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The year that was

With health organisations the world over recognising the validity of U=U and PrEP demonstrably reducing new transmissions in major cities, 2017 has been a pivotal year in the fight against HIV.

You could argue that not since 1996 — and the advent of new life-saving treatments — has such progress been made in the fight against HIV. U=U (undetectable equals untransmittable) is now regarded as an undeniable fact with more than 500 organisations in 67 countries endorsing the science behind treatment as prevention. Meanwhile, in cities such as London, New York, San Francisco and Sydney, PrEP (pre-exposure prophylaxis) has been seen to dramatically reduce new HIV transmissions.

A person with HIV on treatment with an undetectable viral load cannot transmit the virus through sex. That message has been strongly promoted by HIV advocates and researchers for some time. As far back as the Swiss Statement in 2008, there has been evidence that positive people with undetectable viral loads were less likely to transmit the virus. Then, in 2014, the PARTNER study reported near-zero risk of transmission between sexual partners of mixed HIV status. Health organisations, meanwhile, displayed cautiousness. After all, the findings appeared too good to be true.

But then, in March this year, an Australian-led study — Opposites Attract — unequivocally confirmed the science behind U=U. As a result, agencies such as the World Health Organisation (WHO) and the US Centres for Disease Control (CDC) finally came on board to spread the word. “When [antiretroviral treatment] results in viral suppression, it prevents sexual HIV transmission,” read a statement from the CDC. For its part, WHO declared, “It is certain that [treatment as prevention] needs to be considered as a key element of combination HIV prevention and as a major part of the solution to ending the HIV epidemic.” 

For millions of people living with HIV worldwide, U=U is nothing short of liberating. “An undetectable viral load is an equaliser that helps us unpack the fear left over from the early years of the pandemic,” said HIV activist Charlie Tredway. It’s early days, but the hope now is, with the fear removed, the stigma surrounding HIV will dissipate. And with the stigma gone, more people will feel comfortable around getting tested and commencing treatment so they themselves can become undetectable.

As was clear from the latest surveillance reports, 2017 was also the year when PrEP (pre-exposure prophylaxis) began to reveal its impact in real-life settings. HIV diagnoses in New York, for instance, have reached historic lows — an outcome largely credited to the rollout of PrEP. “I'm pretty euphoric about the news, to be honest,” said New York health official Dr Demetre Daskalakis. Likewise, officials in San Francisco have credited PrEP for new diagnoses dropping to record numbers: “To put it simply, it works!” said one.

Meanwhile, in London, Europe's biggest sexual health clinic, 56 Dean Street, reported an 80 percent fall in new diagnoses of HIV — a drop attributed to its PrEP trial. In response, Ian Green, chief executive of Terrence Higgins Trust, said: “These figures show we’ve started something — we’re beginning to see the reversal of the HIV epidemic in some communities in the UK.”

Closer to home, Sydney has also reported impressive results. Recent data from NSW Health showed 101 positive diagnoses among men who have sex with men within the first six months of 2017 — the lowest number since HIV emerged in the 1980s. A major factor was the rapid uptake of PrEP. "We have seen decreases in other international jurisdictions but not at the scale and not at the speed that we've seen here," said Nicolas Parkhill, chief executive of AIDS Council of NSW (ACON). 

While 2017 has undeniably been a significant year of progress, experts warn of complacency. “If you don’t keep up the momentum … you lose everything,” said of one of the world’s leading immunologists, Dr Anthony Fauci. “We have a long way to go, and putting all our tools into action is going to be complicated. Yes, 2017 should be celebrated, but it’s really what happens next that will count.” 

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