Background
On 11 November 2022, ASHM, the national peak body representing the blood-borne virus (BBV) and sexual and reproductive health workforce, and the National Association of People with HIV Australia (NAPWHA) convened a high-level roundtable in Melbourne, Victoria, on initiation of antiretroviral therapy (ART) for HIV. The roundtable brought together clinicians, researchers, community, government and industry representatives from across the country to forge consensus on initiation of ART in Australia.
Key statement
Australia has had significant success with treatment for people with HIV, but it still has much to do. The status quo will not work. It will take incredible effort and innovation to reach the last 5% of people in the UNAIDS 95-95-95 targets: 95% of people with HIV knowing their status, 95% of those people on treatment, and 95% of those people virally suppressed.
Along with these treatment targets, Australia’s National HIV Strategy also includes a target for people with HIV reporting good quality of life. Clinicians, community, government, researchers and industry agree that ART improves overall quality of life for people with HIV and should be initiated as close to seroconversion as possible. While gaps in HIV testing contribute to the number of people with HIV who are not on treatment as they do not know their status, there continues to be a core group of people who have received a HIV diagnosis but are not on treatment.
Initiating ART is not always the only, or even the main, priority for people with HIV, who might also contend with employment and housing insecurity, dependent substance use, family and study commitments, family violence and restrictive visa rules. Moreover, even where starting ART is a priority, some may struggle with initiation due to challenges navigating the health system, the ‘daily reminder’ of their status, fears about side effects or unwanted sharing of health information, and stigma.
Nevertheless, the best-practice approach in all cases is to support people with HIV and provide the best, non-stigmatising, person-centred care available. Best practice entails educating, listening to, and empowering people with HIV. To this end, peer navigators are invaluable. Peers can encourage treatment initiation and support retention in care, and work in partnership with healthcare providers.
People with HIV have done the heavy lifting to keep transmission numbers low and demonstrate the benefits of ART for individuals and the broader community, but these benefits are not equitably distributed among people with HIV. Instead of expecting people to fit healthcare models, it is time to provide person-centred care that is tailored to the individual needs of the person with HIV.
