HIV/AIDS in Australia

"This page is about the history of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in Australia. For a history of the disease worldwide, see the AIDS pandemic.

The history of HIV/AIDS in Australia is distinctive. Australia was a country which recognised and responded to the AIDS pandemic relatively swiftly, with one of the most successful disease prevention and public health education programs in the world. As a result, despite the disease gaining an early hold in at-risk groups, the country achieved and has maintained a low rate of HIV infection.

HIV/AIDS in Australia

The first recorded Australian death from AIDS occurred in Melbourne in 1983. [World AIDS Day Australia, [http://www.worldaidsday.org.au/internet/wad/publishing.nsf/Content/26-years 26 years of HIV/AIDS] , retrieved September 2007] [William Bowtell, "Australia’s Response to HIV/AIDS 1982-2005", Lowy Institute for International Policy, May 2005, p. 15]

Spurred to action both by the emergence of the disease amongst their social networks and by public hysteria and vilification, gay and lesbian communities and organisations were instrumental in the rapid creation of AIDS councils (though their names varied). These were formed in South Australia, Victoria and Western Australia in 1983, and in NSW, Queensland, Tasmania and the ACT in 1985 (a full list is under "External Links" at the end of this article). [World AIDS Day Australia, [http://www.worldaidsday.org.au/internet/wad/publishing.nsf/Content/26-years 26 years of HIV/AIDS] , retrieved September 2007] [Queensland Association for Healthy Communities, [http://www.qahc.org.au/vision Vision & History] , retrieved September 2007] [AIDS Council of South Australia, [http://www.acsa.org.au/History.html ACSA History] , retrieved September 2007] [Western Australian AIDS Council, [http://www.waaids.com/aboutus/history.html History] , retrieved September 2007] [Tasmanian Council on AIDS, Hepatitis and Related Diseases, [http://www.tascahrd.org.au/index2.htm Welcome to TasCAHRD] , retrieved September 2007] The state and territory AIDS councils, together with other key organisations representing at-risk groups, are gathered under the umbrella organisation the Australian Federation of AIDS Organisations. [Australian Federation of AIDS Organisations, [http://www.afao.org.au/view_articles.asp?pxa=ve&pxs=83&pxsc=120&pxsgc=&id=419 List of members] , retrieved September 2007]

Non-government organisations formed swiftly and have remained prominent in addressing AIDS in Australia. The most notable include the AIDS Trust of Australia, formed in 1987, [AIDS Trust of Australia, [http://www.aidstrust.com.au/index.php?option=com_content&task=blogsection&id=4&Itemid=26 About the Trust] , retrieved October 2007] and the Bobby Goldsmith Foundation, formed around 1984. The Bobby Goldsmith Foundation is Australia's oldest HIV/AIDS charity. [Bobby Goldsmith Foundation, [http://www.bgf.org.au/1_3_presidents_message.html message from the president] , retrieved October 2007] It is named after one of the country's early victims of the disease. Bobby Goldsmith was an Australian athlete and active gay community member who won 17 medals in swimming at the first Gay Olympics, in San Francisco in 1982. [Bobby Goldsmith Foundation, [http://www.bgf.org.au/1_2_who_was_bobby.html who was bobby goldsmith?] , retrieved October 2007] The foundation had its origins in a network of friends who organised care for Goldsmith to allow him to live independently during his illness, until his death in June 1984. This approach to supporting care and independent living in the community is the basis of the Foundation's work, but is also an approach reflected in the activities and priorities of many HIV/AIDS organisations in Australia.

Australian responses to HIV/AIDS

The Australian health policy response to HIV/AIDS has been characterised as emerging from the grassroots rather than top-down, and as involving a high degree of partnership between government and non-government stakeholders. [William Bowtell, "Australia’s Response to HIV/AIDS 1982-2005", Lowy Institute for International Policy, May 2005, pp 18, 21] This response included early government funding for non-government organisations, commencing in the mid-1980s, to support community education and action directed both by and towards members of at-risk populations. The capacity of these groups to respond early and effectively was instrumental in lowering infection rates before government-funded prevention programs were operational. [William Bowtell, "Australia’s Response to HIV/AIDS 1982-2005", Lowy Institute for International Policy, May 2005, p. 31] [Plummer, D. and Irwin, L., ' Grassroots activities, national initiatives and HIV prevention: clues to explain Australia's dramatic early success in controlling the HIV epidemic', "International Journal of STD & AIDS", Vol. 17, No. 12, December 2006, pp 787-793] The response of both governments and NGOs was also based on recognition that social action would be central to controlling the disease epidemic. [Susan Kippax, R.W. Connell, G.W. Dowsett and June Crawford, "Sustaining safe sex: gay communities respond to AIDS", Routledge Falmer (Taylor & Francis), London, 1993, p. 1]

In 1987, a high-profile and controversial advertising program was launched, including television advertisements that featured the grim reaper rolling a ten-pin bowling ball toward a group of people standing in the place of the pins. These advertisements garnered a lot of attention: controversial when released, and continuing to be regarded as effective as well as pioneering television advertising. [ [http://www.theage.com.au/articles/2002/10/05/1033538811932.html 'Top ads? The creators have their say'] , "The Age", 6 October 2002, retrieved September 2007] [Altman D., 'The most political of diseases' in "AIDS in Australia", edited by Timewell E. Minichiello V. and Plummer D., Prentice Hall, 1992]

The willingness of the Australian government to utilise mainstream media to deliver a blunt message through advertising was credited as contributing to Australia's success in managing AIDS. [ABC News, [http://www.abc.net.au/news/stories/2007/04/05/1890228.htm 20 years after Grim Reaper ad, AIDS fight continues] , retrieved September 2007] However the campaign also contributed to stigma for those living with the disease, [AVERT, [http://www.avert.org/aidsstigma.htm HIV and AIDS discrimination and stigma] , retrieved September 2007] particularly in the gay community, an impact one of the advertising scheme's architects later regretted. [B & T, 1 October 2002, [http://www.bandt.com.au/news/a0/0c0113a0.asp Grim Reaper's demonic impact on gay community] , retrieved September 2007]

Australian Governments began in the mid-1980s to pilot or support programs involving needle exchange for intravenous drug users. These remain occasionally controversial, but are reported to have been crucial in keeping the incidence of the disease low, as well as being extremely cost-effective. [William Bowtell, "Australia’s Response to HIV/AIDS 1982-2005", Lowy Institute for International Policy, May 2005, p. 27] [Australian National Council on AIDS, Hepatitis C and Related Diseases, 2000, [http://www.health.gov.au/internet/main/publishing.nsf/content/BF779AA5E45815C6CA25712400081717/$File/review.pdf "Needle & Syringe Programs: a Review of the Evidence"] , retrieved 29 August 2008]

HIV/AIDS quickly became a more severe problem for several countries in the region around Australia, notably Papua New Guinea and Thailand, than it was within Australia itself. This led Australian governments and non-government organisations to place an increasing emphasis on international initiatives, particularly aimed at limiting the spread of the disease. In 2000, the Australian government introduced a $200 million HIV/AIDS prevention program that was targeted at south-east Asia. [Department of Foreign Affairs and Trade, "Advancing the National Interest: Australia's Foreign and Trade Policy White Paper", [http://www.dfat.gov.au/ani/chapter_10.html Projecting Australia and its Values] , 2003, retrieved September 2007] In 2004, this was increased to $600 million over the six years to 2010 for the government's international HIV/AIDS response program, called "Meeting the Challenge". [William Bowtell, "Australia’s Response to HIV/AIDS 1982-2005", Lowy Institute for International Policy, May 2005, p. 10] Australian non-government organisations such as the AIDS Trust are also involved in international efforts to combat the illness. [THe AIDS Trust, [http://www.aidstrust.com.au/index.php?option=com_content&task=blogsection&id=11&Itemid=34 Our Projects: Hope For Children - Cambodia] , retrieved October 2007]

HIV/AIDS and Australian Law

In response to the risks of HIV/AIDS transmission, some governments (eg. Denmark) passed legislation designed specifically to criminalise intentional transmission of HIV/AIDS. [The Global Network of People Living with HIV/AIDS Europe and the Terrence Higgins Trust, [http://www.gnpplus.net/criminalisation/index.shtml Criminalisation of HIV transmission in Europe] , 2005, retrieved September 2007]

Convictions

Australia has not enacted specific laws and there have been only a small number of, mostly recent, prosecutions under existing state laws, with four convictions recorded between 2004 and 2006. [Sally Cameron, [http://www.afao.org.au/view_articles.asp?pxa=ve&pxs=103&pxsc=127&pxsgc=139&id=620 'HIV on Trial'] , "HIV Australia", vol. 5, no. 4, 2007, retrieved September 2007]

The case of Andre Chad Parenzee, convicted in 2006 and unsuccessfully appealed in 2007, secured widespread media attention as a result of expert testimony given by a Western Australian medical physicist that HIV did not lead to AIDS. [Jeremy Roberts, [http://www.theaustralian.news.com.au/story/0,20867,21151217-23289,00.html 'HIV experts line up to refute denier'] , "The Australian", 1 February 2007, retrieved September 2007] [Sally Cameron, [http://www.afao.org.au/view_articles.asp?pxa=ve&pxs=103&pxsc=127&pxsgc=139&id=620 'HIV on Trial'] , "HIV Australia", vol. 5, no. 4, 2007, retrieved September 2007] [National Health and Medical Research Council (NHMRC), [http://nhmrc.gov.au/news/media/rel07/hiv_aids.htm 'NHMRC says link between HIV and AIDS "overwhelming"'] , Media Release, 4 May 2007, retrieved September 2007]

In February 2008, Hector Smith, aged 41, a male prostitute in the Australian Capital Territory, an HIV-positive person, pleaded guilty in the ACT Magistrates Court to providing a commercial sexual service while knowing he was infected with a sexually-transmitted disease (STD) and failing to register as a sex worker. [ [http://www.news.com.au/story/0,23599,23174950-421,00.html An HIV-positive male prostitute has admitted to potentially spreading the deadly virus.] , Kate Corbett, News Ltd, 7 February 2008, accessed 10 February 2008] Under ACT law it is illegal to provide or receive commercial sexual services if the person knows, or could reasonably be expected to know, that he or she is infected with a STD.

Discrimination

Australian governments have made it illegal to discriminate against a person on the grounds of their health status, including having HIV/AIDS. [William Bowtell, "Australia’s Response to HIV/AIDS 1982-2005", Lowy Institute for International Policy, May 2005, p. 19. See, for example [http://www.austlii.edu.au/au/legis/cth/consol_act/dda1992264/s5.html section 5 of the "Disability Discrimination Act 1992"] .]

Case law

Australia was one of the first countries to screen all blood donors for HIV antibodies, [World AIDS Day Australia, [http://www.worldaidsday.org.au/internet/wad/publishing.nsf/Content/26-years 26 years of HIV/AIDS] , retrieved September 2007] with screening in place for all transfused blood since March 1985. [Victorian Department of Human Services, [http://www.health.vic.gov.au/ideas/diseases/sti_hosaids Hospitals, AIDS & you] , retrieved September 2007] This was not before infection was spread through contaminated blood, resulting in legal cases in the 1980s around whether screening had been appropriately implemented. One issue highlighted in the course of those actions was the challenge of medical litigation under statutes of limitation. A disease such as AIDS that can lie latent or undiagnosed for a long period of time may only emerge after the time period for litigation has elapsed, preventing examination of medical liability. ["Dwan v. Farquhar", 1 Qd. R. 234, 1988] Concerns about the integrity of the blood supply resurfaced following a case of the contraction of HIV by transfusion in Victoria in 1999. This led to the introduction of new blood screening tests, which also improved screening in relation to Hepatitis C. [Australian Health Ministers, [http://health.gov.au/internet/main/publishing.nsf/Content/health-mediarel-yr1999-mw-hmc1.htm Health Ministers agree to new blood screening test] , 4 August 1999, retrieved 29 August 2008]

Ongoing research and awareness-raising efforts

The Sydney Gay and Lesbian Mardi Gras, one of the largest street parades and gay and lesbian events in the world, [New Mardi Gras, [http://www.mardigras.org.au/internal.cfm?sub=History&nav=About%20us ABout Us - History] ] , retrieved September 2007] has HIV/AIDS as a significant theme, and is one of a number of pathways through which the non-government sector in Australia continues to address the disease. [Dennis Altman, "Global Sex", Allen & Unwin, Sydney, 2001, p. 83]

Australian researchers have been active in HIV/AIDS research since the early 1980s. [See for example the [http://www.nchecr.unsw.edu.au/NCHECRweb.nsf/resources/Publications_1/$file/peerRev.pdf Publications List] of participants in the National Centre in HIV Epidemiology & Clinical Research dating back to 1983] The most prominent research organisation in the field is the National Centre in HIV Epidemiology & Clinical Research, based at the University of New South Wales, which has stated that it focusses on epidemiology, clinical research and clinical trials. [ [http://www.nchecr.unsw.edu.au/ National Centre in HIV Epidemiology & Clinical Research] , retrieved September 2007] It also prepares the annual national surveillance reports on the disease. In 2006 the Centre received just under $AUS4 million in Commonwealth government funding, as well as several million dollars of funding from both public and pharmaceutical industry sources. [National Centre in HIV Epidemiology & Clinical Research, [http://notes.med.unsw.edu.au/nchecrweb.nsf/resources/AR_06/$file/06_annrep.pdf Annual Report 2006] , retrieved September 2007] Three other research centres are also directly Commonwealth funded to investigate different facets of HIV/AIDS: the National Centre in HIV Social Research (NCHSR); the Australian Centre for HIV and Hepatitis Virology Research (ACH2) (formerly the National Centre for HIV Virology Research); and the Australian Research Centre in Sex, Health and Society (ARCSHS).

HIV/AIDS in Australia since 2000

As at December 2005, there had been 22 361 diagnosed HIV infections and 6668 deaths following AIDS in Australia, and just over 15 000 people were living with HIV/AIDS including a low but growing proportion of women. [Ann McDonald [http://www.nchecr.unsw.edu.au/NCHECRweb.nsf/resources/SurvReports_4/$file/06_ansurvrp_rev.pdf "HIV/AIDS, Viral Hepatitis & Sexually Transmissible Infections in Australia Annual Surveillance Report"] , National Centre in HIV Epidemiology and Clinical Research, 2006, retrieved September 2007, p. 9] Survival time for people with AIDS has improved over time, in part through the introduction of antiretroviral drug treatments. [Yueming Li, Ann M. McDonald, Gregory J. Dore, and John M. Kaldor, 'Improving survival following AIDS in Australia, 1991-1996', "AIDS", Vol. 14, No. 15, pp 2349-2354, 2000]

While the spread of the disease has been limited with some success, HIV/AIDS continues to present challenges in Australia. The Bobby Goldsmith Foundation reports that nearly a third of people with HIV/AIDS in New South Wales (the state with the largest infected population) are living below the poverty line. [Bobby Goldsmith Foundation, [http://www.bgf.org.au/1_3_presidents_message.html message from the president] , retrieved October 2007] Living with HIV/AIDS is associated with significant changes in employment and accommodation circumstances. [D. Ezzy, R. De Visser, I. Grubb and D. McConachy, 'Employment, accommodation, finances and combination therapy: the social consequences of living with HIV/AIDS in Australia', "AIDS Care", Vol. 10, No. 2, 1998, p. 189-199] [D. Ezzy, R. De Visser and M. Bartos, 'Poverty, disease progression and employment among people living with HIV/AIDS in Australia', "AIDS Care", Vol. 11, No. 4, 1999, p. 405-414]

After the initial success in limiting the spread of AIDS, infection rates began to rise again in Australia, though they remained low by global standards. After dropping to 656 new reported cases in 2000, the rate rose to 930 in 2005. [ Ann McDonald [http://www.nchecr.unsw.edu.au/NCHECRweb.nsf/resources/SurvReports_4/$file/06_ansurvrp_rev.pdf "HIV/AIDS, Viral Hepatitis & Sexually Transmissible Infections in Australia Annual Surveillance Report"] , National Centre in HIV Epidemiology and Clinical Research, 2006, retrieved September 2007] Transmission continued to be predominantly through sexual contact between men, in contrast to many high-prevalence countries in which it was increasingly spread through heterosexual sex. [ Ann McDonald [http://www.nchecr.unsw.edu.au/NCHECRweb.nsf/resources/SurvReports_4/$file/06_ansurvrp_rev.pdf "HIV/AIDS, Viral Hepatitis & Sexually Transmissible Infections in Australia Annual Surveillance Report"] , National Centre in HIV Epidemiology and Clinical Research, 2006, retrieved September 2007] [Dennis Altman, "Global Sex", Allen & Unwin, Sydney, 2001, p. 78] Indeed, the majority of new Australian cases of HIV/AIDS resulting from heterosexual contact have arisen through contact with a partner from a high-prevalence country (particularly from sub-Saharan Africa or parts of south-east Asia). [Ann McDonald, [http://www.afao.org.au/view_articles.asp?pxa=ve&pxs=103&pxsc=127&pxsgc=138&id=619 'HIV infection attributed to heterosexual contact in Australia, 1996 – 2005'] , "HIV Australia", Vol. 5, No. 4, 2007, retrieved September 2007]

The new trend toward an increase in HIV infections prompted the government to indicate it was considering a return to highly visible advertising. [Sydney Morning Herald, 5 April 2007, [http://www.smh.com.au/news/National/Grim-AIDS-ads-needed-again-experts/2007/04/05/1175366367007.html Govt considering funding AIDS campaign] , retrieved September 2007] Reflecting this concern with the rise in new cases, Australia's fifth National HIV/AIDS Strategy (for the period 2005-2008) was titled "Revitalising Australia’s Response", and placed an emphasis on education and the prevention of transmission. [Department of Health and Ageing, [http://www.health.gov.au/internet/main/Publishing.nsf/Content/health-pubhlth-strateg-hiv_hepc-hiv-index.htm#strategy The National HIV/AIDS Strategy 2005-2008: Revitalising Australia’s Response] , retrieved 29 August 2008]

References

External links

Australian government official information source on HIV/AIDS:
* [http://www.health.gov.au/internet/main/Publishing.nsf/Content/health-pubhlth-strateg-hiv_hepc-hiv-index.htm Australian Department of Health and Ageing resources on HIV/AIDS in Australia]

The AIDS councils and their peak representative body:
* [http://www.afao.org.au/index.asp Australian Federation of AIDS Organisations]
* [http://aidsaction.org.au/ AIDS Action Council of the ACT]
* [http://www.acon.org.au/ AIDS Council of New South Wales]
* [http://www.ntahc.org.au/ Northern Territory AIDS and Hepatitis Council]
* [http://www.qahc.org.au Queensland Association for Healthy Communities]
* [http://www.acsa.org.au/ AIDS Council of South Australia]
* [http://www.tascahrd.org.au/index2.htm Tasmanian Council on AIDS, Hepatitis and Related Diseases]
* [http://www.vicaids.asn.au/content/ContentPage.asp?SectionID=39 Victorian AIDS Council]
* [http://www.waaids.com/ Western Australian AIDS Council]

The four Commonwealth government-funded research centres:
* [http://nchsr.arts.unsw.edu.au/ The National Centre in HIV Social Research]
* [http://www.nchecr.unsw.edu.au/ The National Centre in HIV Epidemiology and Clinical Research (NCHECR)]
* [http://www.hiv.edu.au/ Australian Centre for HIV and Hepatitis Virology Research]
* [http://www.latrobe.edu.au/arcshs/index.html Australian Research Centre in Sex, Health and Society]

Other HIV/AIDS organisations:
* [http://www.bgf.org.au/ Bobby Goldsmith Foundation]
* [http://www.aidstrust.com.au/ AIDS Trust of Australia]
* [http://www.slq.qld.gov.au/find/webcasts/all#aids Bill Bowtell speaks about Aids in Australia] at the State Library of Queensland. He revisits Australia's successes in containing HIV/AIDS and introduces the idea of a renewed threat on our doorstep which could destabilise the Asia-Pacific region.
*The [http://www.youtube.com/watch?v=eDVASm_NA1E Grim Reaper TV advertisement] , at YouTube, retrieved September 2007.