HIV Prevention

Legislative Council
Wednesday 2nd of November 2016




The Hon. T.A. FRANKS ( 16:14 :18 ): I move:

That this council—

1. Notes that–

(a) the South Australian government is a part y 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) e ach 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 H IV by trialling PrEP among high- risk groups in South Australia.

This is a timely motion for this month, leading up to World Aids Day on the 1st of December. I gave notice of this motion on the last sitting week to give members ample time to deliberate, and I indicate from the outset that I intend to take this motion to a vote on 30 November, the day before World Aids Day. This motion notes that the South Australian government is a party to the Council of Australian Governments shared target to end new HIV infections in Australia by the year 2020.

It also notes that, according to the most recent data available via the Kirby Institute, there were 69 new diagnoses of HIV infections in South Australia in 2013. It also notes that each new infection and lifelong treatment brings significant health and personal impacts but, of course, with cold, hard, lifelong costs financially in terms of our health budget of some $200,000 to $300,000 per person. It observes that there is now strong evidence that pre-exposure prophylaxis (PrEP) is a highly effective addition to the HIV prevention tools currently available.

PrEP (pre-exposure prophylaxis) is something we should be looking towards, and this motion calls upon the South Australian government to take the lead of the governments in Victoria, Queensland and New South Wales, and to ensure that we are doing all that we can to meet that target of zero new infections by 2020 by allowing a trial which would enable access of PrEP to high‑risk groups in South Australia without an undue financial burden to those people.

We know that the heyday of hysteria, if you like, and indeed action around HIV AIDS was over 20 years ago. Certainly, when I was in high school, I remember the grim reaper ads, and I am sure many in this chamber, although not all, will vividly remember those particular ads. The truth is that in 2012, Australia recorded its highest infection rate in those 20 years with 1,253 new cases recorded, so despite the great active and proactive measures that Australia took, and I think we were leaders in the world in that eighties period, we still have a problem we need to address, particularly when it comes to this pandemic.

Community health organisations have set a deadline to stop new cases of HIV transmission by 2010, the United Nations declaration has called on zero new transmissions by 2020, and our government, along with the Australian government and other state and territory governments, is a party to that. One major part of the fight against this epidemic is, of course, PrEP (pre-exposure prophylaxis) which is the term used to refer to HIV negative people taking antiretroviral (ARV) drugs to reduce the risk of acquiring HIV. PrEP is the protection offered by a single pill, that when taken daily reduces that risk of infection by 90 per cent.

PrEP is currently created and sold as the drug, Truvada. The efficiency of Truvada has been demonstrated in clinical trials amongst men who have sex with men (MSM), transgender women, heterosexual men and women, and injecting drug users. I note that the UK PROUD study and the French and Canadian IPERGAY study have reported an 86 per cent reduction in risk of HIV infection amongst participants using PrEP to prevent those new HIV infections.

In Australia late last year, my former Greens colleague, former senator Robert Simms, moved a motion in the Senate calling on the government to remove regulatory barriers to HIV prevention tools, including PrEP and rapid HIV tests and home tests, and explore all options to expand trials, and that motion passed the Senate. In May 2016, Truvada was approved by the Therapeutic Goods Administration (TGA) for availability in Australia but the price is still prohibitive without it being listed on the PBS. In August 2016, PrEP was denied PBS listing.

So, we now have a situation where we have approved the drug under the TGA as appropriate but it is financially prohibitive for those who should be seeking its protection to be able to do so. We have a situation where the wealthy or those with access to wealth can afford protection, but others cannot. Indeed, we have a situation where in the states of New South Wales, Victoria and Queensland if you do not have that access to wealth you can take part in a trial that allows you to access PrEP. It is a proactive public health measure that is both sensible and practical.

However, South Australia, yet again, lags behind in the area of these types of public health outcomes. We know that the lifelong cost for treating somebody who has acquired HIV in this state is estimated at $200,000 to $300,000 per person after the infection is diagnosed. Do the maths. Ensuring that we have no new infections, certainly by the year 2020 but earlier if we can, is actually within our grasp and the trial that this motion proposes is a way to get there.

There are, of course, off-brand alternatives to Truvada that are cheaper and are becoming available. Indeed, you can get online and order them but even they are a minimum of $100 a month, and I note that Truvada is roughly $1,000 a month. These are still prohibitive costs for those communities who seek to use these proven methods to reduce HIV infections.

The Greens have been leaders in this debate and our recent federal election campaign saw the release by the Greens of a fully costed plan to make this drug available for high-risk groups across the country. I point out to both this state government and again to the federal government that that is there for either of those governments to take up at any point, should they wish.

There is an enormous human cost, of course, to HIV above and beyond the financial burden on our health system. While it is no longer a death sentence in our country and those people who are HIV positive are able to live long and often healthy lives with effective treatment, an HIV diagnosis is something that can still have a huge and profound impact. It also requires ongoing management and it can have a large impact on a person's relationships. We know that, despite the development in the treatments available, there is still a stigma associated with somebody who is HIV positive.

Governments around the world have been working towards ensuring that we reduce the transmission of HIV and the aim is to end new HIV infections by the year 2020. South Australia can step up and play its part in reaching that global goal. PrEP is a tool that will bring us closer to realising that ambition, along with other sexual health measures.

There seems to be an argument that certainly has been made informally by the minister's office to me in recent days, having seen that this motion would be put on the Notice Paper, that somehow South Australia has too small a population to run a trial. I say that surely that would make the trial smaller and less expensive; surely, by servicing a population and preventing them getting sick, the Department for Health would actually be doing the very job that the Department for Health was set up to do: being the department to make people healthy rather than standing idly by and watching people become unnecessarily sick. It is not the 'department for doing nothing'; it is the Department for Health.

I note that while we do not have an AIDS council in this state anymore, the Victorian AIDS Council has come out in support of this motion. The chief executive of the Victorian AIDS Council, Simon Ruth, has pointed out that South Australia has, like other governments in this nation and nation-states around the world, committed to the global goal and we have a commitment to reach that target. However, Mr Ruth quite rightly says that:

This target is unachievable unless all evidence based prevention options are made available. PrEP is by far the most effective form of prevention for those at high risk of HIV and needs to be made available as quickly as possible.

While PrEP has been approved by the TGA, a submission to subsidise it under the PBS was denied earlier this year.

This is the way forward on this issue. If it is going to be made financially unavailable for those in the community to access it, the health minister must step up and ensure that we provide access to a proven pill that can simply help us reach that global goal, change lives dramatically and ensure that he is the Minister for Health and not the minister for doing nothing. With those few words, I commend the motion.

Debate adjourned on motion of Hon. T.J. Stephens.

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