澳洲持續看到愛滋病毒新感人數穩定下降
資料來源：Dennis Normile/2019年7月2日/財團法人台灣紅絲帶基金會編譯
積極推廣使用保險套有助於遏制澳大利亞的愛滋病毒感染。雪梨的這個巨型保險套是2014年宣傳活動的一部分
澳洲繼續處於扭轉愛滋病毒感染增長的最前沿，今天發布的一項研究表明，2018年新診斷的數量較前年相比下降了13％，達到835例。根據雪梨新南威爾斯大學Kirby感染和免疫研究所的數據，這一下降速度比上一年增加了一倍多。Kirby研究所的流行病學家Rebecca Guy說，新感染率達到了18年來的最低水準，而且全國各地的感染率都在下降。
新感染的下降主要集中在男男性接觸者（MSM）中，特別是在澳大利亞出生的男性。但這一好消息受到異性間感染的輕微下降的影響，從238降到189，以及特別是那些偏遠地區原住民的新感個案持續頑固地維持水平。「澳大利亞正在努力消除愛滋病毒的傳播」，Guy說，儘管她和其他人強調仍有許多工作要做。
由於積極推廣使用保險套、廣泛可用的測試以及成功地使感染者迅速開始使用抗反轉錄病毒藥物，降低了病毒載量，使得感染者不太可能將HIV傳染給伴侶，因此男男性接觸者新感的下降趨勢已經凝集了數年。。
而這一系列的工具庫更得到了極大的推動，在2018年4月聯邦政府增加了暴露前預防（PrEP），這是一種保護愛滋病毒陰性者免受感染的每日藥丸，在藥物福利方案中補貼藥物費用。根據政府資助的healthdirect網站，這將PrEP的花費從每年10,000澳元降至每年480澳元；而有資格獲得更多補貼的人支付的費用更少。
由補貼計畫穫得PrEP好處的人數，從2018年4月的1,980人年飆升至12月的18,530人。Kirby研究所的醫學流行病學家Andrew Grulich說。Kirby研究所認為，2017年有41％的具高風險之澳大利亞男性在PrEP計畫中。 Grulich說，如果我們想要繼續消除愛滋病毒，覆蓋率必須高達75％。在非澳大利亞出生的男男性接觸者中，PrEP的接受率較低。「來自不同文化和語言背景的同性戀和雙性戀男性確實需要成為進一步推廣PrEP的目標」，他說。
要降低受苦於感染率高的原住民群體中的注射藥癮者之感染率則特別具有挑戰性。診斷通常在感染的後期才進行。這種「非常不同的樣貌」的愛滋病毒感染需要「有針對性的介入措施，以確保原住民和托雷斯海峽島民不會落後掉隊」，在Adelaide的南澳大利亞健康與醫學研究所的傳染病專家James Ward表示。
儘管如此，「我們在澳大利亞全國範圍內所看到的降低卻在世界其他地區很少出現」，Grulich說。他說，所有這些綜合的預防措施的組合– 保險套推廣、治療即預防(treatment as prevention)和暴露前預防(PrEP)-「共同起作用以減少愛滋病毒感染」。他確信，這一關鍵性進展的主要部分是澳大利亞的全民健康照護系統，該系統提供「免費或容易負擔得起的檢測、治療和暴露前預防PrEP」。
Australia continues to see steady drop in new HIV infections
By Dennis Normile Jul. 2, 2019
Aggressive promotion of condom use has helped curb HIV infections in Australia. This giant condom in Sydney was part of a 2014 awareness campaign.
Australia continues to be at the forefront of reversing the increase in HIV infections, with a study released today showing that the number of new diagnoses in 2018 dropped 13% year-on-year, to 835 cases. The pace of the decline more than doubled from the previous year, according to the Kirby Institute for Infection and Immunity in Society at the University of New South Wales in Sydney. New infections are at the lowest level in 18 years and the decline is seen across the country, says Rebecca Guy, a Kirby Institute epidemiologist.
The decline in new infections is concentrated among men who have sex with men (MSM), particularly those born in Australia. But that good news is tempered by a modest drop in heterosexually acquired infections, from 238 to 189, and stubbornly persistent levels of new infections in Indigenous peoples, particularly those in remote areas. “Australia is tracking toward elimination of the transmission of HIV,” Guy says, though she and others emphasize there is still much work to be done.
The downward trend in new infections among MSM has been gathering steam for several years, thanks to aggressive promotion of condom use, widely available testing, and successful efforts to get those infected quickly started on antiretroviral drugs, which drive down viral loads, making the host unlikely to pass HIV on to partners.
This arsenal of tools got a big boost in April 2018, when the federal government added pre-exposure prophylaxis (PrEP), a daily pill that protects HIV-negative people from infection, to the Pharmaceutical Benefits Scheme that subsidizes the medicines. This cut the cost of PrEP from AU$10,000 per year to just AU$480 per year, according to the government-funded healthdirect website. Those qualifying for greater subsidies pay even less.
The number of individuals taking advantage of subsidized PrEP soared from just 1980 in April 2018 to 18,530 that December. The Kirby Institute figures that 41% of at-risk Australian men were on PrEP in 2017, says Andrew Grulich, a Kirby Institute medical epidemiologist. Coverage needs to be up to 75% “if we want to keep moving toward HIV elimination,” Grulich says. PrEP uptake is lagging among MSM not born in Australia. “Gay and bisexual men from culturally and linguistically diverse backgrounds really need to be a target for further PrEP rollout,” he says.
It will be particularly challenging to drive down infections in Indigenous groups that suffer high infection rates among those who inject drugs. And diagnoses are typically made at a later stage of infection. This “very different picture” of HIV infection requires “targeted interventions to make sure that Aboriginal and Torres Strait Islander people are not left behind,” says James Ward, an infectious disease specialist at the South Australian Health and Medical Research Institute in Adelaide.
Still, “the decline we’re seeing nationwide in Australia is being seen in very few other places in the world,” Grulich says. The combination of preventions—condom promotion, treatment as prevention, and PrEP—all “act together to decrease HIV infections,” he says. He is convinced that the critical component in the progress is Australia’s universal health care system, which provides “free or easily affordable access to testing, to treatment, and to PrEP.”