Saturday, 30 November 2013

Getting to Zero: A Road Map

In October this year, international and national experts on HIV and sexually transmissible infections convened in Darwin to present their latest research and statistics relating to HIV, AIDS and sexual health. The presentations made for grim reading.

According to Professor David Wilson from the Kirby Institute at UNSW, during 2012, the number of new HIV diagnosis in Australia increased by 10 per cent, to 1253 cases - the largest number of new cases in 20 years. And that number, he stressed, accounts only for those who have been diagnosed; a further substantial number of people living with HIV are unaware of their infection. The HIV infections have hit Australia’s young people particularly hard, hundreds of them in their 20s.

HIV advocates and researchers are now calling for urgent action to increase condom use, speed up access to HIV testing and ensure access to medications for anyone infected with HIV. The reality on the ground, however, points to the opposite happening. There is a decline in rates of HIV testing among at-risk people, particularly gay men, a reduction in condom use, delays between infection and diagnosis of HIV and low rates of HIV treatment uptake.

Professor John de Wit, Director of the National Centre in HIV Social Research at UNSW, imputes the increase in HIV infection to unsafe sex among gay men who no longer view HIV as life threatening. Contracting HIV has now shifted from a death sentence, to a manageable condition. "I'm certain that complacency is an important factor”, he says. “People are living longer with HIV - so they do not take it as seriously as I think they should.”

Writing for The Drum, Robert Mitchell, president of the National Association of People with HIV in Australia (NAPWHA) essentially agrees, but warns that "not only the community is complacent, I think the leadership in Australia, people who are responsible for providing activities for preventing HIV, have become complacent, and accepting, of a certain level of infection rates without challenging or changing the way they're working to reflect a way to drive down the infection rate."

With this, Mitchell raised a point – and the ire of many readers. And they felt compelled to respond.  Should Australia’s leaders be held responsible for the spread of HIV which is predominantly happening among gay men having unprotected sex? No one in Australia, gay or otherwise, can claim to be ignorant of how to avoid contracting HIV. Should we commit extra funds to an easily preventable disease?

Other comments were significantly less compassionate.

In 2004, then-Health Minister Tony Abbott announced that the government would do everything it could to protect Australia from the AIDS epidemic but “containment of the disease was ultimately up to individuals. The government can't be everyone's keeper”, he said. “In the end it's personal behaviour, not governmental behaviour, which largely determines the rate of HIV/AIDS infections."

The idea that these ‘reckless people’ who have contracted HIV should somehow ‘pay for’ or ‘live with’ their mistakes is both reprehensible and misguided. Given that young gay men are now the primary target of HIV transmission, surely a little more insight and planning is needed.

Last Tuesday Governor-General Quentin Bryce highlighted the high suicide rates of young gay, lesbian and gender diverse people – six times the rate of mainstream Australians. Their deaths, she warned, are "too high a price to pay".

The truth is that, yes, more money needs to be spent. It needs to be spent wisely on a renewed commitment to eradicate HIV and a campaign that will drive the ‘safe sex’ message home. Its aim and design must be to change behaviours which put men and women at risk of infecting each other with HIV. Such a campaign will succeed if it is delivered with sufficient resources and an appropriate understanding of the complexity of human behaviour. The arithmetic is simple: if we invest resources in targeting behavioural prevention of HIV transmission, we will avoid lifelong, expensive and complicated medical treatments. Long term, we will end up saving a lot of money and - more importantly - lives. Prevention, as they say, is better than cure – especially when there isn’t one.

In 1987 Bob Hawke’s government launched the Grim Reaper campaign. Many are still haunted by the image of the grim reaper using a bowling ball to knock down entire families. By all accounts, it was an effective campaign.  According to Harold Mitchell, executive director of Aegis, three weeks into the campaign 97 per cent of the Australians had seen it; 75 percent thought it had changed people's behaviour and 44 per cent felt it had changed their own behaviour.

Times have changed and the grim ripper may not be relevant today. But now is the time for a change of heart, and a change of tack.

Prime Minister Abbott, who – to put it mildly – has not endeared himself to the gay and lesbian community since landing at the helm, should state his views on HIV transmission clearly and unequivocally. His government must make firm pledges to eradicate HIV transmission through educational and outreach programs aimed at those most at risk.

The Melbourne Declaration on HIV, was endorsed last year, by all leading HIV community, professional and research organisations. It calls for Australia's HIV response to be revitalised to take full advantage of game-changing scientific advances in HIV prevention and treatment which for the first time enable us to envision an "AIDS free generation".

The global theme for this year’s World AIDS Day is Getting to Zero: Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.
We have a destination. May we please have a road map, so that we can get there?


Ori Golan is a freelance journalist and a former volunteer with the Ankali project.


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