Legislative Council 
November 30, 2016




Adjourned debate on motion of Hon. T.A. Franks:

That this council—

1. Notes that–

(a) the South Australian government is a party to a Council of Australian Governments shared target to end new HIV infections in Australia by 2020;

(b) in 2013, there were 69 diagnosed HIV infections in South Australia;

(c) each new infection and lifelong treatment brings significant health and personal impacts, with lifelong costs estimated at $200,000 to $300,000 per person;

(d) there is now strong evidence that pre-exposure prophylaxis (PrEP) is a highly effective addition to the HIV prevention tools currently available; and

(e) state governments in Victoria, Queensland and New South Wales are currently running clinical trials involving the provision of PrEP to high-risk groups;

2. Calls on the state government to demonstrate leadership on HIV by trialling PrEP among high-risk groups in South Australia.

(Continued from 2 November 2016.)

The Hon. K.L. VINCENT ( 20:40 :50 ): As long-time supporters of the peer-led South Australian based programs supporting people with HIV/AIDS, Dignity for Disability strongly supports the motion put forward by the Hon. Tammy Franks, seeking to provide PrEP in the hope of that being one small measure to prevent HIV transmissions. Further, we are absolutely thrilled to hear that the government has supported the implementation of a trial.

As I gather from information that was shared in a briefing hosted by the Hon. Tammy Franks, I think I am correct in saying—and the Hon. Ms Franks will correct me if I am not—that the cost of implementing one such trial and providing it to everyone in the community who foreseeably may be in a group that is at risk of HIV is the same as providing lifelong HIV support and treatment once a person has HIV. I think that simple fact speaks for itself. This can save money, it can save people from isolation, shame and stigma of HIV, and most importantly it can save lives. So, for those reasons, Dignity for Disability strongly supports this motion, commends the Hon. Tammy Franks on bringing it forward and commends the government for seeing the common sense on this issue.

The Hon. S.G. WADE ( 20:42 :37 ): I rise on behalf of the Liberal team to indicate that we support this motion, as it calls for the government to act to make pre-exposure prophylaxis, commonly known as PrEP, more accessible in South Australia. PrEP is a medication used by HIV negative individuals to prevent them acquiring HIV. Clinical research has established that the treatment is effective in preventing HIV transmission when taken by HIV negative people. My advice is that PrEP can lead to a reduction in HIV transmission as high as 94 per cent in some target groups.

The main PrEP drug was approved by the Therapeutic Goods Administration for supply within Australia in May 2016, but due to its high cost most high-risk patients do not access the drug. More than 8,000 Australians are already enrolled in trials in other Australian states and territories which both allow equitable access to a more affordable generic form of the drug and seek to demonstrate how the drug can be rolled out to high-risk individuals.

Only three Australian jurisdictions do not have some form of demonstration project, and that includes South Australia. PrEP is a key preventative health initiative. Fifty-eight South Australians received a new HIV diagnosis in 2015, with 44 first diagnosed in Australia and 14 overseas. Each of these cases is estimated to cost the public health system around $500,000 over their lifetime. When conservatively I am advised half of these transmissions could be prevented by PrEP, the treatment will save both scarce public health resources as well as individuals from illness.

Of course, PrEP is one treatment amongst a range of treatments and protections against HIV, including condoms and abstinence. With a strong evidence base, especially at a time when there is a threat of an increase in HIV infection in at-risk groups, we cannot afford to turn our backs on successful treatments. Whilst the honourable member's motion calls on the South Australian government to exercise 'leadership', I find that somewhat quizzical, considering that we are only one of three jurisdictions in Australia that do not have some form of demonstration project. I do nonetheless acknowledge the statement by the Premier this morning, as reported by ABC News:

The Government said it would begin talks with other states who are leading PrEP access trials and said modelling indicated about 500 South Australians may be eligible to be part of the trial.

Whilst I welcome that statement, that is basically the extent of it. I do not know whether other honourable members have been given more information, but it almost raises more questions than it answers. First of all, you would say to yourself, 'Well, considering that we are one of the last three jurisdictions to have a PrEP trial, why would we be starting to begin talks with other states about getting involved in a trial?' I think it shows real tardiness on this issue. Secondly, how many people will be in the trial? It is all well and good to say that 500 South Australians will be eligible for the trial, but how many places does the South Australian government intend to have in the trial?

Thirdly, when will it be rolled out? It is all well and good to say, 'We are going to begin talks,' but we all know from the experience of the Weatherill government and the Rann government before them that Labor commitments can often be well beyond the horizon. People at risk of HIV infection cannot afford to wait. I would also make the point that I am surprised to see this statement is being made by the Premier and not by the Minister for Health. To me, the Weatherill government's reluctance to tackle PrEP as an opportunity has hints of moral judgment.

South Australians make a range of choices which impact on their health. Some of them could be characterised as 'moral choices', but a basic value of a civilised society is that we do not use the health system as a form of moral sanction. We treat a car crash driver even if they were speeding. We treat lung cancer even if the patient is a long-term smoker. We treat a drug overdose even if the person has used an illicit drug. Moral neutrality applies across the treatment spectrum, pre-infection and post-infection. In promoting prevention, we are not promoting irresponsible behaviour; we are putting health first. PrEP, in my view and that of my party, is an important preventative health initiative for people at risk of HIV infection and those they have contact with.

In concluding my brief remarks, I would like to particularly thank Mr Heath Paynter of the Australian Federation of AIDS Organisations, who very kindly took on the task of educating me about PrEP and a range of other HIV and AIDS issues. I particularly want to acknowledge the leadership provided by the Hon. Tammy Franks. I have no doubt that with the leadership of the Hon. Tammy Franks by bringing this issue to the parliament and arranging one of the best briefings I have had in this parliament, I believe she embarrassed the government into action. I think there will be many people who, in the years ahead, will have avoided an illness because of her actions, and for that she is to be applauded. I commend the motion to the house.

The Hon. G.E. GAGO ( 20:49 :12 ): On behalf of the government, I rise to support this motion, and congratulate the government on its announcement earlier today that South Australians at high risk of contracting HIV will be able to take part in the trial of PrEP (or pre-exposure prophylaxis).

PrEP is a medical prevention method where people who are HIV negative take antiviral medication to reduce their risk of HIV. The medication commonly used in PrEP trials is Truvada. International trials show that Truvada reduces HIV infection by up to 92 per cent. Truvada is not listed on the PBS and would cost more than $900 per month for South Australians. This cost would clearly be prohibitive for many of those people who might be at risk of HIV and would certainly be a barrier to accessing this preventative medication.

Without doubt, PrEP is a game-changer and expanding access will be integral in reaching the goal of no new HIV infections. South Australia's participation in this trial is a proactive measure which has both emotional and financial benefits for those in high-risk groups. It also provides benefits to our state by helping reduce the rate of infection and, of course, the huge costs associated with treating those with a HIV infection. The government is committed to providing the very best possible health care for all South Australians, and our participation in the trial is yet another example of this, with other states, including Victoria, New South Wales and Queensland, also taking part in this trial.

We now urge the Turnbull government to ensure that all Australians who may benefit from this drug are able to access it by adding it to the PBS scheme. HIV is one of the greatest public health challenges of our time, and PrEP is an effective form of prevention which will help us maintain our commitment to eliminating new infection by 2020. There is obviously a long way to go to remove HIV transmission in Australia, but I think today's announcement by the government is another important step in the right direction. It is with great pleasure that, as I said, the government rises to support this important motion and congratulates the Hon. Tammy Franks for providing leadership on this particular policy matter.

The Hon. T.A. FRANKS ( 20:51 :58 ): I would like to thank those members who have made a contribution this evening: the Hon. Stephen Wade, the Hon. Gail Gago and the Hon. Kelly Vincent. I know there have been many, both in this chamber and in the other place, who have stepped up to ensure that tomorrow, when we celebrate or indeed commemorate World AIDS Day, we will actually have something to celebrate more than usual this year.

When I moved this motion, I certainly did not know as much about PrEP as I currently do. I now know, thanks to my own briefing, which was very informative, that the estimated lifelong cost, should we have a person who contracts HIV, is not just $200,000 to $300,000 for that person for the duration, it is actually around half a million dollars. That is one area where I will correct my own motion and say that the lifelong health cost burden is greater than I originally realised. Additionally, the costs of running the PrEP trial are far cheaper, and that was revealed through the briefing and the work of some wonderful organisations.

I would like to particularly thank SHine SA and the CEO there, Jill Davidson. Heath Paynter has already been thanked by other speakers, but I particularly mention Heath Paynter, who is from the Australian Federation of AIDS Organisations, and his role in assisting all those who participated as expert speakers, both from this state and who either came in by Skype from interstate or travelled from interstate to provide their medical and advocacy expertise on this. It was a really valuable discussion and we discovered that there were options for South Australia to take part in trials, or what are more correctly called demonstration projects, of a proven health prevention measure which, in some places, has had a 92 per cent success rate in stopping new transmissions of HIV.

We discovered through those trials that we could be looking at less than $100 per person, or even cheaper, for a year of treatment for something where, should one person contract it who need not, we could be looking at half a million dollars of costs in the health budget. On that, it is a policy no-brainer. We are not only saving money; we are, of course, improving lives.

HIV is no longer a death sentence; however, it is a sentence of isolation, as the Hon. Kelly Vincent said. It is a life of exclusion, it is a life of stigma and it is a life where people find it hard to hold or gain employment and are socially isolated. It is a life that we should not be consigning any South Australians to if we can help it, and by having this PrEP trial, we will be taking every measure that we can to ensure that we are not.

Unfortunately, in Australia and South Australia, despite our early leadership on HIV/AIDS, when we were the world leaders in this area, since the year 2000, HIV transmission rates have been going up each year, rather than going down. I hope that with the rollout of this particular demonstration project we will start to see those figures of around 60 or so new transmissions each year in South Australia go down rapidly.

We have an international global goal that this state and this nation has signed up to of zero new transmissions of HIV by the year 2020. With PrEP, that goal is achievable. There is a role for the PBS, and we hope to see this drug, Truvada, or the generic versions of Truvada available at a much cheaper rate to a much broader part of the population. The 500 South Australians who were identified in the briefing that I held are those most at risk those who we can most help with this really effective measure. I am glad to see that all parties have supported it so far in this debate, and I welcome the government's words today and Premier Weatherill's announcement that South Australia will take part, either with another state on our own.

It appears that discussions with other states seems to be the preferred method. I note that in the briefing it emerged that Victoria, long ago, proposed that we take part in their trial but we have not yet responded to that offer. Perhaps if we got on the phone to them, we could be setting up the demonstration project quick smart because they are ready to take us on, but I believe New South Wales may well be also. That might be a cheaper option.

I look forward to a World AIDS Day tomorrow when we celebrate an achievement. I note, however, that this will be the first World AIDS Day in a long time in South Australia where we do not have a positive living centre, where we have seen that organisation defunded, where we are one of the states that still does not have rapid testing, where we are a state that lags behind in these areas. There is so much we could do to make the lives of people living with HIV/AIDS better, and I certainly will be committing to doing more in the future.

Motion carried. 

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