The WA AIDS Council and Next Step Alcohol and Drug Service, East Perth have worked together for a number of years, assisting each other with workforce development in their respective areas of specialty. From July 2017, Next Step will begin delivering an outreach service at the M Clinic. The service is designed to be an open-door to gay, bisexual and other homosexually active men, to access peer-based, non-judgemental, friendly and tailored services. This includes general information, education, referral and support with any difficulties they may be experiencing with their substance use.
The idea to co-locate sexual health and alcohol and other drug (AOD) services is not a new one – in fact, 56 Dean Street has modelled how this integration of services can achieve phenomenal results, when provided with sound peer support. M Clinic Manager, Justin Manuel, says, “A lot of our clients just don’t feel comfortable taking that step into an external service, especially if they’ve had poor experiences with traditional AOD services in the past, or know someone who has. The co-location within M Clinic allows clients to remain in a comfortable setting to begin accessing information and support.”
The services commence on Tuesday 4th July, and will initially run fortnightly from 1:00 to 4:00 pm. Clients are free to drop-in between those times, or alternatively, can make an appointment by contacting M Clinic.
There are imminent changes on the horizon for how Pre-Exposure Prophylaxis will be accessed in Western Australia.
A project for accessing PrEP is anticipated to commence in the second half of 2017 (subject to ethical approvals), whereby PrEP and associated support services will be available to people who may be at risk of contracting HIV.
Do you want to be kept up to date on all changes to PrEP access in WA? Make sure you sign up to the mailing list by completing the expression of interest form below!
The WA AIDS Council is thrilled that the Government has confirmed funding for a WA PrEP demonstration project for 2,000 Western Australians. We’ve pushed this for what seems like forever, and the result is better than we dared to dream. We’ll release more details very soon on our websites and social media. This demonstration project will help eliminate new HIV transmission as we aim for our 2020 goals. CEO Andrew Burry has today made the following statement:
Statement on the Establishment of the WA PrEP Demonstration Project
We are thrilled that funding for the PrEP Demonstration Project has been secured and announced. We have been working hard for this for a long time, although I concede that at times our work may not have been visible. In the end, the outcome was greater than we dared to dream, and with 2,000 places available and the project funded for at least two years, it is the country’s largest on a per capita basis.
Whilst the funding is secured, there is still some work remaining before enrolments can commence. This is a partnership between the WA AIDS Council, the Department of Health and the Kirby Institute. Whilst the partnership has had plenty of dialog leading up to the announcement, final agreements between the parties still need to be concluded. This will not take long.
A ‘Demonstration Project’ is a research study. As such, the program must be run within strict protocols, and Ethics Approval must be obtained for each of the participating clinical sites. Training for the WA Chief Investigator and Research Supervisor(s) is also necessary. There are several sites included to ensure the project is well resourced, including clinical services and support, peer support and so on. Obtaining Ethics Approval is relatively complex and detailed and does take some time. Consequently, we have stated our goal as commencement being early in the second half of 2017. To us, this means July 1st, however if we can be fully ready earlier we will commence earlier.
The Demonstration Project is a criteria-based access program. This means that eligibility for participation will be determined based on HIV risk criteria. The aim is to rapidly enrol eligible people and follow them for up to two years while they take PrEP.
To facilitate the smooth entry of eligible people into the project, we will shortly establish a pre-registration program. Pre-registration will involve providing some details of your personal and sexual histories. All information collected will be secure and confidential.
We will also ensure details of implementation progress will be on both the WA AIDS Council and M Clinic websites. People interested will also be able to subscribe to a special newsletter and questions can be directed to a specific email address (details below).
If you currently feel you need PrEP right now, please consider commencing immediately via the existing PrEP access programs using the personal importation process. Details on how to do this are also on the WA AIDS Council and M Clinic websites. Current or previous PrEP use does not affect eligibility into the project.
There are many people who worked together in making this outcome possible. The team at the Sexual Health and Blood-borne Virus Program of the Department of Health shouldered a huge workload in developing costings of various proposals. The Kirby Institute also provided incredible support in helping us to develop a model that best suits Western Australia and takes advantage of some of our special features.
We aren’t the first ‘cab off the rank’, and similar large demonstration projects are underway in NSW, Victoria and Queensland. Our colleagues at ACON, the Victorian AIDS Council, the Queensland AIDS Council, Australian Federation of AIDS Organisations, and the The National Association of People with HIV Australia have tirelessly supported our efforts and occasional disappointments as we worked this through.
I want to acknowledge also the great people in NSW Health who offered extraordinary advice, warned us of potential pitfalls and shared their own experiences so that we can start as efficiently as the NSW program has become. In particular, we acknowledge former NSW Health Minister Jillian Skinner, who shone a light of hope when wide scale PrEP access seemed beyond our reach.
Please keep in touch with our progress in the WA PrEP Demonstration Program by accessing our websites, subscribing to our newsletter and through pre-registration when it becomes available.
Chief Executive Officer
For Information on the WA PrEP Demonstration Project:
2015 was a momentous year for the WA AIDS Council. The year marked the 30th anniversary of incorporation, an occasion marked with a series of events in September and October. Among many achievements, 2015 saw new training opportunites for aged care facilities, record support for STYLEAID, and the introduction of Love Game, a brand of events designed by and for the Perth African Community.
Here, we take a look at an exciting and busy year for the Council, using another major achievement for 2015 - this website!
WA AIDS Acknowledges 30 Years
In September, WA AIDS Council marked the 20th year of incorporation with two major events for staff, stakeholders and community. The first of these events took place at Parliament House, and was hosted by Health Minister, Dr Kim Hames.
After a stunning welcome to country from Kart Koort Wiern - Ingrid Cumming, Council stakeholders, former and current staff, volunteers and guests heard from Minister Hames, CEO Andrew Burry, Prof John Cordery, Provost & Senior Deputy Vice Chancellor, Curtin University, and Dr Graham Brown, Senior Research Fellow, La Trobe University. Performances from String Musicians Australia, Ali Bodycoat and Jay Weston also entertained the audience on a beautiful spring night.
Following on from the formal event, a community event was hosted at the Western Australian Ballet, and included special 30th Anniversary awards, for individuals and organisations who have played a significant role in the response to HIV/AIDS over the past 3 decades.
Newly appointed Chairperson Sam Hastings opened proceedings as host for the day followed by a Welcome to Country by Daniel Garlett of the Dadajaal Dance Company. Paul Baines spoke as a NAPWHA representative followed by a captivating performance by the Gay & Lesbian Singers of WA (GALSWA). After the awards ceemony, Crystal Chandelier took the floor as the final performer with DJ Baxter playing tunes until the end.
It was a wonderful occasion, and a superb tribute to the hard work of staff, volunteers and friends of the AIDS Council over 30 years.
Aged Care Facilities Upskill for HIV
Thanks to advances in treatment, HIV positive people are living long, full lives, on par with the average life span of the general population. As HIV positive people age, new challenges arise in relation to aged care. Never before have aged care facilities been tasked with catering for people with this infection and may require some additional information to overcome any preconceived ideas they may have. In 2015, WA AIDS Council created a training program to assist these facilities in caring for positive people, in a respectful, appropriate and non-discriminatory manner. A number of facilities have already completed the training, with more to follow in 2016. For more information about this program, please click here.
STYLEAID is a GOGO
In 2015, STYLEAID, presented by Curtin University, returned to the swinging 60's with a retro-styled event attended by over 700 people at Crown Perth. Guest were treated to Go Go Dancers, exquisite food and beverages, and a runway show featuring the likes of Ae'lkemi, Zhivago, Monster Alphabets, and Zomp Creative Design winner, I Love Mr Mittens. STYLEAID was supported by a photographic exhibition and an auction during the event, that raised more money than any other in STYLEAID's 18 year history as Perth's premier fashion fundraiser.
Holding the Man
In August, the Council hosted the Perth premiere of Holding The Man, the film adaptation of Tim Conigrave's seminal memoir of the same name. The star of the film, Ryan Corr, attended the film and answered questions from the audience after the screening. The sellout crowd gave a standing ovation for the young actor, clearly impressive with the film and his performance.
Leaver's Sign Off with a K.I.S.S
In November, staff and volunteers attended School Leavers celebrations at Rottnest and Dunsborough, providing young people with information & resources around sexual health, alcohol & other drug use. The teams provided record numbers of materials to a record number of school leavers and were all around super stars! The program continues to build on previous years and has become an institution for keeper school leavers safe.
Let's Get Quizzical!
In June, the WA AIDS Quiz Night made a welcome return, with over 300 people rocking the Yokine Bowls Club in their finest 80's gear. Hosted by Mark Reid and Tash Brockwell, the night was full of laughs, prizes, some serious quizzing - and big hair! Guests shared in over $10,000 worth of donated prizes, and a great time was had by all. The date for the 2016 #WAAIDSQuiz is booked and already selling, click here for more.
Celebrating 25 years of Pride - Pride Parade
Cue shiny mirror balls, silver balloons, white and neon fabrics. Lit by black light, this year the Council created a literally glowing float for the parade
which embraced a ‘Silver City’ theme. See for yourself here. Congratulations to Pride WA on their 25th Anniversary!
World AIDS Awareness Week and World AIDS Day
2015 marked the biggest week of events in the lead up to World AIDS Day in the Council’s history. Social events were held specifically for the PLHIV community throughout the week including a morning tea and a networking event at a city bar. Nic Holas hosted a community forum to discuss all things PrEP with the gay men in Perth which provided great insights. In conjunction with World AIDS Awareness Week, Love Game held a red carpet event to celebrate the work of community members in raising awareness of HIV.On World AIDS Day, MAC Cosmetics hosted their annual Good Spirits makeup workshop for HIV positive people. This years attendance of makeup artists and clients was the most experienced to date.
On the evening of World AIDS Day, we did something different to previous years and premiered the film “It’s Not Over” in the heart of Perth City, at the Northbridge Piazza. Over 100 people attended, and a team of enthusiastic volunteers handed out plenty of red ribbons and merchandise to attendees and passers by. For the full wrap up and photos click here.
By Andrew Burry, CEO WA AIDS Council
It seems logical to say that if you increase the rate of HIV testing within a target community, you will be hoping to see an increase in diagnoses among that population. The aim of testing is to identify infection and without an increase you may well conclude that your testing program is misdirected or otherwise unsuccessful. But how do you respond when there is a significant rise in HIV notifications and the media conclude that the safe sex message has been lost? How can you show this is due to increased detection and not infection?
HIV Notifications by Mode of Transmission
HIV Notifications by Mode of Transmission
HIV Notifications among MSM by Clinic
In 2014, Western Australia recorded a total of 139 new diagnoses. This represented an overall increase of 16% compared to 2013 and was driven almost entirely by a 27% increase among gay and other homosexually active men (GHAM).
Significantly, the 2014 result was double the rate of 2009 and the highest annual total since 1991. On January 24 2015, the West Australian reported the increase under a headline: ‘HIV rise points to safe sex decline’, and quoted health authorities as being worried that the safe sex message has fallen off the radar in WA. The rise (among gay men) was labelled as alarming. Interviewed for the same article, the WA AIDS Council had a different take on the latest epidemiology: we said it would have been much more alarming if there hadn’t been a rise, given the significant investment that has gone into testing over recent years. As we have come to expect, our view of the situation was inadequately reported and readers were once again left with an impression of irresponsible gay men discarding their condoms with an air of ‘complacency’.
In arriving at a position that differs somewhat from the more commonly reported view, we were not indulging in a process of wishful thinking. Far from it, as in fact the available evidence provides strong support for our view.
The first significant indicator is the notification data itself. As Figure 1 shows, there is a very clear rising trend of rising HIV notifications among gay men and other homosexually active men while all other categories are trending downwards or stable. During the five years prior to 2010, the notifications for this group of men were relatively stable, at around 35–40 in each year. So what happened in 2010/11 to trigger such a significant and ongoing increase in diagnoses in this category?
In July 2010, we opened M Clinic for business. M Clinic is a sexual health screening service specifically (and only) for gay and other homosexually active men. It operates five full days per week and includes two evening sessions for those unable to make appointments during normal business hours. The clinic offers a full suite of tests for HIV and sexually transmissible infections (STIs) including hepatitis, and provides treatment for those diagnosed with the exception of HIV.
The testing offered by M Clinic is entirely additional to the testing services already available in Perth, and so the immediate impact was a dramatic increase in specialist testing availability. Not only has the clinic operated at capacity from day one, it was necessary to relocate to larger premises within 18 months of opening. M Clinic now has 3,300 clients.
The other sexual health clinics continue to report that they are operating at full capacity, so the conclusion has to be that since the advent of M Clinic there are now more GHAM testing, and testing more often.
There is further evidence for this: Although this graph only includes data through the end of 2013, it shows the trend of male testing over a five-year period. From 2010 (when M Clinic opened) when the testing rate per 1,000 men was 40, the rate rose steadily until by 2013 the rate was 50; an increase of 25%. Over the same period, the rate of positive test results (as measured per 1,000 tests conducted) stayed constant at 1.5. So what does this mean? If you test more men and increase diagnosis numbers at the same rate of positivity, wouldn’t this suggest that the prevalence of undiagnosed existing HIV is declining – or alternatively that the additional tests are targeted where they are not needed?
One observation over the last year is the increase in the number of homosexually active men diagnosed in general practice. As Figure 3 demonstrates, the proportion of total diagnoses in general practice has remained constant at just over one third. However, when General Practitioner (GP) data is further examined as shown in Figure 4, something interesting emerges.
Of significance here is the change in the reason for an HIV test. In absolute numbers, those presenting with symptoms suggestive of HIV where a positive diagnosis was subsequently made was the same in both years (10). The big changes are in the positive diagnoses where the patient reported risk behaviour with an HIV infected person (a fivefold increase) and as a result of STI screening (a threefold increase).
Whilst we have long been encouraging GPs to proactively encourage their patients to consider sexual health screening, we have no evidence that they have been doing so. The two categories of HIV notification increase are thus seen as resulting from patient initiation or requests. Why would so many more GHAM be requesting tests from their existing or new GP? One possible explanation is onward referral from M Clinic. The popularity of the clinic means that increasingly it is impossible to offer appointments when a client wants one. In such circumstances, those clients are strongly encouraged to try another sexual health service or general practice rather than wait until they can be seen at M Clinic. It is acknowledged that the GP data covers only two years and further work needs to be done here, but it nonetheless provides fairly strong circumstantial evidence in support of believing that detection rather than infection is driving recent epidemiology.
If the rise in HIV notifications among gay and other homosexually active men is a result of increased testing rates, can we conclude that there has not been a decline in safe sex? No!
A rise in risk behaviour – even a significant one – is completely compatible with a conclusion that rising notifications are resulting from increased testing. In reality, the increase in the effectiveness of modern treatments and greater ease of adherence together with the increased proportion of diagnosed HIV positive men on treatment who are maintaining an undetectable viral load means that it has never been ‘harder’ to acquire HIV. Even if the number of men living with HIV continued to grow, community infectivity can still be declining. Even if the number of serodiscordant sexual interactions was increasing, new infections/transmission could still decline.
Increased testing rates that result in new diagnoses reduces the level of undiagnosed HIV amongst the GHAM population. This leads to less undiagnosed and infectious HIV in the community and a declining acquisition/transmission risk overall.
Moreover, the more GHAM that know their HIV status (as at their last test), the more accurate status disclosure is, if made. This then results in improved effectiveness of other risk reduction strategies, including sero-sorting and strategic positioning. However, an increase in risk behaviour
undermines the benefits that increased testing offers, and if the increase in risk behaviour was extreme, this could entirely negate the positive effects of increased testing. There is no suggestion that efforts to promote safer and better-informed sexual behavioural choices can be relaxed.
What is important is that there seems to be very clear evidence both from within WA, as well as nationally and internationally, that of all the behavioural changes we ask GHAM to consider, increasing testing and frequency of testing is the most likely to occur. It is also clear that peer-based testing, particularly in community settings, is effective in achieving increased testing rates. This leads to an additional advantage of providing (in the case of Perth) 7–8,000 risk conversations that may well encourage other better-informed choices.
And so …
It is not unusual for there to be differences of opinion between those that comprise the partnership response to HIV in WA or in Australia generally. A range of perspectives is surely one of the points of
partnerships. One thing we are all agreed upon, though, is our commitment to a variety of targets in the Seventh National HIV Strategy and the United Nations 2011 Political Declaration. Principally, we are all dedicated to the notion of substantially ending HIV by 2020.
As a community organisation rather than a scientific one, the WA AIDS Council perhaps has a luxury of greater freedom in interpreting and acting on the evidence it sees. The Council also has the benefit of sourcing information, evidence and other insights from a richer variety of sources.
For example, we have almost 8,000 direct and individual face-to-face interactions with GHAM each year and can claim a better understanding of the current living experiences of GHAM in our jurisdiction and beyond.
Our view of the immediate challenge may seem simplistic. As long as we diagnose at a faster rate than new infections occur, we will reduce prevalence, increase the proportion of those with HIV on effective treatments and sooner or later we will see epidemiology reflecting falling rates of new HIV diagnoses.
We asked homosexually active men to step up and get tested or get tested more often and they have responded. The increase in diagnoses is an encouraging sign. It would be at the least unfortunate to ‘blame’ these same men for HIV data that may be politically difficult and then to accuse this community of being complacent.
Nobody can now doubt the impact of peer-based sexual health services for GHAM. They require some investment; indeed M Clinic absorbs $750,000 each year excluding the costs of pathology and treatment.
But our four years’ experience in WA should encourage other jurisdictions to recognise the importance of further increasing investment in peer-based testing programs in support of achieving our 2020 targets.
Some may believe that the jury is still out, but we think the verdict is in. It’s detection not infection in Western Australia.
M Clinic is Perth’s only sexual health clinic that caters exclusively to men who have sex with men. M Clinic is an appointment only clinic that provides free, confidential, non-judgemental STI testing & treatment.
M Clinic works on a peer-based model, combining integrated health promotion with clinical service provision, with the aim of reducing acquisition of Human Immunodeficiency Virus (HIV) and other sexually transmissible infections (STI’s) at a population health level.
The clinic provides a full range of STI and HIV testing and also provides vaccination for hepatitis A and B and human papillomavirus (HPV), the main cause of genital warts.
It also gives guys a chance to engage with other health and related services that are on offer to them in Perth by carrying out appropriate referrals.
To read more and make a booking, visit the M Clinic website here.