Fiji has declared a national emergency following a sharp surge in HIV cases. Rates are up 1500% in the last 5 years and health officials suspect that as many as one in 60 adults in the Pacific island nation are now infected. They say that drug use, unsafe sex, needle sharing and the unsavoury practice of \u201cbluetoothing\u201d – where drug users draw blood from one user and inject it into themselves in an attempt to share a high – have all contributed to the alarming rise in cases. Emory University\u2019s Boghuma Titanji is a leading expert on HIV, she manages a significant AIDS caseload among deprived communities in her locale as an infectious diseases specialist, and because of those parallels she\u2019s been keeping a close eye on what\u2019s been happening in Fiji. Boghuma’s been speaking with Chris Smith…<\/p>\n
Boghuma – HIV is the human immunodeficiency virus, which is a virus that targets your CD4 positive T cells, and these are the cells that are very important to helping us fight infection. When you have an HIV infection, because it attacks these immune cells, over time, these cells become depleted, and that results in you having or developing an acquired immunodeficiency, which simply means that your body is no longer capable of fighting common infections. That’s what we dub AIDS, because these individuals then become really vulnerable to all types of infections, and these infections just recur if the virus is not treated.<\/p>\n
Chris – We think this is probably the worst pandemic in mortality terms that humankind has ever confronted. Probably 100 million people have died of or have HIV now. The numbers have been going down, though. Initiatives to drive down the rates of infection have been quite successful. So what’s going on in Fiji?<\/p>\n
Boghuma – The situation in Fiji is really remarkable because what we are seeing is a very sharp increase in the number of new diagnoses of HIV in that country, and several reasons have been advanced. One of the most important being the rise in injection drug use that has gripped the country over the past two years. Essentially, they’ve gone from having one out of about 300, 400 people infected with HIV to one out of 60. And besides the injection drug use, there are also additional factors such as low condom use. It is a very religious country, so although there’s a lot of stigma around educating people around safe sex practises, this doesn’t stop people from still having sex, and if they’re not using prevention measures, what we’re seeing is transmission chains that are emerging of sexually transmissible infections, including HIV.<\/p>\n
Chris – One in 60, though.<\/p>\n
Boghuma – Yes, it’s a really, really striking number, and this is what has signalled the alarm because this has happened just in the space of two years. And again, I think that what this highlights is really the high risk that is associated with injection drug use, particularly in settings where you don’t have safe needle exchange programmes and where people are not educated about how HIV spreads and do not know that there are measures that can be utilised to prevent HIV acquisition and may not be getting tested or connected to care. One of the things we know about HIV is that if you’re treated and the virus is suppressed, you cannot pass it on to someone else. So if there are lots of people who are infected and not being treated, then the risk of them transmitting the virus is just higher.<\/p>\n
Chris – HIV is a pandemic. It’s everywhere in the world. And I mean, in the part of the world where you’re practising, Emory, there is a huge problem with HIV, but not one person in 60. So what has caused this to really take off in Fiji and what do they need to do to rein this in?<\/p>\n
Boghuma – The reasons why we’ve seen declines in HIV across the globe over the last two decades is because we have a combination of factors that have really allowed us to be able to slow down transmission of the virus. As I mentioned before, if you identify individuals who have HIV and you treat them and suppress the virus from replicating to the point where it’s no longer detectable in their blood, they cannot transmit the virus through sex. Additionally, we now have pre-exposure prophylaxis, which are medications that allow people who do not have HIV to be protected from acquiring HIV, and these medications have now been around for over a decade. And now we also have lots of more educational programmes around safe sex practises, the importance of getting tested and knowing one’s status, and programmes that allow people who are infected to be connected to care and treated. Now, moving back to Fiji and the situation that’s unfolding there, we are seeing a country that is dealing with a sudden surge in new HIV diagnosis, which means that they did not necessarily have these measures already in place because the burden of infection wasn’t a significant issue and as such wasn’t a public health priority. So they are playing catch-up on the front of getting people diagnosed and making sure those who are diagnosed are connected to care, starting up pre-exposure prophylaxis programmes to protect those who may be at increased risk for acquiring HIV from acquiring HIV, and also instituting programmes that educate people on how HIV is transmitted and also harm reduction measures like clean needles for injection drug users to reduce that transmission risk.<\/p>\n
Chris – Do you think there’s an element of complacency in terms of human behaviour as well? Because when HIV first burst onto the scene, we’re talking the 1980s, when we realised what this entity was, there was nothing we could do about it at the time, it was literally a death sentence. Then along came this amazing transformation, 25 years ago we had drug regimes that wouldn’t cure somebody but, as you say, suppress the virus right down so it’s undetectable and therefore untransmissible. Has that bred in people’s minds the idea that, well, it’s not such a problem anymore so I won’t worry about it?<\/p>\n
Boghuma – Absolutely, I see that every day in the setting in which I practise, people no longer have the ‘fear factor’ surrounding HIV because it is a disease or an infection that is treatable and individuals who are effectively treated can go on to live completely normal lives and have almost the same life expectancy as individuals who do not have HIV. And this has led paradoxically to people minimising the risk that is associated with HIV and not taking it quite as seriously. So some of those safer practises or precautionary measures that used to be a lot more easily adopted within populations, we are seeing a decline or less enthusiasm around those measures being fully adopted.<\/p>\n
Chris – So do you think Fiji is a bit of a canary in the coal mine then? Or should we be watchful that, in fact, this is coming back to bite us?<\/p>\n
Boghuma – I think Fiji is a reminder of the fact that HIV can always resurge if we forget the measures that led us to be able to essentially have better control of the HIV epidemic. And I think it should be also a warning sign because while Fiji is dealing with the outbreak currently due to the measures that we’ve discussed, we are also noting significant decline in funding globally for HIV prevention measures outside of Fiji. We’re talking about programmes in sub-Saharan Africa, in Asia, in Latin America, and even in North America under the current leadership. So this should serve as a warning. If you don’t do the things that allow us to reduce HIV transmission, it can resurge and you can see significant outbreaks like what we’re witnessing in Fiji.<\/p>\n","protected":false},"excerpt":{"rendered":"Fiji has declared a national emergency following a sharp surge in HIV cases. Rates are up 1500% in…\n","protected":false},"author":2,"featured_media":914176,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[64,63,481758,137,30642,98374],"class_list":["post-914175","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health","tag-au","tag-australia","tag-fihi","tag-health","tag-hiv","tag-national-emergency"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts\/914175","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/comments?post=914175"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts\/914175\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/media\/914176"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/media?parent=914175"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/categories?post=914175"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/tags?post=914175"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}