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WORLD AIDS DAY 2020 1 DECEMBER
Adj Prof Chief Executive Officer
Australian Federation of AIDS Organisations
Darryl O’Donnell
So much that seemed certain AFAO and its members responded
was upended this year by swiftly and effectively to these new
challenges, advocating for telehealth,
COVID-19. Yet as we mark secure medicine supplies and targeted
World AIDS Day and remember public health campaigns. While many
those lost to the HIV epidemic, mainstream services closed down
the bonds of our community during the initial crisis our members
response remain strong. stepped up, reminding us that at their
heart, the DNA of our movement is our
As a movement forged in an earlier responsiveness and accountability to
health crisis, COVID-19 was a novel those we serve.
yet familiar threat. It demanded new tactics and
That grit also characterised the HIV response
strategy, but drew from the same community
to COVID in Asia and the Pacific. Many of the
reservoir of solidarity, empathy and courage.
communities hardest hit by HIV suffered the
Policy makers and clinicians quickly relearned the double whammy of COVID, confronting delays in
importance of community norms, such as social medicine supplies, disruption to counselling and
distancing, mask usage and hand sanitising. outreach services and the decimation of service
This echoed the way gay men, sex workers and and entertainment industries that employ so many
people who use drugs adopted safe sex and safer members of our communities.
injecting in the 1980s.
Civil society organisations we work with in
Other important principles came to the fore: the region tackled these issues head on. Their
positive reinforcement is far more effective than advocacy kept HIV on the agenda with domestic
shame when you are fighting a virus without a and international funding agencies. COVID was
vaccine or cure. And bipartisan consensus is the the emergency of 2020, but successfully treating
glue of a national response. and preventing it must not be at the expense of
Yet while the lessons of HIV informed the progress against HIV.
COVID-19 response, the pandemic also disrupted No year is ever dull or straightforward in our
progress against HIV. We grappled with complex community-led response, but this one was
issues such as sexual practice at a time when especially unpredictable and challenging. I am
COVID-19 made most things unsafe. We also hopeful 2021 will bring new opportunities to stride
saw the rapid transition of HIV services to online forward in our mission.
delivery and the redeployment of staff in public
clinics to COVID-19.
2
Contents
Adj Prof Darryl O’Donnell | AFAO 2
Tim Wilson MP and Senator Louise Pratt 4
HIV globally in 2019 5
Senator the Hon Marise Payne 6
The Hon Greg Hunt MP 7
Senator the Hon Penny Wong and the Hon Chris Bowen MP 8
Adam Bandt MP and Senator Rachel Siewert 9
Eamonn Murphy | UNAIDS 10
Peter Sands | Global Fund 11
Supporting communities in Sri Lanka 12
Tania Rishniw | Department of Health 13
The Hon Michael Kirby AC CMG 14
Professor Sharon Lewin | Doherty Institute 15
Professor Anthony Kelleher | Kirby Institute 16 Coordination
Professor Carla Treloar | CSRH 17 Michael Badorrek
Professor Brendan Crabb AC | Burnet Institute 18
HIV stigma in 2020 19 Design & Production
Alexis Apostolellis | ASHM 20 Biotext
Professor Suzanne Fraser | ARCSHS 21
Scott Harlum | NAPWHA 22
Credits
The World AIDS Day
Jules Kim | Scarlet Alliance 23
booklet is developed by the
Melanie Walker | AIVL 24 Australian Federation of
Michelle Tobin | ANA 25 AIDS Organisations (AFAO)
Novel approaches drive progress in the Philippines 26 through a grant from the
Commonwealth Department
HIV in Australia in 2019 28
of Health We also
Felicity Young | AFAO 30 acknowledge the support of
the Pacific Friends of Global
Health. The booklet is part
of the World AIDS Day
Parliamentary Breakfast,
which was initiated in
2010. AFAO recognises
Cover: Ma Nilar lives with his wife and daughter in rural Myanmar. Ma and his wife are
HIV-positive and receive antiretroviral treatment with support from a peer outreach
the leadership of Mr Bill
worker, who visits them at their farm in Shan State. Ma’s wife received treatment to Bowtell AO in conceiving
protect her baby from HIV during her pregnancy. (John Rae/Global Fund) this event.
3
Tim Wilson MP and Chair and Deputy Chair
Parliamentary Friends for Action on HIV/AIDS, Blood Borne
Senator Louise Pratt Viruses and Sexually Transmitted Infections
2020 is a year that has New treatments continue to become
reminded us of the risks of available which reduce the risks of
side effects. Additionally, research has
health pandemics, and the opened the possibility for people living
need to tackle them head with HIV to move from daily pill-based
on. COVID-19 may have regimens to injectable alternatives with
taken priority in the public month-long lifespans.
consciousness, but it should But our work is far from complete. The
not deter us from our efforts to rising rates of transmission amongst
tackle other viruses which pose Aboriginal and Torres Strait Islander
Australians and amongst culturally
serious health risks around the
and linguistically diverse communities
world. is a reminder that we need targeted
As the UNAIDS 2020 Report Seizing education campaigns. We also have
the Moment outlined, while progress the challenge of helping international
has been made internationally, that students and other Medicare ineligible
progress has not been even, and residents access treatment and be part
the COVID-19 pandemic could delay of the solution of reducing transmission.
progress to meet international targets Australia can meet this challenge. We
by up to a decade. have a proud history of bipartisan
World AIDS Day 2020 is an opportunity to refocus cooperation on HIV/AIDS, and have led the world
our work alongside the risks of COVID-19. Each in transmission control and access to treatments.
year new scientific advances and treatments We have strong community groups that coordinate
become available to compound on the learning with health bodies and government for efficacy.
and legacy of reducing transmissions, helping But we must also continue to confront the stigma
improve the freedom of those living with HIV/AIDS many still face. All Australians are entitled to live
in Australia and around the world. full and happy lives.
We sit on the cusp of a new age of containing As parliamentarians we have a critical role to
and treating HIV transmission. Prevention is play in terms of leading the national discussion,
essential. With home testing kits supported by promoting community education and advocating
community education campaigns we can reduce for effective strategies to improve the health and
transmission rates further. The long-term wellbeing of all Australians.
trend is declining thanks to these
The purpose of the Parliamentary Friends
developments, alongside the listing of
for Action on HIV/AIDS, Blood Borne Viruses
pre-exposure prophylaxis (PrEP) on the
and Sexually Transmitted Infections is to be
Pharmaceutical Benefits Scheme (PBS).
4
a strong and bipartisan advocacy group for together so that Australia can continue to be
parliamentarians, the health community and a world leader in controlling and reducing
those living with these conditions to educate and transmission rates, supporting those living with
work together to inform policy based on science HIV and to look with optimism about what we can
and efficacy. achieve in years to come together.
On World AIDS day we pay respect to the work
that has been done, and recommit to working
HIV globally in 2019
38 million 36.2 million adults
People living with HIV 1.8 million children
25.4 million This is 67% of all
People with HIV were accessing antiretroviral therapy people living with HIV
1.7 million
People were newly diagnosed with HIV
This is a 40% reduction
from the peak
(2.8 million) in 1998
5
Department of Foreign Affairs and Trade
Senator the Hon Minister for Foreign Affairs
Minister for Women
Marise Payne
The COVID-19 pandemic has has reported that 84 per cent of their
had a catastrophic impact HIV programming has experienced
disruption as a result of COVID-19.
on global health security and
threatens hard-won progress The COVID-19 pandemic has also
highlighted the leadership and
against HIV/AIDS. This commitment of communities in the
World AIDS Day provides an HIV response. These communities have
opportunity to take stock of moved swiftly to respond to COVID-19,
the achievements in the global including by using their knowledge and
fight against HIV/AIDS and the experience to work towards ensuring
that those living with and vulnerable to HIV have
gains that must be protected if we are to
the necessary information and services to protect
end the HIV epidemic by 2030. themselves from these colliding health crises.
Since the start of the HIV/AIDS epidemic, over Like COVID-19, the HIV epidemic is a shared crisis,
75 million people have become infected with and we must meet both challenges through global
HIV, and 32.7 million people have died from cooperation. Australia is committed to continuing
AIDS-related illnesses (UNAIDS). The global our strong leadership both domestically and on
fight against HIV/AIDS is a story of compassion, the global stage, engaging with our longstanding
resilience, solidarity and respect. Significant partner UNAIDS in developing the next global
progress has been made. Recent UNAIDS data strategy to combat HIV/AIDS.
shows that AIDS-related deaths have reduced
In our region, new infections are concentrated in
by 60% since the peak in 2004, and at the end of
key populations and their partners. Australia is
2019 of the 38 million people living with HIV over
working with long-standing partners, including
25 million were accessing antiretroviral therapy.
the Global Fund and UNAIDS, to invest in HIV
However, we must remain vigilant. This progress prevention in the Indo-Pacific. The Australian
is threatened by the COVID-19 pandemic, with Government’s increased investment in HIV
a compounding impact on the world’s most prevention will support the work of our partners in
vulnerable, including those women and men, girls protecting the most vulnerable.
and boys living with HIV. Globally, the COVID-19
We will not be able to move forward in the fight
pandemic exacerbated the gender inequalities
against HIV/AIDS unless we work together to
and conditions for increased gender-based
stop the reversal of decades of progress due to
violence. We know the links between
COVID-19. Despite these challenges, Australia
gender-based violence and increased
remains steadfast in our commitment to
risk of HIV exposure and reduced
eliminate HIV.
access to treatments. The Global Fund
to Fight AIDS, Tuberculosis and Malaria
6
The Hon Greg Hunt MP Minister for Health
Minister Assisting the Prime Minister for the Public Service
and Cabinet
World AIDS Day 2020 is an peoples or people acquiring HIV
opportunity to reflect on our through heterosexual sex.
achievements and acknowledge We have to capitalise on the progress
that we still have work to do. we have made if we are committed to
eliminating the transmission of HIV in
2020 has been a difficult year, Australia. Our next steps will require
with the COVID-19 global innovative solutions to engage with
pandemic dominating our hard to reach populations. Any new
time and attention, but the measures we take must be culturally
importance of World AIDS Day appropriate and sensitive, as we
are dealing with some of the most vulnerable
is as strong as ever. So, appropriately,
populations in our society. This may also mean
Australia’s theme for World AIDS Day in we have to address the hard issues, and plan and
2020 is ‘Now more than ever’. implement services aimed at populations who find
Australia continues to be a world leader in the it diffcult to interact with our health care system,
response to HIV, with the overall proportion of such as those living in Australia who do not have
people in Australia who have HIV lower than access to Medicare. The challenges are numerous,
other comparable high-income countries and but not insurmountable.
other countries in our region. We are very close to The commitment of community organisations,
meeting the UNAIDS 90-90-90 targets, and we are researchers, clinicians, governments and people
also tracking well towards achieving the UNAIDS living with, or, affected by HIV will be paramount
95-95-95 targets. as we face these final challenges. We have a
The virtual elimination of HIV is within our reach. strong history of working together of which we
The number of new HIV diagnoses is progressively should be proud, and I have no doubt we will
declining and is the lowest in nearly 20 years. continue to do so in the years to come.
More people are getting tested than ever recorded On this important day, we must pledge to continue
and as a result they are receiving treatment earlier, to work collaboratively and with compassion. We
which in turn has reduced the transmission rate must honour the lives lost to HIV by continuing to
significantly. work towards eliminating HIV in Australia.
However, challenges remain. We are not seeing Once this would have seemed impossible, but we
corresponding decreases in HIV notifications have come a long way and our hope for the future
among Aboriginal and Torres Strait Islander is stronger than ever.
7
Senator the Hon Penny Wong Shadow Minister for Foreign Affairs
and the Hon Chris Bowen MP Shadow Minister for Health
World AIDS Day Australia 2020: that of our Australian born non-
Much to celebrate, but a long Indigenous population. And while just
about every other indicator points to
way to go for our First Nations improvements towards eliminating HIV,
Peoples, and our Pacific the diagnosis rates among Aboriginal
neighbours. and Torres Strait Islander people are on
the rise.
As we come together on World
AIDS Day, in the shadow of a global To reverse this trajectory, communities
pandemic, we are reminded again of must be empowered to lead.
the importance of collaboration and In our region, the global pandemic
shared purpose in meeting our health has underscored the importance
challenges. of Australia improving its efforts
Australian governments have a shared to assist our Pacific neighbours in
goal - to eliminate HIV transmission in making meaningful progress toward
Australia by 2022. eliminating transmission.
Though we will miss the previous With almost six million people
2020 target, the good news is we living with HIV in the Asia-Pacific
are on our way to meeting the 2022 region and COVID-19 threatening
target, having gone from 1,084 HIV access to essential health services
notifications in 2014 to 833 in 2018. and infrastructure – the health and
prosperity of our region is at risk.
But we must do more. Bringing that down to zero
is going to take concerted and sustained effort. This World AIDS Day, let’s reaffirm our
commitment to doing all we can to ease the
We must focus that effort among our First Nations
burdens of HIV not only in Australia, but across
Peoples, where we have seen diagnosis rates go
our region, and in doing so - improve the lives of
backwards. The rate of HIV diagnosis amongst
hundreds of thousands of people.
Aboriginal and Torres Strait Islanders is double
8
Adam Bandt MP and Leader of the Australian Greens
Australian Greens Spokesperson for Family and Community Services,
Senator Rachel Siewert Ageing, First Nations Peoples’ Issues and Mental Health
This World AIDS Day, we We support the development and
should be just two years away implementation of a sustainable model
of access to HIV treatment and PrEP
from the virtual elimination of for people in this situation.
HIV transmission in Australia,
Australia must also play its part
according to one of the key globally in eradicating HIV/AIDS. In
goals of our National HIV the Asia-Pacific, we have an important
Strategy. We’ve already role in providing support and funding
missed that target once, to regional responses to HIV. Both
having originally planned to regionally and internationally, our
contribution to the Global Fund to
eliminate HIV transmission by
Fight AIDS, Tuberculosis and Malaria
this year. To make sure we are is critical. While we welcome the
successful by 2022, we need Australian Government’s continued
concerted, ongoing action and commitment to the Global Fund with a
sufficient investment into a $242 million pledge to the Fund’s Sixth
strong community partnership Replenishment covering 2020-22, the
Greens had called for a greater funding
approach. commitment of $300 million, alongside
A critical component of our work must a significantly increased aid and
be a continued focus domestically on hard-to- development budget from the lowest ever levels.
reach populations. In recent years, First Nations Australia must also play a leading role in the 2021
Australians have experienced a significant increase United Nations General Assembly’s High-Level
in diagnosis rates, while newly diagnosed rates Meeting on HIV and AIDS, including support for
among Australian-born non-Indigenous people participation by people living with HIV/AIDS and
fell. We must do better and close this health civil society in the meeting, and the negotiation
gap, directing adequate funding to First Nations of an updated UN Declaration of Commitment to
community responses focusing on prevention ending HIV.
and treatment. This includes funding support
We want to take this opportunity to again
to develop evidence-informed and long-term
congratulate and acknowledge the tireless work
community-led campaigns to reduce the incidence
of the Australian Federation of AIDS Organisations
of STIs in First Nations communities.
(AFAO), the Pacific Friends of Global
More broadly, we must continue to reduce barriers Health and the National Association of
to access to HIV prevention and treatment. For People with HIV Australia (NAPWHA),
example, those who are ineligible for Medicare and other partner organisations who
face a wide range of challenges to accessing carry on this fight year round.
healthcare in Australia to prevent and treat HIV.
9
Eamonn Murphy Regional Director
UNAIDS Asia-Pacific
While Asia and the Pacific approaches are key to ending the
boast some of the earliest colliding pandemics of HIV and
COVID-19.
successes of the HIV response,
we are not doing enough to This crisis has also been a wake-up
call, an opportunity to do things
prevent new HIV infections. differently—better, and together. In
Some countries are making many respects, the defeat of AIDS as
impressive gains. But, in a public health threat depends on how
others, there are still worrying the world responds also to COVID-19.
increases in new HIV infections. Governments, donors, civil society and
each and every one of us need to contribute to
It is unacceptable that, in this region, 10
making the world a healthier place.
young people become infected with HIV
Now more than ever Australia’s bold leadership
every hour. in the HIV response is showing the world what
In 2020, the world’s attention has been focused it means to work together, in solidarity and to
by the COVID-19 pandemic on health and how support those who are left behind. Australia
pandemics affect lives and livelihoods. COVID-19 continues to set the global standard for an
is showing once again how health is interlinked effective, innovative and inclusive national
with other critical issues, such as inequality, response to HIV, backed by a strong partnership
human rights, gender equality, social protection between government, clinicians, researchers and
and economic growth. With this in mind, the communities. Australia has been at the forefront
theme of World AIDS Day 2020 is “Global of harnessing the potential of emerging evidence
solidarity, shared responsibility”. and technologies, including PrEP. Australia’s
COVID-19 has demonstrated that, during a investments in the HIV response in the Asia Pacific
pandemic, no one is safe until everyone is safe. region also address some of the most critical gaps
Leaving people behind is not an option if we are in the HIV response due to complex and multiple
to succeed. Eliminating stigma and discrimination, factors that are barriers to achieving the Fast Track
putting people at the centre and grounding our targets. In particular Australia provides support in
responses in human rights and gender-responsive areas of new prevention technologies from moving
pilots to impactful scale up.
10Peter Sands Executive Director
Global Fund to Fight AIDS, Tuberculosis and Malaria
On World AIDS Day, we could lead to more than 500,000 extra
commemorate the people deaths from AIDS-related illnesses in
sub-Saharan Africa in 2020–2021. We
we have lost since the HIV cannot let this happen.
epidemic began, while
The Global Fund responded quickly to
recommitting to the ambitious the crisis, making up to US$1 billion
yet achievable goal of ending available to help countries fight
the virus as a serious public COVID-19, adapt life-saving HIV, TB
health threat. and malaria programs and reinforce
systems for health. Approximately
Since 2002, the Global Fund US$130 million had been approved (as of
partnership has saved 38 million lives. In 8 October 2020) for countries in the Asia Pacific
countries where the Global Fund invests, AIDS- region that are an interest to Australia to respond
related deaths have been reduced by 61% and to COVID-19. The Global Fund is also a founding
new infections have been reduced by 41%. In partner of the ACT-Accelerator, the world’s largest
2019, Global Fund investments supported 20.1 coalition to develop and equitably distribute
million people to access antiretroviral therapy. COVID-19 tests, treatments, and vaccines.
Among that number were 718,000 mothers who
received lifesaving medicine that also prevented We must recognise that this is not just a fight
transmission of HIV to their babies. We also saw a against one virus, but a commitment to finish the
massive expansion of HIV self-testing, a powerful unfinished fights against HIV, TB and malaria,
tool in breaking down the barrier to people strengthen our defenses against future pathogens,
knowing their HIV status. and build better health systems to advance global
health security.
However, our progress against HIV has never been
more delicately poised. The COVID-19 pandemic The Global Fund is grateful for Australia’s pledge
poses new challenges to our collective mission. to the ACT-Accelerator and honored to have
As lockdowns and other restrictions took hold, Australia as a partner as we defend the gains of
HIV testing dropped by 50% in some places. the past two decades and recommit to making
Additionally, prevention and treatment programs further progress against HIV and other diseases
got disrupted. Recent studies have predicted that that continue to kill millions every year.
a six-month disruption of antiretroviral therapy
11Supporting communities in Sri Lanka
Since the middle of March there have Many of these people are daily wage earners
been strict COVID measures in place in with no source of income during this time. They
have little, if anything, in savings and sometimes
Sri Lanka with partial lockdown in 19 minimal literacy skills. Many do not have bank
districts and full lockdown in up to eight accounts or National Insurance cards meaning they
districts. Only one family member is are not eligible for government aid.
permitted to leave the home for essential Community based organisations have found that
supplies once a day. many people are scared to ask for support, having
been stigmatised and often criminalised in the past.
HIV services have been heavily impacted with
the only service continuing to function being With lockdown, these marginalised groups face
antiretroviral medicine provision and a one to two- increasing difficulty in accessing support. This is
hour STI clinic per week. partly due to the requirement of a curfew pass
which entails reason for exit.
Those working in the HIV response have worked
to facilitate aid and provide support to community In response, HIV collectives have set up
members most at risk of HIV as well as those living emergency funds allowing the general public to
with HIV, who are increasingly vulnerable. donate funds which are then directly transferred
to those identified via their trusted networks as
being in need.
AFAO’s Sustainability of HIV Services for Key Populations in Asia Program (SKPA Program) with representatives from local
community organisations in Sri Lanka. (AFAO)
12Tania Rishniw Deputy Secretary
Department of Health
World AIDS Day is an important people living with HIV had received
occasion which allows us to a diagnosis, 96% people who had
received a diagnosis were in care with
remember those who have lost 89% receiving antiretroviral therapy
their lives to HIV and reflect on (ART), and of the people receiving ART,
our progress in responding to 95% had achieved a suppressed viral
HIV in Australia. load. Being on the cusp of achieving
this goal is significant, and places
Australia’s achievements in reducing
Australia as a world leader in the
HIV transmission are the result of
response to HIV.
significant efforts over almost 40
years. This work is currently being guided by We can also see where we need to direct future
the Eighth National HIV Strategy 2018-22, which efforts to maintain our momentum – particularly
sets out the direction for Australia’s continuing actions to address the challenges faced by priority
response to HIV, with ambitious targets and goals populations. Aboriginal and Torres Strait Islander
steering our actions. The Blood Borne Viruses people continue to carry a disproportionate
and Sexually Transmissible Infections Standing burden of new HIV notifications.
Committee of the Australian Health Protection As we progress through the remaining life of
Principal Committee, with membership from all the Strategy, we have to reconcile our successes
Australian governments and relevant national with the challenges ahead. We have a strong
community bodies, is charged with implementing foundation to build future activities upon, and
these actions and I commend the work it is doing clear indications on where our efforts should be
to progress the Strategy’s goals by 2022. directed.
At this halfway point, we can see our sustained This year’s theme for World AIDS Day is ‘Now
efforts to reduce HIV transmission, improve more than ever’ – this is especially relevant with
treatment rates and reduce the personal and COVID-19 impacting on all of our lives. It is a
social impacts of HIV are having positive impacts. time for us to recommit to our determination
Australia is close to achieving the UNAIDS 90- to eliminate HIV transmission in Australia and
90-90 targets. Recent data shows that 90% of provide support to those people living with HIV.
13The Hon Michael Kirby Jurist, academic, HIV advocate and former Justice of
the High Court of Australia
AC CMG
I participated with the World • Politicians must become informed
Health Organisation at the and explain why unpopular
initiatives are often essential;
beginning of the HIV epidemic
in 1988. The best scientists • Successful strategies oblige us to
adopt generous aid policies and
predicted a cure and a vaccine mutual support for countries less
within 20 years maximum. fortunate than our own; and
Still we are waiting, although • The voices of patients and their
antiretroviral therapy appeared families are vital. Those voices must
in the mid-1990s to save lives heard throughout the pandemic.
and render those infected with HIV In the struggle against HIV, Australia and New
incapable of transmitting the virus to Zealand led the world with sound policies,
others. Viruses, we learned, are very established across party lines. We conformed,
tricky targets. virtually before all others, to the foregoing
lessons. We stayed the course against occasional
In 2020, much of the world’s attention has shifted
noisy opposition. We saved lives. We helped
from HIV to COVID-19. But there are vital lessons
neighbours to do likewise. We cooperated with
to be learned from the earlier pandemic:
the UN and supported the Global Fund. We
• The foundation for policy on viruses must be maintained these efforts despite the new and
good science, not politics, religion, guess work added demands of COVID-19.
or prejudice;
With COVID-19 we have largely shown the same
• Respecting the human rights of those infected leadership and example. As Winnie Byanyima,
is critical to successful national and global Executive Director of UNAIDS, said in August
strategies; 2020, “Human rights are not only intrinsic,
• Vulnerable groups face special prejudice and but they are also the very means by which
dangers in pandemics; governments can successfully beat a pandemic”.
• It is essential to mobilise global cooperation This was true of HIV in 1988. It is true of COVID-19
and to support WHO and the UN. Pandemics in 2020. An unexpected new target has emerged.
cannot be treated as national problems alone; The focus must remain the same. AIDS is not over.
COVID-19 has just begun.
14Professor Sharon Lewin Director
The Peter Doherty Institute for Infection and Immunity
Every World AIDS Day, I take combat a new virus. I see my fellow
the opportunity to reflect scientists bring advances from HIV
– such as point of care testing, new
on the last 12 months, as a vaccines and antibodies – to COVID-19.
scientist, a clinician and as an I am hopeful that some of the scientific
individual. I pay my respects advances we will achieve through
to those whom we have lost to tackling COVID-19 will accelerate our
HIV and their families, loved search for a cure and a vaccine for
HIV. However, I am worried about the
ones and communities. In 2020,
long-term effects of the pandemic on
more so than any other year, the HIV sector. I worry about social
we have been reminded of the great isolation for many people living with HIV. I worry
success story of the HIV response and that scarce resources will be diverted from HIV
what can be achieved with the right mix to deal with COVID. As a community, we need to
of science, leadership and community. ensure that both pandemics remain high priorities
nationally and globally.
I must start by acknowledging Timothy Brown,
In Australia, we continue to see a reduction in new
the first person to be cured of HIV. Timothy’s
HIV infections but not in all communities. Access
death from a recurrence of his leukemia this year
to treatment remains one of the highest in the
was incredibly sad and a great loss. His personal
world but we need to ensure that every person
commitment to research and his community will
living with HIV is provided with the best available
be missed. He taught us that a cure for HIV is
antivirals and the best care, which includes active
possible and we need to keep working to make it a
prevention of co-morbidities. We need to ensure
reality for everyone.
that all people live well with HIV, both throughout
In these turbulent times of COVID-19, I remain and beyond the COVID-19 pandemic.
proud to be part of the HIV sector, to apply the
skills and experience of the past 30 years to
15Professor Director
Kirby Institute
Anthony Kelleher
World AIDS Day 2020 is Our state-of-the-art laboratories have
occurring in a time like no other been dedicated to investigating HIV
for three decades. We continue our
in living memory. Amid the work to find optimal treatments, and
global COVID-19 pandemic, we hopefully a vaccine and cure for HIV.
have witnessed great tragedy, But it has been testament to our highly
but we also have great cause skilled laboratory scientists how nimbly
for hope. and ably they have adopted new
knowledge and practices to adapt to
The mortality and morbidity rates for COVID-19.
COVID-19 are astounding. But those
This World AIDS Day is also an opportunity to
of us who have been involved in the fight against
reflect on how far we have come in the fight
HIV/AIDS over the past three decades know all too
against HIV/AIDS. There have been many lessons
well the blight of an epidemic health crisis on our
learned throughout the HIV/AIDS epidemic that
communities.
we have been able to deploy this year. Australia
Since HIV/AIDS emerged in the 1980s, teams has done a remarkable job, as it did for HIV/AIDS
of researchers, clinicians, governments and though the 1980s and 1990s; acting quickly and
communities have worked together to establish responsibly across multiple sectors, to contain
extensive global networks to better understand COVID-19 and mitigate the burden of disease on
HIV/AIDS from all angles, and work towards our population. What we have seen, too, is our
treatments, where astounding and transformative communities come together, to do what has been
advances have been made. However a vaccine necessary to protect each other’s health.
and a cure remain elusive. This year, these global
HIV/AIDS remains a significant global health
networks and collaborations have enabled us to
challenge, and the disruption and dislocation
quickly mobilise resources against COVID-19.
of COVID-19 has made that challenge greater.
For example, through our largest clinical trials
We must continue to come together, utilise our
network trialling a second-line HIV treatment,
substantial and skilled workforce to maintain our
spanning 14 countries across the Americas, Asia
hard won gains, and forge ahead in our quest to
and Africa, our researchers have been able to
find a vaccine and a cure, as we adapt to living
quickly establish a cohort study to determine the
with yet another new virus.
impact of COVID-19 on people living with HIV in
low- and middle-income countries.
16Professor Carla Treloar Director
Centre for Social Research in Health
UNSW
In the most exceptional year treatment as prevention (TasP). If we
of 2020, it is very easy to be consider all forms of safe sex, the level
of net prevention coverage during
distracted from usual business. casual sex has increased from 69% in
But it is at these moments 2015 to 75% in 2019. We believe this
that we need to keep an ever is one of the main reasons that HIV
vigilant watch on progress infections among gay and bisexual men
towards the UN goals of have declined in Australia in the last
few years.
90-90-90 by 2020 as well as
becoming more and more Trends in some indicators however
suggest that there are ongoing risks of potential
sophisticated in understanding where
HIV transmission and acquisition, among those
and how progress could be better. who have never been tested for HIV or STI,
Our Gay Community Periodic Surveys (GCPS) or those who are not fully aware of the latest
have collected data since 1996 on the sexual prevention and treatment options, pointing to
practices, risk and engagement in prevention and areas in which prevention responses could be
care by gay and bisexual men. The GCPS data strengthened. We also know that community-
as a whole suggest that among sexually active based HIV testing services were particularly
and community-engaged gay and bisexual men, good at attracting younger and Asian-born men,
the attainment of the 90-90-90 target has been who are of particular interest for HIV prevention
achieved. However, reaching and sustaining the programs as the HIV epidemic diversifies in
higher 95-95-95 target will require additional Australia.
effort and tackling barriers to diagnosis and The 90-90-90 targets (or indeed 95-95-95 targets)
treatment such as Medicare ineligibility, engaging do not refer to the experience of living with HIV
overseas-born men and those not connected or the social conditions that impact quality of
to sexual health services or gay community life. Our focus on the Australian national strategy
networks. goal of reducing the negative impacts of stigma,
During the last decade, especially the last three human rights and legal issues must continue to
years, gay and bisexual men have increasingly be of highest priority and to be explored across
adopted HIV biomedical prevention strategies, the diverse and intersecting populations of people
particularly pre-exposure prophylaxis (PrEP) and living with HIV.
17Professor Brendan Crabb AC Director and Chief Executive Officer
Burnet Institute
Chair and President Advisory Board
Pacific Friends of Global Health
Globally, the COVID-19 Burnet Institute has been proactively
pandemic is exacerbating social contributing to the COVID-19 response
in Australia through public health
and economic inequalities, and and laboratory-based research and
threatens to derail decades of advocacy, implementing new initiatives
hard-fought efforts to control and leveraging existing research
other pandemics such as HIV. infrastructure. Burnet’s world-class
This new public health threat sentinel surveillance system, ACCESS,
is now rolled out across each state
has left people living with and
and territory and is being used to
most at risk of HIV facing new monitor HIV-related outcomes during
barriers to accessing adequate harm the pandemic. ACCESS data indicates COVID-19-
reduction and prevention methodologies, related social restrictions have had a considerable
HIV testing and treatment. impact on HIV testing and PrEP use in Australia.
Ensuring an adequate and timely recovery in HIV
While the COVID-19 pandemic will require a testing and uptake of preventative therapies to
global, coordinated public health response of pre-COVID levels among priority populations
unprecedented scale and cost, it is imperative that will require a concerted effort. We have the
we are determined to maintain momentum in our opportunity to take advantage of new health
goal of achieving HIV elimination. systems innovations, including strengthening of
Great strides towards HIV elimination have been our contact tracing and moving to decentralised
made in Australia and neighbouring countries models of care and surveillance, which can all be
over the past decade. The Asia Pacific region has harnessed in our ongoing efforts to eliminate HIV.
achieved a 12% decline in new infections since Just as the COVID-19 pandemic threatens to
2010. However, significant gaps remain, and the hinder our progress towards HIV elimination, the
COVID-19 pandemic threatens to widen these lessons we have learned from addressing HIV can
gaps. UNAIDS has reported significant, sustained be used to guide our response to COVID-19 both
declines in HIV testing since January in almost all locally and globally. As we move to maintaining
countries with available data, including countries a suppressed level of community viraemia for
in our region. Although the impact on HIV COVID-19, and keep up the effort to do the same
treatment access seems to be less severe, declines for HIV, governments must ensure community
in testing will have consequences for timely engagement is central to decision making for both
diagnosis and ongoing HIV transmission. pandemics.
18HIV stigma in 2020
In 2020, a national survey of men who have sex with men found that 21% of
participants reported feeling stigmatised within the past year by other people
assuming they had HIV.
Number of participants: 973
79 13 7 2
0 20 40 60 80 100
Percentage
Never Rarely Sometimes Often/always
Note: Total does not add up to 100% due to rounding
In 2020, a national survey of the Australian public found that 30% of participants
reported that they would behave negatively towards people living with HIV.
Number of participants: 2,010
70 18 7 3 2
0 20 40 60 80 100
Percentage
Never Rarely Sometimes Often Always
Source: Centre for Social Research in Health, UNSW Sydney
19Alexis Apostolellis Chief Executive Officer
Australasian Society for HIV, Viral Hepatitis and Sexual Health
Medicine (ASHM)
At the end of this long year, ASHM’s regional advisory group
it is impossible to talk about became the taskforce’s arm to reach
out to our neighbours in Asia and the
World AIDS Day without Pacific with education, resources and
acknowledging the impact of other support for people delivering
the COVID-19 pandemic on the HIV, viral hepatitis and sexual health
HIV response in our region. As services. Made up of 70 clinical,
profoundly as HIV in Australia community and research members
from ten countries across Asia and the
has been shaped by COVID-19,
Pacific, the regional advisory group has
the pandemic has exacerbated sought to fill a critical gap in educating
many of the already complex challenges the HIV workforce during the pandemic.
faced by our colleagues in the HIV Driven by our colleagues on the ground in
workforce around Asia and the Pacific. countries including Papua New Guinea, Timor
Healthcare workers in the region face difficulties Leste and the Philippines, the group has helped
getting HIV medicines to patients during lockdown health workers across the region share information
conditions, insufficient access to personal and develop innovative ways of responding to HIV
protective equipment and even a lack of basic in this new environment.
access to information about COVID-19. But as the COVID-19 pandemic worsens globally
Just one example: a doctor we work with in and cases continue to rise within the region, there
Timor Leste told us that when the pandemic is still so much work to be done. While the region’s
began, many fled the city to escape the virus. But HIV workforce operates with limited resources
without transport infrastructure in much of the and under increasingly challenging conditions,
country, this has made it even extremely difficult without further action we risk losing the hard-
for HIV health workers to get vital medicines to fought progress we have made over decades of
their patients. Australia’s regional support.
When ASHM established its taskforce on blood- As 2020 ends and the COVID-19 pandemic
borne viruses, sexual health and COVID-19 in continues, this World AIDS Day is an opportunity
March, we knew that finding ways to support the to reflect on what we have learned over these
HIV workforce beyond Australia and throughout decades of Australia’s work in the region, and
the region would need to be a critical part of how we can take those lessons into this new and
that work. uncertain future.
20Professor Suzanne Fraser Director
Australian Research Centre in Sex, Health and Society,
La Trobe University
La Trobe University Australia to significantly affect quality of life.
has long been a world Concern for the wellbeing of people
living with HIV is about an ethic of care
leader in responding to HIV. and responsibility – recognising that
Lessons from the Australian support must remain core to Australia’s
HIV response have particular HIV response.
resonance in 2020 as we deal Among its goals, the National HIV
with the COVID-19 pandemic. Strategy aims to see 75% of people
Community engagement, living with HIV reporting good quality
community support, and of life by 2022. Largely through our
HIV Futures Study and the PozQol (quality of life)
broader wellbeing – including mental
measure, ARCSHS monitors progress toward this
health and social connection – are key goal. Our research explores the elements that help
to managing any infectious disease improve quality of life for people living with HIV in
effectively and respectfully. This Australia. For example, we know that connection
understanding is reflected in the Eighth to community and knowing other people living
National HIV Strategy which includes in with HIV are associated with better wellbeing
and lower perceived stigma. This points to the
its targets a concern for improving quality potential benefits of investment in peer-based
of life among people living with HIV. programs and services such as peer navigator
Advances in the biomedical treatment of HIV initiatives that enable people who are newly
have driven major changes in prevention and diagnosed with HIV to connect with other people
treatnent. Encouraging earlier and sustained use living with HIV.
of antiretroviral treatment (ART) by people living On World AIDS Day 2020, ARCSHS joins people
with HIV is now seen as central to eliminating living with HIV, and our community, government
HIV transmission in Australia and internationally. and research partners, in affirming the importance
ART allows people living with HIV to achieve a life of quality of life and wellbeing for people living
expectancy equal to that of anyone else. However, with HIV in all their diversity. In this we are
this does not also ensure their mental health is committed both to the value and dignity of the
well supported. Nor does it address the negative lives of the individuals and communities directly
impact of HIV-related stigma, something known affected, and to ending the HIV epidemic for all.
21Scott Harlum President
National Association of People with HIV Australia (NAPWHA)
For World AIDS Day 2020 And we can do better to expand our
I’d like to acknowledge the minds and in doing so expand our
services as well.
community of people living
with HIV in Australia, and But this World AIDS Day I also want
to acknowledge that we can do better
the strength and diversity to engage and listen, on your terms.
of that community, which We can do better by involving you, the
has supported us for near- very people we want to reach, in the
on 40 years, binds and development of health promotion and
protects us again as we face health interventions.
the uncertainty and fear of a second We can do better by valuing peers, and by
pandemic in our lifetime. having peers working within our communities
in clinics, in support services, in NGOs and in
Aboriginal, Torres Strait Islander or Anglo government services. We can do better by valuing
Australian; born overseas, from Africa, South peers translating, supporting, empathising, and
America, South East Asia; a man, woman, trans informing us – in the HIV sector – of what is
or non-binary; gay, straight, lesbian or bisexual; needed to improve your health. And we can do
a person who uses drugs; in a custodial setting; better with clearer pathways for the exchange
a sex worker; a long-term survivor or newly of information, and by being open to listen and
diagnosed; adolescent, young, middle-aged or quicker to act.
older… your face changes, but not the richness
On World AIDS Day 2020 I acknowledge the power
of experience and the opportunities to listen and
of my peers and I challenge us all to harness the
learn which come from being your peer.
diversity of our communities to improve our future
We know that the people who are more likely to response to HIV.
test late, less likely to treat and more often lost to
follow-up come from ‘unconnected’ communities.
22Jules Kim Chief Executive Officer
Scarlet Alliance, Australian Sex Workers Association
Sex workers in Australia in the National HIV, Hepatitis and STI
continue to maintain low Strategies. The findings of this research
will inform critical stigma reduction
prevalence of HIV sustained interventions for sex workers and
through ongoing investment will provide an important baseline to
in health promotion and provide an annual measure of their
prevention efforts of impact on the experience of stigma by
peer based sex worker sex workers.
organisations. In longstanding, Another key barrier are the regulatory
effective partnerships with and legal issues that sex workers
face such as criminalisation, licensing, forced
government, researchers, community
registration and mandatory testing in some
and the health sector, the leadership of jurisdictions. The varied regulatory framework
sex workers and their organisations has in each state and territory that sex workers are
ensured that prevalence of HIV among subject to impede our access to prevention,
Australian sex workers has remained treatment, testing and health services, reduce
among the lowest in the world. our ability to implement workplace health and
safety strategies and increase our risks to BBV and
Unfortunately stigma and discrimination against STI. There is strong evidence to support that the
sex workers remains unacceptably high, creating decriminalisation of sex work improves access to
barriers to HIV prevention and access to healthcare workplace health and safety, access to healthcare
services. Recent research conducted by CSRH and justice, and reduces HIV risk and rates.
examining the expression of stigma towards sex In June this year, the Northern Territory became
workers found 64% of the general public and only the second jurisdiction in Australia to
31% of the health workforce reported they would decriminalise sex work. The Sex Industry Bill
behave negatively towards a person because 2019 was passed in NT parliament on 26th
of their sex work. Despite these incredibly high November, 2019 and was implemented in June
levels of stigma and discrimination experienced 2020 providing sex workers access to the same
in the daily lives of sex workers, including in WHS and industrial protections as other workers
accessing health services, sex workers do not in the Territory. And there is cause to be hopeful in
have access to anti discrimination protections other states and territories with active sex worker
across many states and territories of Australia. led campaigns for poistive law reform, to repeal
There remains an urgent need to ensure consistent criminalisation, licensing, registration
anti discrimination protections for sex workers and mandatory testing; provide crucial
throughout Australia. anti discrimination and anti vilification
Scarlet Alliance have partnered with CSRH to protections for sex workers; and to fully
conduct a survey exploring the experiences of decriminalise sex work for our rights,
stigma among sex workers as a priority population health and safety.
23Melanie Walker Chief Executive Officer
Australian Injecting & Illicit Drug Users League (AIVL)
Globally, people who inject This year, AIVL has also worked with
drugs are 22 times more likely key partners such as the RACGP to
develop the Interim Guidance for
to acquire HIV than those the Delivery of Medication Assisted
who do not inject, and locally, Treatment of Opioid Dependence in
Indigenous Australians who Response to COVID-19: A National
inject drugs account for 12% of Response. This provides a national
new HIV notifications among framework for the provision of opioid
maintenance treatment in healthcare
Aboriginal and Torres Strait
settings. Encouragingly, take-away
Islander Peoples. In Australia, doses of pharmacotherapies have been
needle and syringe programs remain increased throughout this period.
the most effective means to prevent We have also continued to work with key research
transmission in this key population. institutions to inform study into the effects of
However, the lack of this harm reduction COVID-19 on people who use drugs and their
measure in custodial settings remains access to harm reduction measures and services.
and continues to disproportionately Despite some of the hardships and challenges
affect Indigenous Australians. that COVID-19 has presented, the Australian
sector has shown its ability to promptly respond
The COVID-19 pandemic has impacted our in strong collaboration with the interests and
communities and the sector in unprecedented needs of our communities at the forefront of our
ways. As a result, we must find innovative ways actions. Notwithstanding this, globally and locally,
to respond to ensure that HIV and the harms it a reinvigorated response to the needs of key
causes are not overlooked. Additionally, we need populations at risk of HIV is a key priority in these
to continue to fight the persistent issue of stigma unprecedented times.
and discrimination faced by our criminalised
The Australian Injecting and Illicit Drug Users
community.
League (AIVL) is the national organisation
Community-led responses are as critical as they representing people who use/have used illicit
have ever been. drugs and is the peak body for the state and
territory peer-based drug user organisations.
24Michelle Tobin Chair
Anwernekenhe National HIV Alliance (ANA)
Aboriginal and Torres Strait Aboriginal and Torres Strait Islander
Islander people experience people need tailored and differentiated
approaches to HIV prevention
lower HIV testing rates, lower and treatment. Mainstream health
pre-exposure prophylaxis infrastructure must draw on our
(PrEP) uptake, higher HIV wisdom, lived experience, and direct
diagnosis rates, delayed HIV engagement within GIPA/MIPA
diagnoses, and higher rates of principles, as a step to revitalise the
HIV prevention, testing and treatment
HIV diagnosis among women,
landscape.
compared to their non-
While the Anwernekenhe National HIV
Indigenous counterparts. Alliance (ANA) Us Mob & HIV booklet produced
I am a proud Aboriginal woman of the Yorta Yorta in partnership with AFAO is being updated and
Nation living with HIV since 1990. I am a mother, reprinted, as Chair I am still deeply disappointed
grandmother, daughter, sister and aunty and a the ANA remains unfunded. This reality speaks
descendant of the Stolen Generation. volumes to the funding and policy priorities of
policy makers. Despite this, we are encouraged
Our mob faces an unacceptable situation. Two
by the appointment of two Aboriginal Project
years ago, Kirby Institute data showed that the
Officers, working closely with the ANA to ensure
rates of HIV diagnoses for my mob were double
the voice of Indigenous Australians is heard within
that of non-indigenous people. In 2020, I am sorry
the Australian HIV response.
to say these figures have changed little. STI rates
of chlamydia, gonorrhoea and infectious syphilis We have seen significant impacts from COVID-19 on
are now 3, 10 and 6 times greater than non- our mob’s resilience. Physical distancing has strained
Indigenous populations. the way we access and engage with services. For
many of us already living in crowded housing
As an Aboriginal Health Program Officer at
conditions or with poor access to healthcare, our
Positive Life NSW, I lead an Aboriginal co-
risk of COVID-19 is heightened. Despite COVID, the
designed needs assessment project to generate
Positive Aboriginal Torres Strait Islander Network
a culturally sensitive HIV service delivery model
(PATSIN) continues to work closely with HIV sector
in collaboration with an advisory committee of
partners to create a 2021 Resilience Retreat when
Aboriginal and Torres Strait Islander people.
it’s safe to gather together again.
Co-designing a culturally aware and appropriate
service model with, by and for Aboriginal and While the latest HIV epidemiology data still
Torres Strait Islander people is just the beginning show our mob continuing to shoulder
to generate the valuable understanding, a disproportionate burden of HIV and
knowledge and solutions my community needs to STIs, I am hopeful that the co-designed
reduce HIV transmission. approaches to HIV prevention and
treatment will be firmly grounded in
community by next World AIDS Day.
25Novel approaches drive progress in
the Philippines
Since late February, the Philippines
has been under enhanced community
quarantine due to COVID with
movement limited to only accessing
basic necessities.
This has severely impacted HIV prevention and
treatment as resources are diverted to address
the impact of COVID-19. Access to antiretroviral
medicine, PrEP, condoms and testing has been
limited.
United by the value of self-worth, LoveYourself
is a community of 2,000-strong volunteers who
aim to reach out to others to propagate ideas,
Approximately 7,000 clients with HIV rely on LoveYourself for
attitudes, and practices and provide spaces that uninterrupted access to life-saving medication and other HIV
encourage one to dare to be oneself, to care for services. (EBagasol/LoveYourself)
and love oneself, and to share oneself.
LoveYourself staff at an intra-country meeting to exchange ideas and develop skills to respond to HIV. (EBagasol/LoveYourself)
26LoveYourself is a community of volunteers who
aim to reach out to others to propagate ideas,
attitudes and practices that encourage people to
take care of their health.
Despite the lockdown Love Yourself has
demonstrated how to maintain pre-existing
services while progressing important objectives.
With clinics being suspended and quarantine
measures in place they have:
• Digitally mapped operational HIV facilities/
treatment hubs so patients can see what is
open and closed before leaving their homes.
• Increased the number of phone hotlines for
arranging medicine delivery. One of LoveYourself resident nurses Norman Libao contacts a
client via phone call. (EBagasol/LoveYourself)
• Employed motorbike riders to collect and
deliver medicines. This has ensured continuity
of care for people with HIV and continued
income for motorbike riders.
• Maximised the opportunity of quarantine
to use chatbots for sign up to HIV programs
and delivered testing kits to clients for free
via motorcycle riders. Recently, they have
also opted to pick up clients who want to get
tested, and bring them to their clinics, so that
other health services can be provided in a
wrap around service.
• Helped to set up telehealth options.
• Maximised digital approaches for campaign
related activities such as an online concert Nurse Ron (left), together with staff, ensures all scheduled
to deliver HIV prevention and treatment deliveries are accomplished before the day ends. Operating
messaging. from 10 AM to 5 PM from Wednesday to Sunday, health and
program staff of LoveYourself facilitate delivery of medicines for
an average of 100 clients a day. (EBagasol/LoveYourself)
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