With public consultations about to begin for the Fifth National HIV/AIDS Strategy, DAVID MENADUE explains the importance of this key document.

HIV community agencies have placed considerable importance on getting the federal government to commit to a Fifth National HIV/AIDS Strategy. When it became obvious that the fourth National Strategy (from 1999-2004) had run its course and a government review suggested a need for major changes, AFAO and NAPWA pressed for an earlier start to the next strategy rather than wait till its expiry in July this year. This wasn’t to happen and with some delays in preparing the new strategy, it has been agreed by all parties that the new one will start in January 2005.

Some people may ask, “So what?” What is the importance of having a strategy in place anyway? Is it just a bit of paper with a few “feel-good” thoughts and ideals on it that won’t actually mean much in reality for people with HIV/AIDS or those most affected by the virus?

This is a valid question because, as of the fourth National Strategy, the funding for state and national HIV/AIDS programs was no longer attached to the strategy itself, as it was in the past. Instead a system of “Public Health Outcome Funding Agreements” (PHOFAs) has been agreed between the federal and state governments which attaches funds to the states achieving certain agreed public health goals (such as implementing a number of campaigns to reduce HIV infections, provide care and support to people living with HIV/AIDS, etc).

Because of this change in the funding formula in 1999 there was some thinking in government circles that a national strategy could be dispensed with. It had been important to establish the basis for our approach to HIV/AIDS in the past but now that we understood these principles, it was the funding agreements that really counted. This line of thought was firmly resisted by the HIV community agencies — and a good number of government bureaucrats as well.

There are some very strong reasons why we fought so hard. For starters, the strategy document is a written commitment from government to work in partnership “between all levels of government, community organisations, people living with and affected by HIV/AIDS and the medical and scientific communities.”

This concept of partnership entitles community organisations to be consulted on all major policy decisions on HIV/AIDS by government, to have a seat at the table of government advisory committees (in most cases!) and for us to be acknowledged and funded as major players in implementing the directions that the strategy outlines.

In a time when some people the community are thinking that “AIDS is over” because of treatments advances and reduced mortality, it is crucial that the true realities of HIV/AIDS at this time are acknowledged in a substantial strategy document — which outlines the need to tackle the recent increased rate of HIV infections and the considerable treatment, care and support needs of people living with HIV/AIDS at this stage of the epidemic. A document which determines which groups are most at risk of coming in contact the virus and who should be given priority in the allocation of funds at a state and national level.

Once this detail is signed off by government, it has to be given a significant level of priority — or face a potential grilling by opposition parties in parliament. It makes it less likely that HIV/AIDS will slip off the government’s agenda altogether or just be merged into a broad public health response.

A strategy document is probably the only government document that outlines all the players in the HIV/AIDS response and their various responsibilities. The specific roles of the states and territories and the Intergovernmental Committee on HIV/AIDS and Related Diseases, the National Public Health Partnership, local government and the various responsibilities of federal government departments apart from the Department of Health and Ageing — such as the Attorney-General’s Department (which handles law reform issues) and the Department of Foreign Affairs and Trade (which oversees AusAID and our international response in the region) — are all outlined in the strategy documents. The crucial roles of Australia’s national centres in HIV research are documented and their continued existence guaranteed in the life of the strategy document.

Each new strategy has taken on new directions in response to the changing environment and the writers of the Fifth National Strategy have decided (largely in response to a government request) to include sexually transmissible diseases (STIs) in a combined HIV and STI Strategy for the first time. This has not been without controversy within the HIV community as there has been a concern that a STI strategy for the whole community would be expensive and divert valuable funds from the HIV response unless considerable extra funds were to be found by government.

It now seems likely that the STI strategies will select the main risk groups (for HIV and STIs) as its main targets rather than attempt to fund a campaign for the whole community. Ideally government will agree to a National Sexual Health Strategy after this strategy expires with a life, identity — and funding base — of its own.

The strategy documents play a particularly important role for state and territory governments — and the HIV agencies that are funded by them — in outlining a common national response to the epidemic. In my state of Victoria, we only saw the development of a first state HIV/AIDS strategy in 2000. As a member of the drafting committee, the guiding principles of the national strategy, the priority groups and the particular national policy directions outlined were followed as a base for the document we produced. For those states and territories with no strategy of their own, the national strategy becomes an even more important basis on which community agencies can negotiate with government for funding and to ensure that states are abiding by the terms under which they accept their PHOFA monies for HIV/AIDS.

The central principles which underlie the national strategy approach — including the idea of partnership and the centrality of people with HIV/AIDS — are vital tenets for state agencies to be able to point to when dealing with their governments and ensuring that they are consulted and involved in decision-making.

Perhaps the best reason we can give for needing a national strategy is to look at comparable overseas countries that have not adopted our approach from the early days of the epidemic. Both the USA and the UK came late to the idea of a national strategy and they have experienced a disjointed service delivery in HIV/AIDS with different approaches and priorities being adopted by community agencies in health promotion and care and support with little national coordination. Such an environment encourages competition between the various agencies for funds with no overarching policy agreements on which to base funding decisions.

It is clear to me, as a member of the HIV and STI subcommittee of Ministerial Advisory Committee on AIDS Sexual Health and Hepatitis (MACASSH), that the Fifth National Strategy that we have been drafting over the past few months will be an important indicator of trends in the HIV/AIDS epidemic in this country and of what our national response should be. But you needn’t take my word for it. There will be a national consultation process taking place in late August and September where the draft will be circulated through AIDS Councils and PLWHA agencies.

A national meeting of HIV peak bodies will then take place in Adelaide on September 8 to make appropriate changes and hopefully gain overall endorsement for the document from the HIV community. If you’d like to have a look at this document and make your views felt through your local organisation, please do. We want to make sure that the Fifth National Strategy is a vital, relevant and inclusive document. We want it to be more than just a piece of paper.

• The draft of the Fifth National HIV and STI Strategy had not been signed off by the Minister for Health and Ageing at the time of writing this article. These priorities may be changed at the Minister’s request.