Complacency and living with HIV

HIV and Aids have largely slipped from the headlines since the dramatic days of the 1980s when diagnosis was a death sentence. But that does not mean HIV should be out of sight and out of mind.

It affects many lives in New Zealand and the economic cost continues to grow.

The Aids Epidemiology Group, at the University of Otago, last month reported new HIV cases are at their highest level yet. In 2016, 244 new cases were diagnosed. Of these, 159 were men who had sex with men. Of this group, 98 picked up the infection in New Zealand, and the others overseas.

Aids, acquired immune deficiency syndrome, was first established in medicine in 1981, and first diagnosed in New Zealand in 1983. The following year HIV, human immunodeficiency virus, was found to be the cause and testing began in New Zealand in 1985. While Aids was made notifiable, HIV was not, because it was feared that might discourage testing.

The highest number of Aids diagnoses was in 1989 and 1990, at 71 cases. Deaths peaked in 1992 at 66. By the mid-1990s, Aids cases were falling in rich countries as effective antiretroviral therapy (ART) came to be used. This has been refined and developed and those with HIV under treatment can lead near-normal lives with near-normal life expectancy.

The jump in HIV cases, however, is threatening. The Aids Epidemiology Group estimates about 3500 people in New Zealand are living with HIV. That is based on the number of people receiving therapy and perhaps about 20% more in the community undiagnosed. Given the trend in new infections, numbers appear likely to rise steadily.

The cost of treating people over their life is about $800,000 each, and the annual bill has doubled over the past five years to $32million. Given the rise in new cases, this bill, and the burden on the health system and the taxpayer, will increase.

What is likely to have happened is that as the personal consequences of HIV infection lessen, many men having sex with men could well have relaxed their behaviour and be acting with less caution. The onset of easier internet access to partners might also have had an impact.

The rise prompted Aids group leader Sue McAllister to raise the increase in New Zealand-based infections among men who have sex with men as the biggest concern. She has noted many of the new cases appear to be have been infected relatively recently.

Dr McAllister sensibly argues all prevention tools available need to be used. These include increasing and sustained promotion of condom use as this is the most effective barrier to HIV and other sexually transmitted diseases (STDs), timely testing for HIV after potential HIV exposure and early access to HIV treatment as well as screening and treatment for other STDs. They increase the risk of acquiring or transmitting HIV.

The issue is also raised of other prevention methods, such as the use of antiretroviral drugs by HIV-negative people before or straight after risky behaviour.

Quick and easily available testing is important because the risk of transmission from those with HIV who are on a antiretroviral programme is much lower than for those who are not. In fact, for those with unmeasurable levels of HIV in their blood the risk of sexual transmission just about disappears.

The best news is the impressive downturn in mother-to-child-transmission, none recorded in 2016, and infection through injected drug use, only one case last year.

Much good work has been achieved since the Aids/HIV scourge swept the West from the 1980s. Much still needs to be done to prevent numbers with HIV - and all the consequences that brings - from steadily rising.

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