Tuesday 19 June 2012

Impressions from AFAO’s National Gay Men’s HIV Health Promotion Conference

"Liberty leading the People" by Eugène Delacroix,
was a popular trigger for musings on the meanings
of  the prevention 'revolution' - she featured on the slides
of four presenters. 
These are some impressions from AFAO’s National Gay Men’s HIV Health Promotion Conference held late May. The conference was a place for many discussions. The development of  new HIV prevention options that can be added to our existing tools  was described as a 'revolution' by some, and as an 'evolution' by others. Whether it is thought of as a revolution or an evolution, several major ways to intensify HIV prevention were discussed throughout the conference. 

The major themes of HIV treatments and HIV testing also came up in many presentations, and this was reflected in two of the three resolutions made at the end of the conference. 

The other resolution related to the alarming announcement by the new Queensland Government to strip funding from Healthy Communities (one of AFAO’s member organisations).

The use of HIV treatments as a prevention tool was a common topic, with the recent HPTN 052 study showing that in heterosexual couples when the HIV-positive partner is on effective treatment, the chances of transmission are greatly reduced. (Andrew Grulich from the Kirby Institute highlighted recent research findings in his plenary presentation). Some speakers - Colin Batrouney from VAC, for example - raised concerns about the applicability of the HPTN 052 study to gay men. Ben Bavinton discussed the pros and cons in his overview of the 'Opposites attract' study. However, it was reiterated throughout the conference that the primary reason for a HIV-positive person to go onto treatment should always be the benefits to their own health, and should be a choice made by them with their doctor.

Removing barriers in order to improve access to treatments was a key discussion, and was noted in one of the resolutions of the conference. There were also many concerns about other structural and cultural issues relating to treatments. These included the Australian treatment guidelines and what these should be, as well as the perceptions of doctors and clinicians about when their patients should start treatment. Many people thought that community perceptions about treatments toxicities and complicated regimens may be based on older treatments. Phillip Keen (NAPWA) explored some of these concerns in his presentation about the new NAPWA treatments campaign

Pre-exposure prophylaxis (also known as PrEP), which is the use of HIV treatments by HIV-negative people to help prevent acquisition of HIV, was also raised in several presentations and discussions in terms of how this could be progressed in Australia, particularly in light of the imminent decision by the FDA in the United States on whether to approve an HIV treatment (Truvada) for this use.

HIV testing was another key theme at the conference, and the third resolution made at theconference called for improved access to testing. Shortening the time between infection and diagnosis was seen as key to help prevent onward transmission. Discussions also focussed on how to increase testing frequency. Ian Down (ARCSHS) addressed some of these issues in his presentation of findings from the Seroconversion study and Martin Holt (NCHSR) outlined what is known about HIV testing among gay men. Michael Atkinson (WA AIDS Council) suggested peer education as a valuable strategy for increasing uptake of testing.

Both presenters - such as Phillip Keen, John de Wit (NCHSR) and Peter Aggleton - and speakers from the audience, identified the need to progress the availability of rapid HIV tests in Australia, as well as the need to simplify conventional testing processes for HIV and other STIs to make full sexual health checks easier. Other settings in which testing could take place and how they could be implemented and managed, such as in non-clinical settings and at home, were also discussed. 

Many countries are already embracing tools like rapid testing, recommending the earlier commencement of treatment for people living with HIV, and considering the use of PrEP. It was noted that we don’t need to throw the baby out with the bathwater and forget what already works. However, we do need to respond to changing trends, technologies, and information on how treatment lowers risk of transmission, and add these to our existing prevention toolkit.

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