With the shadow of AIDS still looming large across the Pacific, World AIDS Day in Australia will return the focus upon treatment and testing as the nation gears up for a renewed push in time for the International AIDS Conference to be held in Melbourne in July 2014.
Figures released last month show that Australia has a lot of work to do to reverse the rate of new HIV transmissions, increase HIV testing levels and get many more people on HIV treatment, according to the National Association of People with HIV Australia (NAPWHA).
New HIV infections rose by 10 percent in Australia in 2012, continuing worrying trends of previous years, with most new HIV cases occurring among men who have sex with men.
Perhaps of most concern are the figures suggesting that HIV testing uptake is not increasing fast enough.
World AIDS Day held on Dec. 1 each year seeks to raise awareness about issues surrounding HIV/AIDS.
The global theme for this World AIDS Day is Getting to Zero: Zero new HIV infections. Zero discrimination. Zero AIDS related deaths.
As well as promoting the global theme, World AIDS Day in Australia will be promoting the International AIDS Conference to be held in Melbourne in July 2014.
AIDS 2014 is expected to be the largest medical conference ever held in Australia and gives the Australian government the opportunity to highlight Australia's successes in prevention, support and treatment.
Professor Sharon Lewin is the director of the Department of Infectious Diseases at the Alfred Hospital and Monash University in Victoria.
"We currently know that there are 25,000 people living with HIV in Australia, and on average... well last year there were 1,200 new infections," a number that would surprise many Australians for whom the disease has retreated into the memory.
From its terrifying emergence in fringe communities in the 1980 's, the epidemic is now commonly perceived to be largely under control in rich countries like Australia and to be just one of a long list of intractable health problems that poorer countries face.
However, HIV rates have increased by some 50 percent in Australia over the past decade.
Science has not yet produced an HIV vaccine or a cure, but highly effective drug treatments not only quash side-effects, but dramatically reduce infectiousness, minimizing the likelihood of transmission.
In developing countries where most of the world's 35 million people with HIV live, drug prices have been slashed by 99 percent of initial costs.
University of New South Wales Professor John Kaldor from the Kirby Institute said that Australia has been too lax in its approach to scientific innovation.
"We have been slow to embrace several new technologies that may prove beneficial in HIV prevention. For example, a decade after the rest of the world, Australia has only just begun to adopt point-of-care testing, in which results can be provided on the spot," he said.
Professor Kirby notes that those who know their HIV status are able to act immediately to access early treatment and to prevent transmission.
There are still long gaps between when people contract HIV and they are diagnosed; and many people with HIV who should be on HIV treatment are not. The proportion of Australians with HIV who are taking HIV treatment may be as low as 50 percent.
This disturbing picture is at odds with scientific advances and international HIV treatment guidelines. Many expert HIV clinicians recommend that all people with HIV should be offered HIV treatment, not only for the potential individual health benefits, but also because taking HIV treatment can play a critical role in helping prevent transmission of HIV to others.
"Australia is not responding fast enough to these opportunities and our HIV response has become increasingly less coordinated, particularly at the national level," said Robert Mitchell, NAPWHA president.
"We are at risk of losing our place as a world leader in this new era of HIV prevention and treatment."
One hopeful sign is the recent agreement by all Australian health ministers to set clear targets and timelines for the Australian HIV response. This includes reducing sexual transmission of HIV by 50 percent and uptake of HIV treatment by people with HIV by 90 percent, by 2015.
"This is a very welcome initiative," Mitchell said, "but all health ministers must now move quickly to implement on the ground actions.
"Australia needs a new National HIV Strategy to replace the current one which is completely out of date and also due to expire.
"Strong national leadership in HIV has been pivotal in Australia's HIV response and we need it more than ever today," Mitchell said.
The new Australian government has embarked on a major overhaul of foreign aid, starting with the integration of AusAID into the Department of Foreign Affairs. This presents a perfect opportunity to rethink the current models of how Australia delivers aid in specific domains of health.
Next year Australia will host the World AIDS Conference in Melbourne, with over 20,000 participants, focusing global attention on Australia's leadership in reducing the impact of HIV in the region.
Professor Kirby is hopeful that leadership will be reinvigorated by the time Australia hosts the World AIDS Conference.
"By more effectively projecting our own strengths in health crises such as HIV, we will be better able to help deliver optimal outcomes for our neighbors most in need. As such, Australia could have much more to celebrate on World Aids Day 2014."
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