Andrew Laming (Bowman, Liberal Party) Share this | Hansard source

The first World AIDS Day was back in 1988, and it was 1984 when I first turned up as a first-year medical student and the world was grappling with this new viral infection of which we knew very little. It was, at that time, HTLV-1 and -2, and we could not really see where this was going to head. But here we are, 30 years later, with 35 million people living with HIV, and about the same number having passed away due to HIV since the first cases were recorded.

Back in the eighties, there was great uncertainty and incredible fear. There was First World HIV and there was developing world HIV, and for some time we almost thought that they were completely different conditions, until we better understood the pathophysiology. Then, when I was an eye surgeon, in 1996, one of my major jobs in a major Sydney hospital was to treat CMV retinopathy, which was almost exclusively, at that time, due to HIV. So, as a medical student, I saw that this exploding area of HIV, then known as AIDS, was going to become a major job for clinicians of my generation. And it is only now—since, as we once said, we 'scienced the heck out of it'—that we can finally say that most people will live with and not die from AIDS. And that has been an incredible scientific and technological achievement.

Of course, the numbers are still very stark if you go to sub-Saharan Africa, where two-thirds of the world's cases still exist, and the great challenge there is to get people on treatment. So I do commend the 90-90-90 goals that have been set as part of World AIDS Day, and those are that: we know about at least 90 per cent of all infections; 90 per cent of those we know about are able to access ART, the appropriate therapy; and, for those on therapy, 90 per cent carry zero or near-zero low viral loads. Now, 90-90-90 sounds really good, until you do the multiplication and find what that really means is that only 72 per cent of people living with HIV are actually appropriately treated under ART. So it is still a very, very distant goal, particularly in parts of remote and sub-Saharan Africa.

To improve that, we have done things in different parts of the world. The most important things, I think, were major deals done, driven by Jeffrey Sachs, Michael Kremer and others out of Harvard, to set up a global fund, first of all, to provide a pull mechanism to fund the cures, but then—as it became pretty obvious that the cures were there and we simply needed to strike agreements—to make sure that these expensive drugs were available in countries where HIV was endemic. And, while we saw some potential risks—that these drugs, sold for one price in a developed economy, and provided virtually for free by beneficent pharmaceutical manufacturers, created some tensions where some of these products could be siphoned away and sold on the black market—that ended up being an incredibly minor challenge, compared to the overwhelming benefit of making sure that these drugs were available.

Closer to home, right here in Australia, we have seen an absolute focus on approving these drugs as soon as they have been appropriately assessed by international agencies and then by the TGA. We took away, as a government, the CD4 count requirement which said that, until you had a particular blood test result, you could not access the treatment. We realised that that was just delaying treatment. And what this is about is early identification and treatment.

The last national HIV strategy is coming to its conclusion, and we are talking about where we go from here. So, to remind ourselves of those facts: there were still, around the world, 2.1 million new cases last year, and 150,000 of those were children; and we know that the number of people receiving ART has gone up from 7½ million to closer to 17 million in the last 10 years, but that is still only halfway to where we would like to be.

But, most importantly, we have worked really hard on maternal to child transmission. Around the world, there are 1.8 million children who have HIV through no fault other than they were born to a parent who was a carrier of HIV. In Australia, we have seen that number fall precipitously. Around the world we have now seen a halving, since 2010, of maternal to child transmission, and that in itself is a major victory because, when you talk about maternal to child transmission, you are talking about someone living for the full period of their life carrying this disease, which is an incredible burden.

In closing, this is a victory of science and technology. Never had the world got together, I do not think, save for forms of influenza and epidemics, to be so singularly focused on finding a cure, and, for a decade, there was very, very little hope that that would be possible, and it injected huge amounts of community fear, uncertainty, stigma and discrimination. Thankfully, we are past that. Thankfully, now, we have got these numbers down. I think, without being too self congratulatory, developed economies found solutions for developing economies, like we have often failed to do in other areas. So, on World AIDS Day, I salute every clinician and researcher involved in that victory.

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