preventative health for plhiv: some key issues - sean slavin
DESCRIPTION
Presentation from the AFAO National Symposium on Prevention, held in Sydney, Thursday 27 May, 2010.TRANSCRIPT
Preventative health for PLHIV: some key issues
Preventative health for PLHIV: some key issuesSean Slavin
Assistant Director
Context • ‘Prevention’: changes in meaning over time
o transmission preventiono HIV disease prevention
• More PLHIV, living longer, thus the median age of PLHIV rising.
• Observational studies increasingly emphasise risks of non-AIDS morbidity and mortality
Diagnoses of HIV infection and AIDS in Australia
Source: State and Territory health authorities
HIV viral load and CD4+cell count by year1
Source: Australian HIV Observational Database
1 Dashed lines indicate the years of retrospective data collection.
Clinical Infectious Diseases 2008 47(4):542–553
Age distribution of HIV positive MSM in Australia
Thanks John Murray – NCHECR / UNSWE
stim
ated
num
ber
of p
eopl
e liv
ing
with
HIV
Multiple co-morbidities: HIV versus controls
Guaraldi G et al. CROI 2010. Abstract 727
Comorbidities analysed: hypertension, Type 2 Diabetes Mellitus, Cardiovascular disease and osteoporosis Guaraldi G, CROI 2010 Abstract727
“Prevention” has a broader meaning among PLHIV
• Heart / vascular system, liver, kidneys, psycho-social, bones, brain
• Risk factors – being HIV+ - also lifestyle, family history, social context.
• Many of these are the same as for the general population, although they may work in slightly different ways
• What do we do?o A number of scientific questions need to be answered
through researcho Lifestyle change is probably a step in the right direction but
not a complete solution
Aetiology & Consequences
• HIV disease (various theories re. mechanisms)• Rx (still much to learn about long term effects)• Lifestyle risks (elevated among PLHIV)
• Specific co-morbidities esp. brain, bone, vascular, liver, kidney
&/or• A non-specific acceleration of senescence
Problems with prevention
• Treatment as preventiono Rx lowers VL and reduces transmission risk
• Public healtho Prioritises populations over individuals
• Need to emphasise health and human rights of individuals
o Individuals responsible for population health• Need a political agenda around social context that goes
beyond the homilies
CVD risks – what we can influence
A cautionary note
• Health reform is moving fast – increasing role for primary health care to reduce reliance on hospitals
• A place for community based health promotion
• Even good GPs time poor and often prefer a drug intervention and increasingly being asked to squeeze more into a 15min consult.
Conclusion: HIV+ health and the national prevention agenda
• There is some overlap• Lifestyle risks can and should be reduced but this
isn’t a silver bullet for non-AIDS morbidities• Remain cognisant of:
o social determinants – poverty, stigmao Confounding conditions – mental health esp.
• Health not universal good – social identity• Critical relationship with social contexts and
particular behaviours that includes things like pleasure, quality of life, social identity
www. .org.au