Here are some interesting news articles for people living with HIV about COVID-19 vaccinations generally, and about the rollout in Australia specifically. Have a read for yourself and Pozhet will keep you updated with information about COVID-19 vaccinations as it comes to hand.

Have COVID vaccines been tested in people with HIV?

In this article, the British HIV Association states:

“There is no reason to think these vaccines will be less safe for people with HIV,” say the British HIV Association (BHIVA). “Both include some of the genetic material from SARS-CoV-2 (the virus that causes COVID-19) but not the whole virus. This means they are not live vaccines and so are no less safe in people with damaged immune systems.”

Their statement referred specifically to the Pfizer and Oxford/AstraZeneca vaccines, but this is also the case for almost all COVID-19 vaccines being tested.

I’m living with HIV and have had the COVID vaccine. This is the story of a man with HIV in the UK who was part of a COVID vaccine trial.

COVID vaccines will be recommended to almost all Australians. But are there people who can’t be immunised? This article provides information in response to this question.

The ASHM COVID-19 Taskforce on HIV, Viral Hepatitis and Sexual Health recently stated:

Based on recent initial meetings alongside the National Association of People Living with HIV Australia (NAPWHA), we have received in-principle agreement from the Commonwealth that all people living with HIV including those who are incarcerated, in migrant detention centres, people here on visas and those without Medicare numbers will be prioritised to receive COVID-19 vaccines during Phases 1a and 1b of the vaccine roll-out strategy. We have received assurances that confidentiality will be a key consideration in determining exactly how this process will operate.  (Taskforce Newsletter)

Stay up to date with the Australian Government national roll-out strategy

Covid-19 and PLHIV

Coronavirus disease (COVID-19) has changed our everyday lives and impacted us in many different ways. There are a lot of concerns about COVID-19 for people living with HIV (PLHIV). Our clients have asked the following questions about COVID-19 and what it means for people living with HIV:

1. FAQ

Are people with HIV at higher risk for COVID-19 than other people?

There is no evidence that the risk of infection or complications from COVID-19 is different among PLHIV (who are on effective antiretroviral treatment and with an undetectable viral load) than the general population.

Some people living with HIV may have other health conditions such as diabetes, hypertension or other diseases that can increase the risk of COVID-19.

PLHIV are advised to take the same precautions as the general population:

• Wash hands often
• Cover your nose and mouth with a disposable tissue or flexed elbow when you cough or sneeze
• Continue to use physical distancing, that is maintaining a distance of 1.5 metres between you and the next person
• Stay home and self-isolate from others in the household if you feel unwell

A large US study presented at the recent 23rd International AIDS Conference, AIDS 2020: Virtual), reported that PLHIV were not more likely to contract the Coronavirus. Those who did were not more likely to develop severe COVID-19. Researchers found that people with HIV had higher testing rates but that this did not result in a higher rate of positivity among those tested.

Other studies from around the world including London and New York City reported similar findings. However one study from South Africa did report a modest increase in mortality for people living with HIV. It was acknowledged that it was people with a high viral load and low CD4 count who had a somewhat higher risk of death.
.aidsmap.com/../-study

Will pharmacies run out of HIV medications?

During the COVID-19 health emergency, people living with HIV, hepatitis B and hepatitis C are understandably concerned about access to their medications.

There is enough medication for everyone!

All you need to do is to keep one month’s supply at home and to ensure prescriptions are refilled two to four weeks in advance. There are currently no expected shortages for HIV, hepatitis B and hepatitis C medications.

Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) recommends that people concerned about going to the pharmacist in person should talk to their pharmacist about delivery options. Many pharmacies are now offering a home delivery option, don’t be afraid to ask!

Will I have access to medical appointments?

Many doctors are happy to do phone or video consultations so give them a call if you need to speak to them. Medicare currently allows doctors, nurses and mental health professionals to deliver services to all Australians via telehealth up until 30 September, 2020. General Practitioners and other Medical Practitioners must bulk bill Commonwealth concession card holders and patients who are more vulnerable to COVID-19. People who have chronic health conditions or are immunocompromised or are Aboriginal and Torres Strait Islander people over 50 are included. Many health services are offering telehealth consultations to limit the need for travel, and to reduce risk of COVID-19 exposure.

Give your doctor or service, a call if you need a consultation.

From July 20, Telehealth GP providers will be required to have an existing and continuous relationship with a patient in order to provide Telehealth services. This means that you need to have visited the GP or the practice in person at least once during the last 12 months.

This will ensure all patients continue to receive quality, ongoing care from a GP (or medical practice) who knows your medical history and needs.

If you don’t have a GP you can get your non-GP specialist prescriber to give you a referral to a GP. There are four exemptions to the requirement for an existing and continuing relationship with the GP providing the service:

1. homeless people
2. children under the age of 12 months
3. people receiving Telehealth from a GP at an Aboriginal Medical Service
4. patients referred to a GP by a non-GP specialist
5. people living under COVID-19 restrictions

Will Antiretroviral medications protect me against COVID-19?

No.  Contrary to reports of HIV drugs being trialled as treatment for COVID-19, there is currently no evidence that antiretroviral medications (including PrEP) provide protection against COVID-19.

Be careful about where you get your information about COVID-19. Discussions about COVID-19 on social media can be confusing and not always based on evidence.

Source: ASHM, WHO, Positive Life NSW, NAPWHA

2. MENTAL HEALTH

 It is understandable that during these times you may feel worried or anxious.

Here are some wellbeing tips to look after yourself:

• Limit your exposure to news and social media, if it makes you feel overwhelmed
• Access reliable information, please see the links we recommend below
• Stay (virtually) connected with family and friends
• Engage in activities that you enjoy and find relaxing, perhaps yoga, a bath, painting, cooking or reading a book
• Maintain physical activity, the Australian Government recommends 30 minutes of moderate intensity exercise each day.
• Practise gratitude each day. Start the day identifying three things you are grateful for – perhaps, a friendship, a recent encounter or having access to the essentials
• If you, or someone you love, is experiencing distress please contact Lifeline on 13 11 14
  or Mental Health Line on 1800 011 511

3. USEFUL LINKS ON COVID-19

Pozhet has compiled the following links from different organisations to provide our clients with the latest information
on COVID-19.  The situation is evolving rapidly and we will provide updated information as it becomes available.

Positive Life NSW

News and updated information about COVID-19 and HIV.

positivelife.org.au/

National Association for People with HIV Australia (NAPWHA)

Updated information about COVID-19 and HIV.

napwha.org.au/covid-19/

NSW Health

Provides updates and detailed information about COVID-19, particularly as it relates to NSW.

health.nsw.gov.au/…/coronavirus

People living with HIV (PLHIV) can have healthy children without transmitting (giving HIV to another person) to their partner or baby. Transmission of HIV from mother to child is extremely rare in Australia.

By taking HIV medications and with the support of health workers:

• Women living with HIV can get pregnant without transmitting to their partner
• Women living with HIV can reduce the risk of transmission to their baby to almost zero (<1%)
• Men living with HIV can have children without transmitting to their partner or baby

Preparing to Have a Baby

If you, your partner, or both, have HIV and are thinking about having children you should tell your HIV doctor that you would like to have a baby. They will talk with you about the safest way to get pregnant and have a HIV-negative baby. They will make sure your HIV medications are safe for pregnancy and that you have the right support.

Sometimes pregnancies can be unplanned. If this happens, see your doctor as soon as possible so they can give you the help and information you need.

Fertility

HIV can affect your ability to become pregnant. If you do not become pregnant in the first year of trying, it is a good idea to talk with your HIV doctor. They can give you helpful advice or refer you to a fertility clinic.

Having a Baby with a HIV Negative Partner

When one partner is living with HIV and the other is not, it is possible to become pregnant without transmission to the negative partner. If the HIV-positive partner takes their HIV medications and maintains an undetectable viral load, there is no risk of transmission.

Regular testing is important to ensure the viral load is undetectable. Before trying to get pregnant, both partners should be checked and treated for sexually transmitted infections.

The HIV-negative partner can also take HIV medication before and while they are trying to get pregnant to prevent infection. This treatment is known as PrEP (Pre-Exposure Prophylaxis) and is an additional option if the partner with HIV has a detectable viral load. Talk to your doctor about this if you want more information.

Timing of sex to coincide with ovulation (about 2 weeks before the period starts) can be discussed with a treating doctor to increase the chance of getting pregnant and reduce risk of transmission. This means having sex for a few days when the female partner is most fertile.

Having a Baby when both partners are living with HIV

When both partners are living with HIV, couples can still have a HIV-negative child. If both partners are on HIV medications and have an undetectable viral load, the risk of transmitting HIV to their baby is almost zero.

Transmission to a Baby

The risk of transmitting HIV to the baby is reduced to less than 1% if a woman living with HIV:

• Remains on HIV treatment during pregnancy. The doctor will recommend how the baby will be delivered (C-section or natural birth) depending on the situation, e.g. the mother’s viral load
• Does not breastfeed
• Makes sure her baby is given HIV treatment after birth (usually 4-6 weeks)

If a man living with HIV has an undetectable viral load and remains on HIV treatment during his partner’s pregnancy there is no risk of transmission to his partner or the baby.

Breastfeeding

In Australia, it is not recommended that HIV positive mothers breastfeed their babies, even when taking HIV medications. While transmission through breast milk is low it is NOT zero. It is important to speak to your HIV doctor so you can make the best decision for you and your baby.

Conclusion

All people living with HIV and their partners have the right to choose when and how they want to have children, and should be treated with respect whatever they decide. They are entitled to all the information they need, and the support of health workers so they can make informed decisions.

Useful Contacts:

Pozhet (Heterosexual HIV Service)

Support, information, referrals and events for heterosexuals at risk of living with HIV
Phone: 1800 812 404
https://pozhet.org.au/
pozhet@pozhet.org.au

Multicultural HIV and Hepatitis Service

Information and support for individuals and communities from culturally diverse backgrounds
Phone: 1800 108 098
www.mhahs.org.au
info@mhahs.org.au

Positive Life NSW

A community-based organisation for people with HIV
Phone: 1800 245 677
https://www.positivelife.org.au
contact@positivelife.org.au

Sexual Health Info Link

Sexual Health nurses who answer questions about HIV and STIs confidentially
Phone: 1800 451 624
https://www.shil.nsw.gov.au/
seslhd-shilmail@health.nsw.gov.au

Local Sexual Health Clinic

Visit the website below to find your closest appropriate sexual health service
https://www.health.nsw.gov.au/sexualhealth/Pages/sexual-health-clinics.aspx

The Albion Centre

Provide testing, education and counselling for people living with HIV
Phone: (02) 9332 9600
http://thealbioncentre.org.au/
education@thealbioncentre.org.au

The Paediatric HIV Service at Sydney Children’s Hospital

Medical management, psycho-social support, research, consultation and education for children and families living with HIV
Phone: (02) 9382 1508
www.schn.health.nsw.gov.au/hiv-sydney-childrens-hospital-randwick

TIS National Translating and Interpreting Service

Provides access to phone and on-site interpreting services in over 150 languages
Phone: 13 14 50
https://www.tisnational.gov.au/
tis.prebook@homeaffairs.gov.au

People living with HIV (PLHIV) can have relationships, have sex and have children without passing on HIV.
A positive person might feel nervous when starting a relationship with someone who doesn’t have HIV.

They might think things like:

• When should I tell them that I have HIV?
• How will they react?
• How do I explain what it means to be undetectable and the ways to prevent HIV transmission
  (giving HIV to another person)?

With the right information, treatment and support, PLHIV can have healthy sex and relationships.

Telling

Telling other people your HIV status is often called disclosure. It is something to think about if you are starting a new relationship.
You will need to decide:

• If you must tell them
• If you are ready to tell them
• How to tell them

If you are not having sex with them, you may decide not to tell them.
It is a good idea to talk to a social worker or counsellor if you want to tell a partner about having HIV. They will help you prepare and support you to decide what to say, when to tell them, and what to expect.

Disclosure and the Law in NSW

If the relationship involves sex, you do not have to tell the person as long as you are taking action to not pass on HIV. Under the law this is called ‘reasonable precaution’. This can mean using condoms and/or taking your medication as prescribed, and having an undetectable viral load (see below).
Your doctor will tell you what you need to do for this

Things to Consider before Disclosing HIV Status

• Can I trust this person?
• Do they treat people with empathy and respect?
• Do they care about me?
• Am I ready for questions like ‘How did you get it?’
• Many people in the general community don’t know a lot about HIV and I may have to educate them or tell them where to find information.

Explaining HIV

Your partner may not know as much about HIV as you do. You can help them understand things like:

• What it is
• How it affects the body
• How medication stops HIV spreading in the body
• How medication stops HIV from being passed to another person
• What it means to be undetectable

You may want some help to talk with your partner about these things. Your doctor or social worker can help you and your partner learn about, and understand HIV.

PrEP (Pre-Exposure Prophylaxis)

There is a medication, called PrEP taken by the negative partner to stop HIV being transmitted.
You can talk to your doctor about taking this medication.

Happy and Healthy Together

It is normal to have some worries, even if you have an UVL and take medication as prescribed. It can be helpful to talk to a counsellor or social worker about how you are feeling. Your partner can also make an appointment to talk to someone if they need to.

Treatment is very effective if you take it as the doctor prescribes. There is support for you and your partner (see list). People who have HIV can have sex, can have partners and relationships and have children.
Love, sex and relationships are all part of a healthy and happy life.

Life, Loving and HIV

Having HIV can create challenges when negotiating sex or forming a relationship. However, everybody has the right to form intimate relationships and to enjoy a satisfying sex life; and people living with HIV are no exception.

Our booklet, ‘Life, Loving and HIV: A Heterosexual’s guide to serodiscordant relationships’ covers topics such as:

• If/when to tell your partner you have HIV
• Supporting each other in the relationship
• Having fun and staying safe

Did you know in NSW?

• There are about 10,000 people living with HIV
• At least 10% of people living with HIV don’t know they have the virus and could pass it on to others without knowing it
• One in six people diagnosed with HIV are heterosexual
• Early treatment means you can live a long and healthy life
• Testing is free, easy, fast and confidential

Click to watch Zainab talking about living with HIV.

Ask for a test today

Click to find out more about HIV testing