We really do show the world how to manage HIV/AIDS
HIV/AIDS comes under the microscope from this weekend as the largest conference ever held in the Asia/Pacific gets under way. Australia’s success in managing its HIV epidemic is certain to be a talking point for experts seeking ways forward in this global pandemic. Up to 7500 delegates are expected at the International AIDS Society’s fourth IAS Conference on HIV Pathogenesis, Treatment and Prevention.
For the first time this highly scientific conference is devoting an entire track to HIV prevention. Australian experts will gather in advance of the conference to reflect on 20 years of Australia’s HIV response, and attempt to unpick for our international audience what we’ve done that’s worked and what lessons might be translated elsewhere.
Discussions will start from an acceptance that Australia has been very successful at keeping HIV in check. And we have. We took courageous steps early on, trusted our instincts and took charge of HIV in partnership.
As a result, Australia has the second lowest level of HIV in the industrialised world. Innovative programs and sustained commitments by affected communities mean HIV in Australia remains virtually contained in small, readily identifiable populations.
It’s a remarkable achievement. What have we done right? What lessons might be translated?
The National Centre in HIV Social Research at the University of NSW believes it all boils down to high and sustained levels of condom use by homosexually active men, and commitment by successive governments to needle and syringe programs.
Needle programs and partnerships forged with gay communities were bold steps in the 1980s — a political death sentence for their supporters if they failed. But Australia’s needle programs have prevented at least 25,000 HIV infections, and Sydney is one of the few cities where HIV infections among gay men have stabilised — and are possibly decreasing.
Outside Australia, political opposition to needle and syringe programs remains strong despite evidence they reduce transmission of HIV and blood-borne viruses. Had Australia followed the US approach and refused to consider needle and syringe programs, instead of 6600 deaths from AIDS today we would have seen 50,000. Instead of 22,615 people with HIV today, we would have 150,000.
The 2005 Australian Government’s Return on Investments in Public Health report concludes the benefits of its HIV/AIDS public health program massively outweigh the cost. Over the period 1984 to 2010, the program’s projected benefit is estimated to be $3.1 billion, a figure that includes $416 million in avoided treatment costs. Estimated benefits from national needle and syringe programs are $7.8 billion relative to $130 million invested. This same report claims HIV education and prevention will avoid 6973 new sexually transmitted HIV infections. These are massive monetary savings, apart from the human costs of illness, disability and death avoided.
The National Centre in HIV Social Research argues that it’s not just what we’ve done, but the way we’ve done it that’s important. The Australian response has been based on a partnership approach, involving extensive community engagement. Community engagement means people living with and affected by HIV participate in policy-making and deliver essential prevention education.
Because of this, HIV policies are not imposed from above, but grappled with, designed and implemented by the very people whose health depends upon it. The partnership model may not be easily grafted onto different cultural settings, but working with populations at risk and community engagement are important lessons that can be shared.
Recent increases in HIV notifications across Australia are a genuine cause for concern and have brought accusations that gay men are becoming complacent about HIV. True for a few perhaps, but the reality is that gay men in Australia have embraced and sustained condom use like no others.
Rather than complacency, government, community and academic experts agree the rises are more likely due to a weakening in some contexts of the partnership model that has long underpinned our response. Responsibility for one’s own sexual health and one’s partner’s is an ingrained social norm of Australian gay life that can only work well in a supportive environment.
But any lost ground can be regained. Australia’s gay capital, Sydney, is actually bucking an international trend — seeing small decreases in new HIV infections. The 2006 figures show a 9 per cent drop in new HIV notifications among gay men, or 22 fewer new cases than in 2005.
What stands out is that the HIV decreases observed in Sydney are almost certainly attributable to increased uptake of safe sex by gay men. Surveys in Sydney and London show nearly twice as many Sydney gay men routinely use condoms as gay men in London.
We have done well. The fact of our success means there is much to lose and much to do. Vigilance is the key. Maintaining our enviable position requires hard work, gutsy targeted policies, sustained financial investment and plenty of creative thinking.
The 4th International AIDS Society Conference will be held at the Sydney Convention Centre from tomorrow until Wednesday. Associate Professor John Imrie is head of the HIV program at the National Centre in HIV Social Research, at the University of NSW in Sydney