HIV remains a public health threat: Journal Watch

Time again for this months “must read” article from the Journal Watch service of the Public Health Advocacy Institute of WA.

This month a reminder that HIV remains a major public health issue and that there is no place for the complacency that seems to have arisen in developed countries. 

Dr Melissa Stoneham writes:

Globally, HIV/AIDS continues to be a major public health issue, with more than 34 million people estimated to be living with the disease and 1.7 million dying from it in 2011. amfAR estimates that nearly 7000 people contract HIV every day. As expected, according to UNAIDS, more than two-thirds (69 per cent) of all people living with HIV, equating to 23.5 million, live in sub-Saharan Africa—including 91 per cent of the world’s HIV-positive children.

For many in the developed world, HIV has become yesterday’s epidemic, particularly with advances in drug development that means, for most people who contract the virus; it is manageable through medication.

Public health professionals could assume that the HIV/AIDS campaigns such as the memorable Grim Reaper advertisement which was launched in Australia during 1987 and the more recent and positively worded UNAIDs campaign Together we will end AIDS have worked for those fortunate to live in a developed country. But according to a World Report article titled “New HIV diagnoses in London’s gay men continue to soar” which was published in The Lancet during July 2013, the level of new HIV diagnoses among gay men in London had risen by 21 per cent in the period from 2011 to 2012.

The World Report authored by Tony Kirby and Michelle Thornber-Dunwell, is a follow up to a January report in The Lancet that raised concerns over high-risk drug practices in the London gay scene, including smoking, injecting or snorting of party drugs such as crystal methamphetamine (crystal meth) and mephedrone, often in combination with sex parties. The authors suggested that serious concerns existed about these behaviours leading to an increase in new HIV infections, hepatitis C infections, or both.

With London’s 24-hour world famous gay scene, where clubbing goes on all weekend and beyond, the authors have expressed concern that party-goers often have multiple partners, both male and female sometimes over several days, and are not using condoms. This is in line with a study conducted by the UK Health Protection Agency in 2011 which found a 26 per cent rise in the proportion of men who have sex with men who did not use condoms during the period from 1990-2010. The study also identified that one in four people with HIV are completely unaware of the infection, meaning they cannot receive treatment and may still be spreading the virus.

The authors said that many of London’s drug-using men have sex with men (MSM), and also lesbians, and their heterosexual male and female friends often congregate at post-club parties known as chill-outs where drug-taking continues until drugs, money, energy, or all three run out.  “Slamming”, a relatively new behaviour where crystal meth or mephedrone is injected to get a bigger rush, is becoming increasingly common at these chill-outs.  It is suggested that a slamming community, largely hidden to the rest of the gay scene, exists behind closed doors in London. Slamming involves sharing equipment without sterilising it. Most slammers inject the drugs dissolved in water, but some are withdrawing their blood with a needle, adding either crystal meth or mephedrone to that blood, and then re-injecting it into themselves or someone else. Users can then be high for days, reinjecting and having sex with multiple partners without protection. The result is an increased likelihood of both HIV and hepatitis C infections.

The moral of this story? Well it seems pretty clear. Complacency has set in – people with HIV in developed countries have come to rely on drugs that help suppress the virus that was once a death sentence. Changing behaviour is always difficult and I dare say that sex parties and sharing needles will continue on for a very long time. Some positive strategies are occurring– Barrack Obama recently recommended mandatory HIV tests for everybody between the ages of 15 and 65 years. Yet, with around 24000 people living with HIV with 1031 new cases of HIV among men and women aged 13 years and over, being recorded and in 2010 in Australia alone, there is a need for ongoing action. HIV remains deadly and continual reminders to avoid behaviours such as shared needles and unprotected sex need to be promoted to high-risk groups as well as more mainstream education for all people, despite their age, sexual preferences or gender. With World AIDS Day not far away on 1 December, there is still time to think of opportunities to unite in the fight against HIV, show support for people living with HIV and commemorate people who have died.

Article: New HIV diagnoses in London’s gay men continue to soar. Tony Kirby & Michelle Thornber-Dunwell. The Lancet, Vol 382; Issue 9889; Page 295.

About JournalWatch

The Public Health Advocacy Institute WA (PHAIWA) JournalWatch service reviews 10 key public health journals on a monthly basis, providing a précis of articles that highlight key public health and advocacy related findings, with an emphasis on findings that can be readily translated into policy or practice.

The Journals reviewed include:

Australian & New Zealand Journal of Public Health (ANZJPH)

Journal of Public Health Policy (JPHP)

Health Promotion Journal of Australia (HPJA)

Medical Journal of Australia (MJA)

The Lancet

Journal for Water Sanitation and Hygiene Development

Tobacco Control (TC)

American Journal of Public Health (AMJPH)

Health Promotion International (HPI)

American Journal of Preventive Medicine (AJPM)

These reviews are then emailed to all JournalWatch subscribers and are placed on the PHAIWA website. To subscribe to Journal Watch go to http://www.phaiwa.org.au/index.php/other-projects-mainmenu-146/journalwatch

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PHAIWA is an independent public health voice based within Curtin University, with a range of funding partners. The Institute aims to raise the public profile and understanding of public health, develop local networks and create a statewide umbrella organisation capable of influencing public health policy and political agendas. Visit our website at www.phaiwa.org.au