Grim Reaper stemmed AIDS tide

The Weekend Australian - Travel - - Career One - Adam Cress­well Health ed­i­tor

EV­ERY­ONE over the age of about 30 re­mem­bers the Grim Reaper cam­paign of 1987, which ter­ri­fied and of­fended Aus­tralians in nearly equal mea­sure. But that TV cam­paign — one of the most mem­o­rable and suc­cess­ful health aware­ness cam­paigns ever de­vised — was just one of the strate­gies that saved the coun­try from a far worse epi­demic of HIV/AIDS.

While the Grim Reaper cam­paign is still some­times crit­i­cised — on the grounds that it over­stated the threat of HIV to the het­ero­sex­ual pop­u­la­tion — a TV doc­u­men­tary to be screened next week ar­gues that with­out this and other mea­sures, the virus could well have be­gun cir­cu­lat­ing among in­ject­ing drug users, pros­ti­tutes and the gen­eral com­mu­nity to a much greater ex­tent than in fact oc­curred. The one-hour pro­gram, called Ram­pant:How a City Stopped a Plague , starts with the first di­ag­no­sis of AIDS in Aus­tralia — at Syd­ney’s St Vin­cent’s Hospi­tal in 1982.

Based on archival footage and in­ter­views with key fig­ures — in­clud­ing then fed­eral health min­is­ter Neal Blewett — the doc­u­men­tary charts the shock that the ad­vent of AIDS wrought on Syd­ney’s newly lib­er­ated gay com­mu­nity, and the cul­tural, po­lit­i­cal and other hur­dles that nearly con­founded the at­tempts to keep the dis­ease from spread­ing out of con­trol.

The re­sponses in­cluded break­ing a num­ber of ta­boos and even laws — such as set­ting up an il­le­gal nee­dle ex­change pro­gram in Syd­ney to limit likely spread of the in­fec­tion among drug users, a move that put the health work­ers in­volved at risk of pros­e­cu­tion. A group called the Aus­tralian Pros­ti­tutes Col­lec­tive also re­ceived fed­eral fund­ing, which it used to drive a cam­paign pro­mot­ing con­dom use by clients, and gay groups were also left to de­vise safe-sex ad­ver­tis­ing cam­paigns, most of which left lit­tle to the imag­i­na­tion.

As a re­sult, just un­der 6700 peo­ple have so far died of AIDS in Aus­tralia — a frac­tion of the 50,000 pre­dicted in the early 1980s. The rate of AIDS is 1.3 per 100,000 pop­u­la­tion, a frac­tion of the about 14 per 100,000 seen in the US, which un­der the Repub­li­can lead­er­ship of Ron­ald Rea­gan cut off fed­eral fund­ing for aware­ness cam­paigns di­rected at gay men and re­fused to al­low nee­dle-sy­ringe pro­grams.

How Blewett and oth­ers walked the tightrope of po­lit­i­cal ten­sions and com­mu­nity con­cerns, such as by gain­ing the sup­port of the fed­eral Lib­eral op­po­si­tion for their poli­cies, is one fo­cus of the doc­u­men­tary.

In­ter­vie­wee doc­tor Rob Fin­layson, di­rec­tor of the Tay­lor Square Private Clinic in the heart of the city’s gay strip in Dar­linghurst — which, once a test was de­vel­oped, had to tell hun­dreds of clinic pa­tients they had HIV — says the pro­gram ‘‘ con­veyed the sense of be­ing over­whelmed that nearly ev­ery­body felt’’ at the time AIDS ap­peared.

In 1982, HIV had not been dis­cov­ered, and it was not even known if a virus caused AIDS or how the dis­ease was trans­mit­ted. Ex­perts ini­tially acted on hunches — later proved right — that the in­fec­tion was trans­mit­ted in blood and that con­doms were pro­tec­tive.

The mes­sage that gay men ought to start us­ing con­doms did not ini­tially go down well in the he­do­nis­tic world of Syd­ney’s gay night­clubs, which had boomed in the short time since re­pres­sive pub­lic at­ti­tudes to­wards ho­mo­sex­u­al­ity had started to shift.

‘‘ You still get the sense (watch­ing the pro­gram) that it’s a very dif­fi­cult thing for all of us who were around at the time to re­mem­ber,’’ Fin­layson told Week­endHealth . ‘‘ I think it’s been a huge les­son for pub­lic health — that if you don’t in­clude the af­fected pop­u­la­tion, you are not go­ing to have a suc­cess­ful (pub­lic health) cam­paign.’’

Doc­tor Alex Wo­dak, now di­rec­tor of the al­co­hol and drug ser­vice at St Vin­cent’s Hospi­tal, and col­leagues risked their jobs by set­ting up the nee­dle ex­change pro­gram. He says the pro­gram is ‘‘ pow­er­ful’’ and Aus­tralia’s suc­cess in im­ple­ment­ing a har­m­min­imi­sa­tion approach, rather than the ze­ro­tol­er­ance poli­cies of forced de­ten­tion and test­ing ad­vo­cated by some re­li­gious groups, were not only vin­di­cated but taken up in­ter­na­tion­ally, in­clud­ing by the World Health Or­gan­i­sa­tion.

‘‘ It shows how for­tu­nate we were at the time that the Lib­eral Party was ruled by the lib­eral wing, and not the group that has been run­ning the Lib­eral Party for the last decade or more,’’ Wo­dak said. Ram­pant:HowaCi­tyS­toppedaPlague will be shown on ABC TV on Tues­day, De­cem­ber 3, at 8.30pm

Pic­ture: Bob Fin­layson

Re­mem­bers: Robert Fin­layson be­lieves the AIDS cam­paign proved a huge les­son in how to han­dle pub­lic health is­sues

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