MHAHS - Multicultural HIV and Hepatitis Service

TUESDAY 26 MARCH 2019

UNDETECTABLE = UNTRANSMISSABLE – Dr Fiona Fargie

•    What does undetectable HIV viral load mean
•    How does someone achieve and maintain an undetectable viral load
•    The journey of the evidence to support U=U
•    Implications for transmission
•    Contentious issues – breast feeding, child birthing decisions

What is the ‘Viral Load’?

 
What is the effect of Antiretrovirals?
 

 




Nov 2017


 
Contentious issues?

• Breast feeding
• Not covered by U=U
• Needs supportive multidisciplinary care
• A separate talk…

Prevention of Vertical Transmission

 


UNDETECTABLE = UNTRANSMISSABLE (U=U) – Craig Cooper

What does it mean for people living with HIV (PLHIV)?

What does U=U mean?

Undetectable=Untransmissable

2016 Partners Study

• Over 1000 couples had sex (anal and vaginal) more than 58,000 times without condoms
• Heterosexual and same sex (gay) couples
• No transmissions of HIV between partners with a viral load (VL) below 200
• 6.2% reported a detectable VL at some point in the study

2017 Opposites Attract Study

• 358 same sex couples had anal sex 16,899 times without condoms
• No transmissions of HIV
• 0.9% reported sex with a partner with a detectable VL
• 32.1% were on PrEP  (a pill that prevents HIV)
• The 3 men in the study who seroconverted – sex outside their primary relationship

Treatment as Prevention (TasP) & Undetectable Viral Load (UVL)

• HIV treatments prevents the onward transmission of HIV, known as TasP
• TasP reduces the Patient viral load to undetectable
• UVL is known as 200 copies or less, in Australia the doctors understand UVL as under 20 copies
• When people have an UVL there is zero risk of passing on HIV – U=U

Undetectable HIV

• Undetectable means you remain HIV positive, but has undetectable virus levels
• To remain Undetectable, people need to take their medication as prescribed – every day
• Remaining engaged in your health, regular appointments with your doctor and blood tests
• If you have medication breaks, HIV will rebound

Disclosure, the Public Health Act & Reasonable Precautions

Disclosure

• Legal
• When to disclose?  Why?   How?
• Risks/benefits of disclosing earlier / later
• Positive Life can help with disclosure –peer support

Stigma & Discrimination

HIV Stigma & Racism

• Stigma in your communities
• The intersection of stigma and racism
• The role of Education
• U=U – what difference could it make? How?
• What can you do about Stigma?
• The role of Positive Life NSW

U = U  DISCUSSION – Dash

After Fiona’s presentation Dash facilitated a quick discussion about the implications and gaps in knowledge for CALD affected communities and CALD people living with HIV.
Cultural Support Workers in small groups answered a number of questions and gave feedback to the rest of the group.

Key ideas from these small discussions were:
-    Confirmation that knowledge about U=U is not understood by a broad range of CALD communities – the need for further education – and this as a key message for an anti-stigma message.
-    Further work is needed  to also ensure that the U=U understanding is shared and reinforced with all people living with HIV.
-    Comments and suggestions about how the U=U messaging could be translated into other languages meaningfully.

MANAGER’S REPORT – Barbara

Barbara informed staff about the newly established Cultural Support Program (CSP) which is part of Diversity Programs and Strategy Hub within Population Health. Denise Voros is the Co-ordinator for CSP.

Denise has been working tirelessly to recruit new Cultural Support Workers (CSW). There were 175 applicants. It seems that around 60 of them have been chosen as new CSWs. They will have the induction training at the end of April and beginning of May.

They will be working on tasks other than HIV and viral hepatitis.

We would like to say welcome to them.

 
Next meeting: 6 - 8pm, Wednesday 7 August 2019 KPEC Auditorium 4.1 RPA