The National HIV/AIDS Strategy: Opportunities for the HIV-positive community?

The 5th National HIV/AIDS strategy document — launched by health minister Tony Abbott in Sydney on June 23 — has some opportunities in it for HIV-positive people and their organisations to work at improving services and initiatives, particularly in the treatments care and support areas.

NAPWA worked closely with the writers of the Strategy document through our representation on the HIV/Sexually Transmissible Infections subcommittee of the Ministerial Advisory Committee on HIV Hepatitis and Sexual Health (MACASSH) and while the final product does not give us everything we asked for, it is a workable document which we hope will be implemented fully with sufficient dollars attached to it.

A meeting is to be held between MACASSH and the Intergovernmental Committee on HIV/AIDS and Related Diseases (IGCHARD) in August to map out an implementation plan for the strategy — hopefully to translate the promises in the document into achievable, funded activities and agreed outcomes.

There are a number of important promises made in the strategy.

Firstly, there is to be a new, targeted, national education and health promotion campaign for priority groups, particularly for gay and homosexually active men. The substantial increases in HIV infections in the gay community (close to 20 percent nationally) in 2002 have dropped in most states but not to previous levels. Approaches to HIV prevention will include education about the role played by sexually transmissible infections in HIV transmissions, working with internet chat sites and producing culturally appropriate messages for changing gay communities.

Importantly, this strategy acknowledges the importance of involving positive people in prevention campaigns.

“Overwhelmingly, positive people have acted with great care and responsibility in the prevention of HIV transmission,” the strategy document says. “Positive people play an important education role in maintaining and reinforcing the practice and understanding of safe sex”, it says, calling for the development of education prevention programs for people living with HIV/AIDS. I believe this is an opportunity for PLWHA organisations to play a greater role in health promotion and HIV prevention work — and that positive people will be more comfortable and trusting of these messages coming from their peer organisations.

Secondly, a new priority of the strategy will be addressing the care and support needs of people with HIV. As we live longer with the virus [1]A small infective organism which is incapable of reproducing outside a host cell. and grow older, the complexity of our care and support needs will become greater. We are hopeful that a national mapping exercise will be conducted to examine and address gaps in services for positive people in each of the states and territories — particularly in areas like supported accommodation, cognitive impairment, mental health, drug and alcohol and welfare (including addressing high levels of poverty).

Managing the side effects of treatments, maintaining adherence to regimens and ensuring access to the latest treatments are major priorities of the strategy This includes managing long-term toxicities like lipodystrophy and their impact on the physical and mental wellbeing of people living with HIV/AIDS. The government has accepted that structured treatment breaks are a reality in the world of HAART [2]Highly Active AntiRetroviral Therapy ??? aggressive treatment of HIV infection using several different drugs together., suggesting that if they are taken, they must be taken with consultation with a doctor.

There is a specific section on the particular challenges for women with HIV and the need to increase the visibility of HIV-positive women in the epidemic and encourage their involvement in service delivery and educational initiatives.

Measures to address possible future shortages in HIV-trained GPs and to help reduce some of the current financial disincentives for doctors to work in this complex area are to be examined as part of the strategy. HIV-positive patients in the larger capital cities are starting to notice difficulties getting into their HIV-experienced GP of choice and it is clear that efforts need to be made, in consultation with the medical profession, to ensure that there is an adequate supply of trained medical personnel working in HIV into the future.

Other initiatives are included to address the needs other priority groups including injecting drug users, Aboriginal and Torres Strait Islander people, people from countries with high prevalence of HIV, people in custodial settings, and the increasing work which Australian community agencies are doing to help our international neighbours with HIV prevention and care (some of which NAPWA is involved with — including work in developing positive people’s groups in Papua New Guinea, East Timor and other countries in our region).

Apart from the promises made for initiatives, the other crucial part of this document is the principles it espouses that underlie the HIV/AIDS response. The principle of an equal partnership between community, the medical profession, researchers and government is stated and it is a central tenant that has helped Australia deliver one of the best international responses to the virus so far. The acknowledgement of the centrality of positive people to the response, the principle of harm minimisation as the approach to injecting drug use and the need for the government to provide leadership in combating HIV/AIDS are all stated in the document — which is encouraging.

As such then it is a promise and commitment from government to keep up the funding and support for Australia’s community response and to keep HIV as a government priority. Some community leaders had been worried that we would not even get a strategy document for another three-year period this time or maybe one that we could live with.

This document has been broadly accepted by the various community players but, as always, the proof of the pudding is in the eating, so we will look forward to see how well it is resourced and implemented.

David Menadue is vice-president of NAPWA.