This is the third story in OUTinPerth’s The Last Mile project which is exploring strategies on how Australia can reach it’s 2030 goals for HIV.

Can you tell us a little about your journey, leading up to your current role as Chair of POWA?

My [HIV] diagnosis was something that really made me stop and think about my life and make changes. For me, it was part of not living ‘the lie’. At the time I was closeted, both as gay and with my status.

It was a turning point in my life where I started to be honest with myself as to who I was – that was back in 2008/2009. I’ve now lived in Perth for the last 13 years! Yes, I’m a Kiwi-Aussie, I take the best of both sides of the Tasman.

Since you’ve come to Perth, you’ve been very involved as a voice for people who are HIV Positive – tell us about the organisations you’ve been working with.

Originally, I started as the community representative here in WA for NAPWHA (National Association of People with HIV), the national peak body, before we had a positive organisation here in Perth.

It was about eight years ago that we incorporated POWA, which is a peer-based organisation for HIV Positive people living in Western Australia.

The main focuses of the organisation are around facilitating opportunities for social engagement within the community, because we know that HIV Positive people do suffer with higher mental health issues and isolation.

Social isolation can be a huge factor in someone’s mental health, and we also know combatting social isolation helps with someone’s quality of life. That’s a really big thing for people living with HIV. Now that we understand ‘undetectable’ and we have people on treatment, it’s about ensuring that quality of life is that of any standard citizen.

How would you describe the recent changes we’ve seen in HIV prevention and treatment?

We’ve seen huge changes, even if you just go from the last five years. We didn’t even have PrEP available for anyone who was HIV Negative and wanted to take management of risk into their own hands. PrEP was a huge game changer for both HIV Positive and Negative people, because it meant that HIV Negative people had their own control of a safer sex strategy.

Then we’ve seen injectables come in the last 24 months. This has been a huge game changer for those of us that live on medication every day, whether that’s just the simple fact of not having to take a pill every day.

For people like me, I used to struggle a lot with reflux from the medication, and now I’ve found going on to the injectable I have noticed those co-morbidities are reduced somewhat. Injectables are about to be huge going forward. Potentially we’ll even see injectable PrEP come through – we’re already seeing it worldwide, but we haven’t got it here in Australia. I think that’s mainly a cost issue.

Looking at the big picture – we have set the goal here in Australia for virtual elimination of new transmission of HIV by 2030. New figures show we may not be able to make that goal.

In your opinion, how important is that goal in the overall landscape?

I think it’s a great target to have. I think we also need to be really careful that we don’t get taken up with the idea of ‘virtual elimination’ and think that’s the end of HIV.

We have to remember that even with virtual elimination, we’re still going to have people diagnosed with HIV. We will still have HIV Positive people who have to live the rest of their lives, taking treatment and living with the daily stigma of HIV.

I think it’s really important for a public health response, looking at that data coming through, that we recognise we probably won’t achieve it.

I think in WA we have a real opportunity to maybe reach it as a state, but that is going to take input from all of the organisations, as well as the Department of Health, to achieve that.

We often see news stories about a “major breakthrough” towards a cure for HIV. We understand these can be frustrating, because those stories usually reveal that would still decades away from practical.

As a person living with HIV, is a cure something you think about? How do you feel about that kind of reporting?

It’s not something I think about. Especially now that I’m on the injectable treatment, I go to my doctor once every two months,

The injectable that I’m on is about to launch a trial to see if it can be used every four months. Three times a year. Otherwise, I live a very “normal” life.

I think for a lot of people with HIV, they just go on their medication and they carry on with their lives. That’s not to diminish those that really struggle to get an undetectable viral load as they don’t have all the same treatment options.

I’m sure there are HIV Positive people who long for the day there will be a cure. I think the media, especially mainstream media, are very good at blowing out of proportion any little development towards a cure.

Working towards virtual elimination – how to we make sure we reach a diverse range of people and don’t leave anyone behind?

This is something that leaders in the community are asking questions about often. It’s important we don’t leave anyone behind.

I think we have some really good programs around rapid testing. NAPWHA has a free HIV testing program, so you can go to a website and punch in your details and they will post out a free HIV rapid test – you can do it in the privacy of your own home.

We’re also seeing uptake from regional and remote areas because people are able to test privately, without going to the family or community doctor.

If you had a wishlist of what activities you’d like to see happening more frequently – what’s on it?

Testing, testing , testing! That’s really important if we want to reach our virtual elimination goals.

Then it’s around peer navigation, so that when people have a diagnosis, they’re instantly put in touch with a peer that helps them navigate the health system, helps them to navigate social issues, because we do know that getting people onto treatment and into good housing and counselling helps improve quality of life.

The phrase ‘The Last Mile’ grew out of the telecommunications industry where they discovered connecting individual properties to networks was the most challenging task.

In the journey of HIV, Australia is looking down The Last Mile. Which why we adopted the phrase for this new series of reports that explores how the goals of 2030 can be achieved.

This is a Solutions Based Journalism project. The goal is to interrogate the challenge, explore the data, hear the stories and experiences and present the ideas and practices that will hopefully lead us to all achieving the 2030 goals.

Contact
Graeme Watson
Co-editor
graeme@outinperth.com

The post The Last Mile: Positive Organisation WA (POWA) Ryan Oliver interview appeared first on OUTinPerth.

This is the second story in OUTinPerth’s The Last Mile project which is exploring strategies on how Australia can reach it’s 2030 goals for HIV.

Opt-out testing in hospitals, self testing vending machines, and more discussions prompted by GPs are some of the ideas to make an impact.

Asked how he’d describe the concept of virtual elimination of HIV to someone who had not previously come across the concept, Dr Vujcich offers the following explanation.

“The way they’ve calculated the target for virtual elimination, it’s a 90% reduction in new cases diagnosed in Australia compared to what the baseline level was at 2010 when those targets were set.

“So in 2010 nationally, we had 895 new cases of HIV diagnosed in Australia. So a 90% reduction of that by 2030 would mean no more than 90 cases nationally by 2030.”

Dr Vujcich describes the target as ambitious, and at this stage it looks unlikely that Australia will reach the goal.

“I would say it is ambitious, and we’re unlikely to reach it unless there is a fundamental systemic change.” he said.

“If we are aiming for no more than 90 cases nationally by 2030, we are a long way from that, in that last year we had over 700 cases nationally.

“If we’re looking at sort of 90% of the rates of the numbers of HIV notifications in WA from 2010, well, in 2010 we had about 101 cases I think, so the target for 2030 would be no more than 10 cases.

“Last year in WA we had over 70 cases of HIV. And so it seems unlikely that, with all things being equal, we’re going to see a radical shift in those numbers in order to reach the 2030 goals.”

Who do we need to focus on?

When the WAAC CEO spoke about the issue at World AIDS Day in 2024 he noted that there were six groups of people who would most likely still be facing challenges relating to HIV as we head towards to goal of virtual elimination. And while in the past education campaigns targeted larger cohorts, as we move forward, the messaging and approaches most likely need to be specifically tailored to each group.

“I think they are going to be different approaches and that’s kind of why this, for want of a better word, ‘tail end’ of the epidemic is kind of the most stubborn.” Dr Vujcich said.

“It would be simplistic to say that it has been easy to get where we are in relation to gay and bisexual men, because actually a lot of work went into that over many decades in order to achieve that. But we are at the stage now where gay and bisexual men are really knowledgeable about HIV.”

Dr Vujcich highighted the great uptake of preventative treatments like PrEP, which has changed the landscape of HIV prevention, as a major change in recent years, and he notes that gay and bisexual men have connected communities and a high level of health literacy.

“What we’re seeing in terms of the communities that are being left behind is that they’re really diverse.” Dr Vujcich noted.

He cites people who are born overseas as one target group, highlighting that although people may come from countries with a higher prevalence of HIV they may not think of Australia as place where HIV is something they need to continue to think about.

“We’re seeing overseas born people, people who might be coming to Australia and have this perception that HIV isn’t an issue over here, because they see Australian as ‘a safe kind of country’ with low prevalence of HIV, and therefore they might have a really low perception and might not necessarily engage in the same protective behaviors that they might have engaged with in their country of origin.” Dr Vujcich said.

Women are another group of people the WAAC CEO expresses concern about, as well as the number of people who are classed as late diagnosis, people who have been unaware they’ve been living with the disease for considerable time.

The Indigenous communities and street present people are another two groups Dr Vujcich notes will be harder to reach.

“It’s when people have competing priorities, and they don’t have access to housing, and they don’t have access to basic food. Well, then actually trying to get a message about HIV prevention to them might be really low down on their list of priorities.

“That requires a more structural, broader advocacy kind of interventions. The approach for all of those groups is different, which is why this last part of the journey to virtual elimination is the hardest.” he shares.

Dr Vujcich says the campaigns and approaches of the past have been successful in reaching many people who are classed as men who have sex with men (MSM), but a more nuanced approach is needed moving forward.

“We can’t rely on the same old ways of delivering healthcare access to people and just assume that that is going to keep working because it’s worked for the majority. We need to be sort of meeting people where they’re at, and recognizing the many kind of structural barriers and determinants that actually stop people from walking in the door of a health service.” he said.

Advances in medicine are making an impact, but new ways of working are needed too

Advances in medicine are making big impacts and Dr Vujcich says new approaches will be rolled out where they will have the most effect. While PrEP treatment requires people to adhere to a daily medication regime, an injectable approach may soon be rolled out people at most risk who struggle to adhere to that requirement.

Perth has also become a global leader for injectable treatments for those living with HIV, coming only second to San Francisco in uptake of the treatment. The positive effect of this is people who have contracted the virus have an undetectable viral load, meaning they are unable to transmit the virus to other people.

A big change Dr Vujcich would like to see is HIV testing being offered more regularly at primary health settings. If all GPs had routine discussions with their patients it could make a major impact, especially given that many cases in WA are revealed to people who have had the virus for considerable time before being diagnosed.

Installing vending machines that allow for self testing in university campuses is also about to be rolled out.

“The idea is it’s a point of care finger prick test where people don’t have to go to the doctor. They can access it discreetly and without any sense of stigma, and make sure that they they know their status, and there is no cost associated with that. We look forward to seeing that rolled out during the course of this year.” Dr Vujcich said.

Opt-out testing in emergency rooms as worked in the UK

In the United Kingdom they made great advances by implementing a systematic change.

“They’ve achieved really great outcomes as a result of making HIV testing an opt out test whenever someone goes to an emergency room and gets tested for anything. It’s been phenomenal in terms of capturing people who would not have been tested and have not been tested for many years, and are presenting with late and advanced stage diagnoses.

Dr Vujcich cites the UK experiment as the kind of bold move he’d like to see trialed in Australia, and he hopes a national conversation about the proposal will be embraced.

“There’s a question about making sure that the hospitals that you choose have sufficient HIV prevalence for it to be a cost effective option. There are definitely hospitals in Australia where that is the case.” he notes.

He also suggests looking to the success stories in countries like Belgium who have developed an effective program for reaching new immigrants, and also suggests looking to the developing countries who are making inroads even though they have limited resources.

“We always need to recognise the incredible work that’s being done in developing countries, including in Sub-Saharan Africa, where prevalence is huge. We shouldn’t be seeing that as a sign of failure.

“We need to be looking at what those countries are doing really well, in really resource limited circumstances, in order to reach people who have a range of structural barriers that prevent them from accessing healthcare, and look at how we can adopt those models to reach the communities that are being left behind in Australia.” Dr Vucich said.

No room for complacency

One of the greatest danger to reaching the 2030 goals however is complacency. The health expert warns of the dangers of an attitude of ‘near enough is good enough’ which may arise as the levels of new cases of HIV begin to drop. Dr Vujich says sustained effort is essential.

“As soon as you take your foot off the accelerator, you’re going to start seeing a rebound in rates, and we’re going to go back to where we were. That is the risk.” he said.

He also expresses concern about recent cuts to HIV prevention efforts on as global level. This year US President Donald Trump pulled funding from many international programs, and Dr Vujcich warns that while the effects will hit developing nations first, the results will flow through to countries like Australia.

Finally he shares his concern over the 90 people annually who will still be diagnosed with HIV even if Australia does reach it’s 2030 goals.

“If we do reach 90 cases nationally, looking at who those 90 cases are, and recognising that we can’t create a two tier caste system in terms of people that we are okay with getting HIV and people who we don’t want to get HIV.

“We want to send the message that actually any case of HIV in Australia represents a failure in the public health system, not an individual failure, but a failure in the systemic response.”

The Last Mile

The phrase ‘The Last Mile’ grew out of the telecommunications industry where they discovered connecting individual properties to networks was the most challenging task.

In the journey of HIV, Australia is looking down The Last Mile. Which why we adopted the phrase for this new series of reports that explores how the goals of 2030 can be achieved.

This is a Solutions Based Journalism project. The goal is to interrogate the challenge, explore the data, hear the stories and experiences and present the ideas and practices that will hopefully lead us to all achieving the 2030 goals.

Contact
Graeme Watson
Co-editor
graeme@outinperth.com

The post The Last Mile: Dr Daniel Vujcich interview appeared first on OUTinPerth.

A meandering crowd of socialites and arty types work their way through the different rooms of the gallery where photographs, videos and installations created by Will and Garrett Huxley hang. Later in the evening the duo will take to the stage in their elaborate costumes to perform a slow version of Sylvester’s disco hit You Make Me Feel (Mighty Real).

The names and faces on the giant hanging quilt include Larry Levan, Herb Ritts, Kenny Everett, Sharon Redd, Timothy Conigrave, Willi Ninja, Patrick Cowley and Leigh Bowery.

“What connects all these people together?” a woman standing nearby loudly asks her friend. “I can’t figure out the link.”

An acquaintance is nearby; he rolls his eyes.

I don’t know every name on the quilt, I promise myself I’ll learn more about the life of Cookie Meuller, Peter Tully, Brad Davis, Antonio Lopez and David Wojnarowicz – just some of the names and faces that are unfamiliar.

But there’s more than enough names to quickly realise they’re all people lost to AIDS. Among them many personal heroes, Derek Jarman, Alvin Ailey, Fela Kuti, Ofra Haza, and that disco legend – Sylvester.

This memorial highlighted fabulous famous people died after contracting HIV, most at a time before treatments and medications improved. But the virus has taken many more. Each year at the AIDS Candlelight Memorial we remember all of those who are lost.

As you walk through the WA AIDS Memorial in Robertson Park it’s the names of the equally fabulous, but maybe not as famous that are remembered, Dale, Peter, John, Neville, Chad, Ray, Terrilee, Andy, Scott and Graham are among the names engraved.

Knowing where you’ve been is essential to understand where you are going

Recently in our LGBTIQA+ communities we’ve had some opportunities to look back on the journey we’ve been on for more than forty years. Some of us were here when the journey began. For others we’ve always been on this journey. Thankfully, for many, the darkest part of the journey is something that is in the past, before they were even born.

This year marks the 40th anniversary of WAAC, formerly the WA AIDS Council. It’s provided a timely pause to recall the journey so far, celebrate achievements, and take stock of the work that lies ahead.

During the recent Boorloo Heritage Festival a timeline of the organisation’s history was created by young archivists working with the WestPride Archives.

As the archivists in their twenties were searching through WAAC’s decades of posters and flyers for different promotional campaigns, they were discovering much of the material was from the 1980s and 1990s – most of them were born after this millennium.

Their exhibition laid out the many steps we’ve trodden as a community, the roadblocks, the wrong paths, the detours and distractions. The achievements have been many.

Another event at the festival saw now retired Dr Martyn French recall the scientific steps and medical responses to tackling HIV, with the Royal Perth Hospital taking on a world-leading role.

Dr French talked about how the creation of multi-disciplinary teams had been a key factor in developing an effective response for those who found they were HIV positive at a time when medications had lots of side effects and could only delay a patient’s death for a matter of months or years.

Heartbreakingly, Dr French shared a story of a patient whose death came maybe not from the virus, but the stigma that surrounds it. So afraid was she of people finding out she was living with HIV, she refused to take any medication out of fear it would lead to a discovery of her status. She died, but Dr French notes that her story allowed medical professionals to understand just how powerful the stigma around the disease could be.

Virtual elimination of HIV in Australia is in sight

In 2024 the Australian government launched the Ninth National HIV Strategy with Health Minister Mark Butler restating Australia’s commitment to eliminate blood borne viruses and sexually transmitted infections by 2030.

Under the previous strategy the rates of HIV transmission in Australia had dropped significantly. The introduction of better medications and treatment regimens means people living with HIV now face a chronic, but manageable, disease.

More importantly, the introduction of PrEP treatment, the process of taking a daily pill that stops those at risk from contracting the virus has had a huge impact on cases in Australia.

Butler and the government’s HIV Taskforce set the 2030 target that the Minister described as “ambitious but achievable”.

“Our goal is virtual elimination of HIV transmission in Australia.” he declared.

A three-pronged vision was laid out. HIV transmission is virtually eliminated in Australia. Everyone has access to safe, affordable and effective HIV prevention, treatment and care, and all people living with HIV live well, free from stigma and discrimination.

If virtual elimination is achieved, it will mean that for the first time in over four decades HIV will no longer be considered a public health challenge. It will require that there are 90% fewer diagnoses of HIV than 2010.

Australia is well on the way to reaching the goal. Between 2014 and 2023 Australia nearly halved the number of new cases. In 2023 there 722 notifications of HIV, with cases among gay, bisexual and other men who have sex with men still making up a significant part of the population.

While treatments have improved, there is no cure for HIV. Scientists around the world continue to strive for that elusive goal. There will always be some new cases of HIV, but virtual elimination means no more that 90 cases per year.

Who do we need to reach, and who must we not forget?

When Western Australia marked World AIDS Day last year, Dr Daniel Vujcich from WAAC spoke about the goal of virtual elimination, and asked people to think about the 90 people in 2030 who still might be receiving a positive diagnosis.

“They will not be statistics. They will be people.” he said.

He identified six groups of people who are likely to be within that cohort of 90. Those which may be hardest to reach and support in the push to achieve the 2030 goals.

People born overseas, unfamiliar with the health system, who may encounter a health system that does not speak to their fears or meet their needs was one group. Men who have sex with men, but do not identify as being gay or bisexual were also on the list.

Women would still be getting HIV, because the rollout of PrEP treatment has been focused on those most at risk, gay and bisexual men, and the other men who have sex with men.

First Nations people, and those experiencing homelessness and poverty would still be overly represented, and most alarmingly – people who’ve just never gone and got themselves tested. For those people they are potentially losing the opportunity to take advantage of the life-saving treatments, late diagnosis means people are more likely to have advanced complications that are much harder to treat.

The Last Mile

Running a marathon, connecting phone cables, or online shopping, all face the same challenge. In supply chain management it’s recognised that the last part is the hardest.

To finish a marathon, you need to run all 26.2 miles, and afterwards you’ll still need to walk home.

Online suppliers know that even if they can get your attention, persuade you to select some goods, guide you through the checkout process, and have the good in stock in a warehouse, they still have to get it delivered to you – and that last bit is the hardest part of the process.

The phrase ‘The Last Mile’ grew out of the telecommunications industry where they discovered connecting individual properties to networks was the most challenging task.

In the journey of HIV, Australia is looking down The Last Mile. Which why we adopted the phrase for this new series of reports that will explore how the goals of 2030 can be achieved.

This will be a Solutions Based Journalism project. The goal is to interrogate the challenge, explore the data, hear the stories and experiences and present the ideas and practices that will hopefully lead us to all achieving the 2030 goals.

Contact
Graeme Watson
Co-editor
graeme@outinperth.com

The post The Last Mile: Where do we need to go in the journey of HIV? appeared first on OUTinPerth.