countries in the world, such as Zimbabwe, Nepal, Lesotho, Rwanda, Eritrea and Malawi, have achieved a decline greater than 70 per cent, while declines of about half have been documented in the Netherlands, England, Singapore and US cities, such as New York and San Francisco.

But no locality had reported a decrease as large as that of inner-city Sydney, said Grulich, who led the study and warned health officials against complacency.

“Without a vaccine and a cure, elimination of HIV is impossible . . . One thing people shouldn’t think in reading this data is: ‘we can pack our bags and go home’. That’s not the case at all,” he said, urging “continued investment” in testing and treatment.

Meg Doherty, head of the HIV, hepatitis and STIs programmes at the World Health Organization, noted the strong public health programme was backed by a “government that put money behind this”.

O’Donnell, who was head of the NSW government’s HIV unit 20 years ago, said the progress made in the country dates to the 1980s, when Australian politicians took a non-ideological approach to the epidemic and opted to work closely with the gay and bisexual community, drug users and sex workers to get on top of the crisis.

“The ending of AIDS is not going to happen once, all in a big bang,” said the WHO’s Doherty. “It’s going to be Sydney, other localities, and then slowly over time we’ll see it more globally until we have a vaccine.”