On World AIDS DAY 2018, Burnet Institute Director and CEO Professor Brendan Crabb AC surveys recent advances and the long road towards HIV elimination in this edited extract of an essay commissioned by the Australian Federation of AIDS Organisations.
In 2018, UNAIDS released an interim report on global progress towards the 2020 target aimed at achieving virtual elimination of HIV as a public health threat by 2030.
While the Miles to Go report highlighted many successes, it also provided, as the title suggests, a sallow picture of populations still not reached by new prevention tools, and quality treatment in the context of global reductions in funding which threaten our HIV elimination goals.
In Australia and our region, we have seen many success stories but like much of the world, we too have miles to go and must ensure we continue to invest and innovate to ensure we take long-term advantage of the gains we are making.
Australia has made many impressive steps towards HIV elimination.
The listing of HIV pre-exposure prophylaxis (PrEP) on the PBS in April 2018 builds upon the significant state-funded jurisdictional level trials.
The impact of PrEP can already be seen, with New South Wales reporting significant declines in HIV incidence following the large roll out of PrEP in that state, and similar reductions more recently being observed elsewhere.
Australia is on track to achieve UNAIDS targets of 90-90-90; 90 percent of people living with HIV knowing their status, 90 percent of people who are diagnosed on treatment and 90 percent of people on treatment virally suppressed.
Asia and the Pacific recorded a 14 percent decline in new HIV infections over the past eight years; sustained investment is needed to continue this trend.
Biomedical prevention is hampered by limited funding and overburdened health systems.
Papua New Guinea recently experienced a stock out of ART, drug resistance is rising, and PrEP is not widely available.
With stagnated or reduced funding there is little advancement in primary prevention and community systems that engender strong community response to HIV.
The most vulnerable, including the young, are being left behind and evidence suggests that a resurgence of transmission is likely.
As we commend ourselves for our efforts to increase access to HIV prevention locally and the gains we have made in reducing transmission, we must ensure that these successes are equitably distributed within Australia and the region.
We have come a long way but still have miles to go to end HIV.