Prologue Journal

How medication could help Hong Kong end HIV transmission by 2030

• prologu5
• 11/12/202311/12/2023

Hong Kong Free Press

By Jerome Yau

HIV/AIDS has been a major global public health threat for more than four decades. Locally, the epidemic began in 1984, and the Department of Health has recorded a cumulative total of close to 12,000 HIV infection cases and nearly 2,500 AIDS cases, as of June 2023.

Thanks to the tremendous efforts by stakeholders, HIV transmission in Hong Kong peaked in 2015. Also, advances in medicine means that people living with HIV can enjoy the same life expectancy as HIV-negative individuals. Most importantly, we can end the HIV epidemic in Hong Kong, once and for all, by 2030.

Inner Sydney, once the epicentre of Australia’s HIV epidemic, is believed to be the first place in the world that has virtually eliminated HIV transmission. The incredible achievement Down Under is due in part to vigorous efforts in community outreach and prevention, including the widespread availability and use of HIV pre-exposure prophylaxis (PrEP).

The science is unequivocal. PrEP is highly effective for preventing HIV – studies have shown that it reduces the risk of getting HIV from sex by 99 per cent if taken as prescribed. Also, an HIV-positive person with an undetectable viral load cannot sexually transmit the virus to others, and this underpins the concept of “undetectable equals untransmittable”, or U=U.

According to the World Health Organisation, 144 countries reported that they had adopted the WHO recommendations on oral PrEP in national guidelines in 2021. The guidelines say that people at substantial risk of HIV infection should be offered PrEP as an additional prevention choice. The Hong Kong Advisory Council on AIDS also endorses the use of PrEP as part of combination prevention.

Three PrEP clinical studies have been conducted in Hong Kong, and the findings are crystal clear – PrEP can prevent transmission. Further, researchers have identified that a partially self-financed model of PrEP delivery is feasible in the city.

With such a strong body of evidence, it is puzzling that the Hong Kong government has yet to implement a PrEP programme. It should take a leaf out of Thailand’s book and roll out a PrEP programme – the Kingdom of Smiles is recognised as a leader in the global AIDS response. Local policymakers need to think outside the box and take bold action if Hong Kong wants to attain the ambitious goal of ending HIV by 2030.

People living with HIV (PLHIV) require lifelong treatment and care, and as they age they may also develop chronic conditions and experience physical and cognitive issues. Amid an ageing population, this aspect of the HIV epidemic should not go unnoticed by healthcare providers and policymakers. In particular, we need to combat discrimination and stigma within the healthcare system and adopt an integrated and client-centric approach for the long-term care of older PLHIV.

HIV stigma and discrimination are very much alive in Hong Kong society, and this has taken a toll on the wellbeing of PLHIV. Sadly, fear and ignorance about the disease are still not uncommon in this day and age. And this is unacceptable. We can do better by making comprehensive, science-based sexuality education mandatory in our schools. This is about equipping our youth with age-appropriate, progressive and non-religious sexuality knowledge so that they can grow up healthy and make responsible decisions for themselves.

As December 1 will mark the 35^th anniversary of World AIDS Day, let us renew and strengthen our response to HIV by investing in evidence-based prevention and treatment programmes and putting people first. As the saying goes, “if there’s a will, there’s a way.”

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Jerome Yau is chief executive of AIDS Concern, the longest-running NGO in Hong Kong dedicated to HIV/AIDS care.

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