Human Immunodeficiency Virus: Prevention, Control and Management - Report Example

This report card provides a snapshot of HIV, prevention and policy making to control and management in NSW The number of people who are newly diagnosed with HIV infection in Australia has been increasing constantly over the past decade. For example, the number increased to 1253 cases in 2012, an increase of 10% from the number diagnosed in 2011, and from 724 cases in 1999. However, in NSW, the rate of HIV diagnosis decreased by 24% from 2003 to 2010, and then increased by 29% in 2012 compared to the number diagnosed in 2010. Over a decade NSW has recorded a good track of achievement in prevention of the spread of HIV infections and the HIV infection rate is now stable. Evidence of containment of HIV epidemic and opportunities for improvement It is difficult to estimate the number of people living in the community with new HIV infection due to the fact that the diagnosis is not always conducted during the acute infection time. However, the number of diagnosed HIV infections is used to monitor the transmission trend. The trends indicates pattern that include recent and past infections. The trend of the newly diagnosed HIV infection cases in Australia is shown in figure 1 below. The data shows an increased transmission of HIV over the last decade. Figure 1: Notifications of newly diagnosed HIV in Australia, 1984-2010 The prevalence is high among males with the rate of 175/100,000 population, which is approximately ten times the rate among the females with rate of 18/100,000 population. 70-80% of the people who have been infected with HIV in Australia were affected through sexual contact with other men, heterosexual accounts for 15% and 3% by drug injection. The transmission of HIV among children of less than 15 years of age is less than 1%. The trends in rates of HIV transmission by State, as presented in figure 2, shows an overall increase except in NSW, where there has been a decrease from 6.1 /100,000 population for the period between 2002 and 2006 to 5.3 for 2007 -2011. Figure 2: Age standardized rate/100,000 population of new HIV infection by Territory and year between 2002 and 2011 The rates of new diagnosed HIV, as HIV transmission markers, are relatively high in NSW, Queensland and Victoria; the rates have increased by 40% in Victoria and by 55% in Queensland. The rates in other states have also increased at lower level but with relatively similar amount. Prevalence among homosexuals The main cause of HIV transmission in Australia is sexual contact with people of the same sex as illustrated in the charts below. Between 2008 to 2012, the new HIV diagnosed infection for men who had sex with other men accounts for 67%, heterosexuals accounts for 25%, and 2% were attributed to drug use. 65% were not determined. For newly acquired HIV infection, the homosexual men accounts for 88%, the heterosexual and drug injection accounts for 9% and 1% respectively. The data is summarized in figure 3 below. Figure 3: HIV diagnoses in Australia, 2008 – 2012, by HIV exposure category In NSW alone, the number of people who were newly diagnosed people with HIV infection in 2011 was 330. Most of those who were infected were gay and homosexual men accounting for 84%, while the heterosexual accounts for 13% and those who were injecting drugs accounts for 2.4%. However, the good news is that the death related to AIDS in Australia has drastically decline due to effective HIV treatment. According to the international research, the average lifespan of people living with HIV is almost similar to the average life expectancy of the population. Advances in HIV treatment There was no treatment or anything to prevent the spread of aids when it first appeared in NSW. There has been advancement in development in HIV and AIDS management. The Department of Human Services and Health in US provided guidelines on the treatment of ARV for HIV infectio, to the effect that the individual affected by HIV should be treated. A person CD4 count below 500cells/mm should be treated strongly. The Australia pharmaceutical Scheme (PBS) which has been prescribing drugs for a long time does not allow prescription of ARV drugs to HIV positive infected people having over 500 CD4 cells, unless there are symptoms. However, the government of NSW will ensure that PBS align their prescribing criteria are aligned with clinical evidence, so that the all people living with HIV can also get treatment. Treatment as prevention In recent studies, it has been found that the transmission of HIV cannot only be halted through the combination of ARV treatment, but also the health and life expectancy the people living with HIV are improved. Mathematical model suggest that voluntary testing combined with treatment with ARV is effective in treating HIV transmission. The economical model predicts that as the rate of infection decrease, the cost associated with HIV care and treatment will also decline. The figure 4 below illustrates steps which can be taken to reduce undiagnosed people infected with HIV and supporting those who have been diagnosed access treatment and adhere to it. In 2012, the estimated numbers of people who are infected with HIV in Australia are approximately 33,000 people. Figure 4: The Australia treatment cascade which gives a summary of the estimated number of people living with HIV. Approximately 24,750 of the people are aware of their status, accounting for 75% of the people who have HIV infection. 11,523 people of those who know they are infected receive ARV treatments, accounting for 55% of the people who know they are infected. Also, 10,560 people of those who receive treatments have suppressed viral load. The table below provides a mathematical model which estimates how undiagnosed people with HIV infection, those diagnosed although untreated and the cases that have been treated contribute to HIV cases. Table 1: Categorization of people in Australia living with HIV and their contribution to annual transmissions The people who have not been diagnosed are likely to transmit HIV 1.66 times the diagnosed people. A snapshot of NSW Health actions to reduce HIV transmission The NSW Government is committed to reducing the HIV in the community. Thus, it is implementing comprehensive actions supported by political process aimed at reducing the infections. For example, the UN agreed in June 2011 to a declaration on HIV and AIDS. This declaration aimed at preventing and treating HIV cases for the global community before 2015. The targets include: Reduction of HIV sexual transmission by 50% by 2015. Reduction by 50% of HIV transmission through drug injection by 2015 Eliminate infection between mother and child before 2015 Provision of ARV treatment and care to all HIV infected people by 2015 As such Australia has committed to renew its general HIV plan so as to reflect the he aim of the declaration as well as prevention by use of all appropriate and valid course of action. Current HIV prevention The national jurisdiction for HIV strategy provides the policy framework for prevention of HIV, support, treatment and care. The framework emphasized on: Reducing other risk behaviors such as maintenance of safe sex, injection and community practices. Creating an enabling regulatory, policy and legislation including bipartisan political means. Prioritizing resources targeting those who are in need most. Cooperation between the government, science, medicine and the affected communities. In accordance to the above legislation, the government has implemented different strategies. For example, it has focused on the use of condoms, especially in casual sex relationships. The targeted groups include men who have sex with other men. Those who use injecting drug has decline due to syringe and needle program, as well as through peer education and outreach. The government has integrated response in health care facilities, hospitals, community and public sectors which has resulted in: Decline in New HIV infections especially among gay and homosexual men. Low rates of HIV infections among the people who use drug injection and sex workers. Access to ARVs treatment leading to more people with HIV infection living longer. Challenges that still remain New HIV infections cases each year, with a lifetime cost of approximately $450,000 per person. Rising rates of HIV infections among heterosexual people, especially those with partners in countries with high prevalence. Rising rates of STIs among gay people and those who are homosexually active. Sexually transmitted infections increase the risk of HIV transmission. Increase in the number of people with HIV and thus increasing the need for HIV treatment as well as manage chronic illness. Maintaining low rates of transmission of HIV the affected communities. Strategies The main goal of the strategic approach is to increase treatment and prevention, in order to obtain maximum outcome in the management of HIV. The government is using the following strategies: Increase the number of HIV testing among the people at risk, using simple test and laboratory technology. Establishing sites within the community so as to increase access to HIV testing Reduce the viral load in the community by increasing the number of ARV treatment. Introduce Pre-Exposure Prophylaxes to the people at high risk of infection. Increasing the supply of post-exposure prophylasis. Biological approach In spite of the research on the vaccines, there has been limited biological HIV prevention. Anti-retroviral drug has therefore been used to prevent HIV transmission through: Preventing of mother to the child HIV transmission during delivery. The mother is given ARVs immediately before and after birth and the infant is given post partum. Pre-exposure prophylaxis - ARVs drugs are given to individuals who are exposed to HIV within 72hrs and the treatment last for four weeks. This program is available for occupational as well as non-occupational exposure. HIV treatment and the prevention of transmission The Antiretrovirals inhibits the replication of the virus with the aim of treating undetectable viral load in plasma. The reduction also occurs in other body fluids which are responsible for transmission of HIV, like semen fluid. The national government has increased its response to HIV prevention, by increasing access to voluntary testing and counseling (VCT), care, ARVs treatment as well as provides clear guidelines on mother to child transmission (MTCT). References 1. Harcourt J., (2013). Current Issues in Lesbian Gay Bisexual and Transgender Health, Routledge 2. Aral S. O., Fenton K. A. and Lipshutz J. A., (2013). The new public health and STD/HIV prevention: personal, public, and health systems approaches, New York: Springer 3. Q. Ashton Acton, PhD, (2012). Sexually Transmitted Diseases: Advances in Research and Treatment: 2011 Edition: ScholarlyBrief, ScholarlyEditions, 4. Standing Council on Health SCoH Out of Session Item 199, Report on Progress on the Australian Response to HIV and AIDS as obtained from http://www.ashm.org.au/images/SCoH_Report_on_HIV_and_Recommendations.pdf 5. Sixth National HIV Strategy 2010–2013 obtained from http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-national-strategies-2010-hiv/$File/hiv.pdf on May 12, 2014 Read More