Promises and Limitations

Promises & Limitations

Last week I attended a day of the 13th social research conference on HIV, viral hepatitis and related diseases that was being held at UNSW. It’s title topic was the “Promises & Limitations” of the current treatment approaches used – in particular, treatment as prevention (TasP). Professor Deborah Lupton opened the conference with a plenary on digital health which was particularly interesting to me because I’m taking part of the movement right at this very moment. Lupton pointed out the many mobile apps now readily available which I’d never even thought to look for.

Apparently there are apps on self diagnosis, reproductive cycle tracking and even sexual performance measures. Taking a quick search now, the apps that first come up are a GP finder, an express medicare claim app, symptom search and healthcare tips. The rate at which healthcare is expanding is pretty enormous but are people actually aware of this?

As a self professed technology dunce, maybe I’m not the best indicator in terms of the relationship between health and digital devices but I feel that the availability of self monitoring or ‘self help’ would definitely be beneficial in an increasingly digital future. A potential app discussed was one that could track the growth of the unborn or your children. As such, a level of marketing campaign could go a fair way in shedding light on the multitude of healthcare apps on our mobile. A curator would be nice to sort out the good ones from the useless too.

Moving on from the opening plenary though, (and after one or two deliciously moist red velvet cake slices), I primarily followed streams on HIV and the current trend of thinking among the gay and bi community, youth and the affected minority communities of heterosexuals and low income populations.

So: Here are some of the very preliminary findings of social research on HIV treatment approaches, current strategies proposed to improve HIV living and an expose on how minority communities affected with HIV are coping.


Treatment as prevention is the big thing right now in terms of HIV treatment and prevention in the population. TasP is the early use of anti retroviral treatment as a mechanism to both prevent spread of HIV and treat the affected individual. To those who have heard of it, it’s believed to be the most effective treatment.

The so called ‘Promises’ of TasP is that it provides a safety net for people who practice unprotected sex, open options to reproduction and sexual eligibility. ‘Limitations’ however, include a pressure of excessive responsibility, to start a treatment regime before the individual may be ready. These promises and limitations seems to be shared across all groups of HIV affected populations – the gay and bi community, and heterosexuals.

Yet it seems to be able to bridge a divide between serodiscordant couples, removing an anxiety about transmission. Preliminary interviews with such couples show that it removes a sense of guilt and fear when engaging in intercourse, allowing them to “…love who I love…” and not be restricted to a ‘positive HIV’ or ‘negative HIV’ partner.

The majority of gay men that have been interviewed so far remain to be skeptical of TasP. Others who have no personal reason to start TasP will be more likely to oppose it until they feel the need to. Taking medication to control spread among a population holds no true motivations for them and honestly, no one likes taking meds. With TasP being fairly recent, there are also no long term effects to be aware of. There’s also a distrust with pharmaceuticals and/or enterprises that can play into an individual’s perspective of TasP.

Contradictory statements seem to be happening between public campaigns and clinicians on the topic of TasP as well which I will come back to.

With some of these studies being at very preliminary stages of research, it’ll be interesting to see how things change as they progress and evolve.


This set of people is like a unique minority. Shockingly, there seems to be a low level of awareness about treatment for affected heterosexuals and views of thinking may even be outdated. There appears to be a lack of knowledge both with heterosexual couples and GPs. For one, there is the Swiss Statement and the HPTN052 studies which are being used as flags of victory for heterosexuals living with HIV but not a lot seem to be aware of this progression.

The Swiss Statement and the HPTN052 study provide an opportunity for heterosexuals who undertake antiretroviral therapy consistently, decrease their viral load to undetectable and are free of STIs to be free of the fear of sexual transmission.

Of greater concern is the observation that while many people rely on clinicians and GPs in Australia for information, there actually seems to be a knowledge gap between the ordinary GPs and sexual health specialists. Going back to contradictions between public campaigns and clinicians – while some may know, information could be withheld on account of personal opinions and evaluations.


With NSW being the highest users of ART, there has been a proposal made to assist treatment payment. Chronic health is linked with a reduced employment rate and concurrently a reduced income. Unfortunately, chronic health requires a high health spend. The review into this proposal has found that while the cost to the government is manageable, it was rejected on the concern that it would lead to similar proposals for other chronic diseases.

Never to fear, a new proposal is being revised and it is hoped that waivers will be simply done through medicare and at the local GP. The question then raised is what of those who are not on medicare. All good things to consider.


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