The following article references the National Consensus Statement on the Future of the Australian HIV Response. To read the full report, please click here.
The Australian HIV response has represented the collective efforts of numerous passionate individuals, community organisations, clinical and research experts and political leaders that have been relentless in their attempt to reduce transmission and improve the lives of people with HIV (PWHIV). Naturally, the response has become more than just a political or clinical ‘issue’. Instead, it has become a symbol of advocacy, ethical treatment and empowerment of communities impacted by HIV, staying true to its grassroots origins. It has provided hope and support for thousands of individuals and instilled a broader consideration of the diverse needs of impacted communities.
There are huge variabilities across the HIV response. Variabilities across cultures, communities, locations, orientations, identities and degrees of impact. Since the HIV response acts as a proxy representation for the collective identities of individuals and communities that are impacted by HIV, by default the response is highly diverse. Reductions in HIV transmission and the Quality of Life (QoL) for PWHIV vary greatly across Australia with variabilities seen in resourcing, accessibility and recognition. Aiming to reduce HIV transmission provides additional opportunities to address systemic inequality and inequity that has previously slowed down the response.
The HIV response has experienced changes to the epidemic over time, with shifting characteristics due to factors such as legislative, economic or biomedical technologies. This includes the peak in HIV notifications in 2012-2014, the subsidisation of Pre-Exposure Prophylaxis (PrEP) and broader access to anti-retroviral therapy (ART) in conjunction with the Treatment as Prevention (TasP) strategy and Undetectable = Untransmittable messaging and a resulting 60% reduction in transmission rates from 2010 – 2019.
The collective interventions and strategies to test, treat, prevent transmission, reduce stigma and research to enhance the response has seen a rapid decline in notifications. So much so that Australia’s HIV transmission trends are on a trajectory towards a statistical milestone called ‘Virtual Elimination’. This is technically defined as a 90% reduction in HIV transmission numbers from a 2010 baseline or less than 91 cases of HIV notifications by 2030. In the inner suburbs of Sydney, transmission rates were reduced by 88% in 2023, making it the first place in Australia and the world to reach a state of virtual elimination. This indicated that not only is it feasible to reach virtual elimination, but that Australia can now turn its sights towards the horizon and begin planning for an HIV response that can replicate this milestone.
Recently, Health Equity Matters partnered with the National Association of People With HIV Australia (NAPWHA) to initiate a project that would develop a national consensus statement on the future of Australia’s HIV response. The project was designed to engage over 100 experts from clinical, community and research groups in the response to conceptualise a future scenario to move towards and beyond virtual elimination of HIV transmission.
As part of the project, a group of experts were asked to score the importance of 41 draft statements that covered a range of priorities such as PrEP access, testing models, legislative reform to address stigma and universal access to treatment. Two hypothetical scenarios were provided to the experts to guide the scoring of the statements: 1. Achieving Virtual Elimination where a continuation of the current response and an upscaling of certain activities and 2. Moving Beyond virtual elimination where a cure is still not available however the response becomes more nuanced and impactful, allowing for notifications to drop below 91 cases annually.
This is one of the first national consensus statements in the world to conceptualise and identify priorities for the future HIV response. The final 36 statements that reached consensus (scored above 80% acceptance by the 100+ experts) define a clear path towards virtual elimination and highlights the need for ongoing and, in some instances, increased commitment to address the inequalities across the response. The statements also detail the priorities that should continue beyond the point of virtual elimination.
By shifting the response’s focus toward the long-term, we draw focus to the maintenance and upscaling of the response required to build upon previous successes. To prevent future transmission amongst at-risk individuals, it is critical that multipartisan support remains continuous from federal and state/territory governments as this has been one of the features of the Australian response that has differed from other responses and resulted in world-class successes.
Furthermore, the continued empowerment of the HIV community to lead and shape the future response is another critical feature that must be sustained. The reason for this is largely due, again, to one of the unique features of the Australian response and when compared to other responses globally, a community-led approach has repeatedly demonstrated its effectiveness and ability to advocate and protect the rights of PWHIV. This is particularly true for PWHIV and ensuring the response supports PWHIV to ‘live their lives to their full potential, in good health and free from discrimination’[1]. Placing the needs and rights at the centre of the response will ensure that efforts to reduce transmission is conducted justly and diversely through co-design and bespoke considerations of impacted communities.
The numerous successes of the HIV response so far have allowed us to conceive a reality of low transmission rates. This national consensus statement builds upon this vision and enhances its trajectory by providing specific priorities that can be used by policymakers and government departments to fund, support and strengthen Australia’s approach towards virtual elimination of HIV transmission.
It also allows communities to strengthen their visions and purpose by working on a unified objective that still considers their own unique needs. The consensus statements also encourage communities to interpret the statements in a way that is meaningful and purposeful to their own identities, experiences and needs. One size does not fit all when it comes to health interventions and the project has highlighted the need for a nuanced approach to address differences for those impacted by HIV in a state of low transmission.
In summary, the national consensus statement on the future of the Australian HIV response is intended to clarify the vision of reducing HIV transmission in Australia. By providing a detailed roadmap on future priorities, we have worked with the response to take the first step in a direction that is afforded to very few other countries. By looking ahead, we can better prepare and ensure that with increased specificity, the response can consider the inequality across Australia’s legal and health landscape in relation to reduced HIV transmission. In addition, the consensus statements reinforce the importance of continued, and in many instances, increased political, financial and legislative support from state/territory and federal governments.
To read the full report, please visit the consensus website: click here.