The 19th International AIDS Conference held in Washington DC last month came at what experts have called a “defining moment in the history of AIDS’”.
Shaun Robinson, executive director of the New Zealand AIDS Foundation (NZAF) reflects on a key theme of the conference and what it means for the New Zealand HIV epidemic.
‘Treatment as prevention’ was the hot topic throughout the six day event. The rationale behind this strategy is that drugs like Truvada will lower HIV viral load to undetectable levels, therefore vastly reducing the risk of sexual HIV transmission. The NZAF is concerned that this is simplistic and could be providing a hall pass for people to practice unsafe sex. The consequences could be catastrophic.
“That HIV treatment could be considered a replacement for condoms is extremely dangerous,” says Robinson. “There is no magic pill to prevent HIV, regardless of how the media have been positioning it.”
One inescapable limitation of treatment as prevention is that an individual must know they have HIV to be treated. Robinson adds, “HIV is not primarily being passed on by people who know they’ve got it – it’s mainly being passed on by people who don’t know. Research says around 50% of transmission occurs within the window period before HIV can be detected in a test.”
A study conducted at the 2011 Get it On! Big Gay Out confirmed that one in five gay men in Auckland who have HIV don’t know it.
“Using treatment as prevention won’t work to stop HIV in the community in this environment,” says Robinson. “Treatment is essential for people with HIV and we welcome the fact that it has some impact on reducing infectiousness. However, if gay men get the message that positive guys are not infectious so they don’t need to wear condoms, we will see a sharp increase in HIV.”
Dr Mark Thomas, senior infectious diseases physician at the Auckland District Health Board agrees, saying, “Reduced viral load as a result of treatment can dramatically reduce HIV transmission, but if gay and bisexual men think this means they can stop using condoms we are in big trouble. 100% condom use should be the goal for all episodes of anal intercourse.”
In New Zealand, it has been condom promotion rather than treatment that has kept HIV rates down. The low point in HIV was in 1997, before Antiretroviral Therapy (ART) was in place, which the NZAF say can only be attributed to high condom use.
“Some countries, including America, have largely given up on condoms, so they are clutching at the straw of drugs as a solution,” says Robinson. “They forget that all the research says that without strong condom use, treatment as prevention won’t work.”
Robinson adds that New Zealand should be proud of our condom culture and our low level of HIV among gay and bisexual men compared to the rest of the world (6.5%, compared to 14% in Australia and over 20% in America). The NZAF’s Get it On! programme, aimed at increasing condom use, distributed 500,000 condoms last year and nearly 90% of gay men at the 2012 Get it On! Big Gay Out said they support condoms.
“Most important of all,” concludes Robinson, “We should all be delighted that HIV diagnosis for gay and bisexual men dropped by over 33% in 2011. More condoms on more cocks equalled less HIV. It’s still that simple.”