In recent years, news stories relating to HIV in Australia have focused on some common themes such as PrEP, cure research, HIV criminal cases and HIV exposure risk in the community. This section provides information and recommendations for when reporting on these issues.
HIV prevention
HIV prevention in Australia has been transformed in recent years by new scientific evidence for the efficacy of biomedical prevention strategies, also known as ‘combination prevention’.
Combination prevention includes:
- Post-exposure prophylaxis (PEP) – use of antiretrovirals after a suspected HIV exposure to prevent infection.
- Pre-exposure prophylaxis (PrEP) – the use of antiretroviral medication by HIV-negative people to reduce the risk of acquiring HIV.
- Treatment as prevention (TasP) or undetectable equals untransmissible (U=U) – people with HIV who are on treatment and have an undetectable viral load cannot transmit the virus.
To report effectively on HIV prevention strategies, it is crucial to address common misunderstandings about HIV transmission, especially those related to casual social contact with HIV-positive individuals. When reporting on supposed public exposure to HIV, it is important to emphasise that HIV cannot be transmitted through everyday social interactions, such as shaking hands, hugging, using the same toilet, drinking from the same glass, playing sports, or being near someone with HIV who is coughing or sneezing. Additionally, it is important to communicate that HIV cannot be transmitted if the person is on treatment and has an undetectable viral load.
Pre-exposure prophylaxis (PrEP)
Pre-exposure prophylaxis (PrEP) is a method for HIV-negative people to take antiretroviral drugs regularly to reduce their risk of acquiring HIV. PrEP is a significant HIV prevention tool, attracting considerable media attention both in Australia and internationally.
PrEP is easy to take and has minimal side effects. The antiretroviral drug Truvada has proven effective in preventing HIV in clinical trials for men who have sex with men (MSM), transgender women, and heterosexual men and women.
Oral PrEP was added to the Australian Register of Therapeutic Goods in 2016 and listed on the Pharmaceutical Benefits Scheme in April 2018, making it accessible with a valid prescription.
Initially, daily use was the recommended dosing schedule for PrEP. However, research has since found that alternative dosing schedules are equally effective. Today, PrEP can be taken daily, on-demand, or periodically. It’s the same pill, just different dosing options.
PrEP should be part of a program that includes regular monitoring and check-ups by a GP, allowing for the early diagnosis and treatment of any STIs.
The introduction of oral PrEP has led to a dramatic decrease in new HIV diagnoses. PrEP is a proven, safe and effective HIV prevention method.
HIV cure research
Over the last few years, there have been some significant developments in scientific research pointing to the potential for an HIV cure; however, HIV cure research is still in its infancy.
While there is much optimism about its potential, it is likely that a cure for HIV will not be realised for some time. Regardless of how successful cure research is, a focus on HIV prevention will remain pivotal.
Cautious reporting is essential as optimistic media reports have sometimes implied that a cure for HIV is ‘imminent’.
The Doherty Institute has an HIV cure guide for the media that outlines ‘how to sort fact from fiction’. Key things to consider include:
- Publication Source: Genuine breakthroughs are reported in reputable medical journals or international media outlets.
- Report Source: Verify if the report is based on a single individual’s claim, presented at a conference, or published in a medical journal. Personal claims are not equivalent to peer-reviewed scientific studies.
- Quoted Experts: Be cautious if the report only quotes individuals directly linked to the study or those without expertise in HIV cure research. Quality reports should include quotes from independent experts.
- Evidence Basis: Determine if the report is based on a theory, an early-stage lab study, or a late-stage clinical trial. Findings from small lab studies differ significantly from large-scale clinical trials, which can take decades to progress from lab to clinic.
HIV criminal cases
In Australia, there are no laws that specifically criminalise the transmission of or exposure to HIV. The repeal of the last HIV-specific criminal legislation in 2015 emphasised that deliberate HIV transmission is better addressed through public health measures.
However, individuals can still face prosecution for HIV transmission or exposure under general criminal laws. Additionally, public health legislation in some areas also criminalises HIV transmission or exposure. Various state and territory criminal statutes include provisions for prosecuting individuals who intentionally or recklessly transmit or expose others to infectious diseases. HIV is often singled out due to stigma and is notably the only blood-borne virus or sexually transmitted infection commonly prosecuted under these laws.
Criminal cases in Australia involving HIV transmission or exposure are rare. There have been fewer than 50 prosecutions since 1991 among more than 38,000 Australians ever diagnosed with HIV.
The quality of Australian media reports on criminal cases involving HIV transmission or exposure varies. While some reports have been accurate, others have occasionally been sensationalised or inaccurate. Sensationalised reporting can perpetuate misconceptions about transmission and risk, dehumanise those involved in the cases and stigmatise individuals living with HIV.
Common pitfalls when reporting on HIV criminal cases include:
- Confusing HIV exposure with transmission
- Using careless or sensational headlines that misrepresent the facts, even those presented in the report
- Incorrectly implying that genotyping can definitively prove that one individual transmitted HIV to another, which misunderstands the science of genotyping
- Suggesting that HIV can be transmitted through biting or spitting, which is inaccurate
Case studies
‘Hundreds of women’
In 2010, print, television, and other electronic media ran with headlines that a Queensland-based African-Australian man may have exposed ‘hundreds of women’ to HIV. Photos and video images of the man generally accompanied these reports. Some coverage included a suggestion that an ‘HIV register’ be used to track people with HIV. A year later, the man was tried and convicted of charges in respect of one woman.
‘Man admits infecting woman’
In June 2011, a man was convicted for HIV exposure. The content of news reports about the conviction reflected this; however, the headline that ran across several news outlets was ‘man admits infecting women’. It is crucial to ensure that headlines accurately reflect the facts and do not defame the individuals involved.
Zaburoni v The Queen appeal success
The High Court’s April 2016 appeal decision in the case of Zaburoni v The Queen establishes that if an HIV-positive person has sex with someone without protection/condoms, it cannot be said/inferred that they intended to transmit HIV.
The appeal clarifies existing law by finding that ‘foresight of risk of harm is distinct in law from the intention to produce that harm’. Until this High Court decision, these issues had not been determined in a court at this level.
The High Court appeal was from a 2013 Queensland Supreme Court decision which found Mr Zaburoni guilty of intentionally transmitting a serious disease (HIV). Mr Zaburoni had had frequent unprotected sex with his girlfriend without telling her he had HIV. Mr Zaburoni was sentenced to imprisonment of 9 years and six months.
This decision serves as a solid refutation to the idea that it is a crime for an HIV-positive person to have condomless sex, as is often implied in media reporting on criminal cases of people with HIV.
HIV exposure risk in the community
Uncritical media reporting can fuel unnecessary fear in the community by exaggerating HIV transmission risk.
This can occur in reporting minor incidents where there is negligible risk of HIV transmission.
HIV transmission risk has been exaggerated in media reports involving casual contact with HIV-positive people where biting or spitting is involved or other scenarios where broken skin or blood is present, such as sporting injuries, accidents or medical procedures. None of these scenarios involve any significant risk of HIV transmission.
In over 30 years of HIV in Australia, there has not been one report of HIV transmission as a result of injury with discarded needles outside of a hospital setting, e.g., from stepping on a discarded syringe.