HIV/AIDS in Australia
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.
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 New South Wales, Queensland, Tasmania and the Australian Capital Territory in 1985 (a full list is under External Links at the end of this article).13456 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.7
Non-governmental organisations formed swiftly and have remained prominent in addressing AIDS in Australia. The most notable include the AIDS Trust of Australia, formed in 1987,8 and the Bobby Goldsmith Foundation, formed around 1984. The Bobby Goldsmith Foundation is Australia's oldest HIV/AIDS charity.9 The Foundation is named in honour of Bobby Goldsmith, one of Australia's early victims of the disease, who was an athlete and active gay community member, who won 17 medals in swimming at the first Gay Olympics, in San Francisco in 1982.10 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.
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.12 The capacity of these groups to respond early and effectively was instrumental in lowering infection rates before government-funded prevention programs were operational.1314 The response of both governments and NGOs was also based on recognition that social action would be central to controlling the disease epidemic.15
In 1987, a famous 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.1617
The willingness of the Australian government to use mainstream media to deliver a blunt message through advertising was credited as contributing to Australia's success in managing HIV.18 However the campaign also contributed to stigma for those living with the disease,19 particularly in the gay community, an impact one of the advertising scheme's architects later regretted.20
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.2122
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.23 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.24 Australian non-government organisations such as the AIDS Trust are also involved in international efforts to combat the illness.25
In response to the risks of HIV transmission, some governments (e.g. Denmark) passed legislation designed specifically to criminalise intentional transmission of HIV.26
Australia has not enacted specific laws and there have been only a small number of prosecutions under existing state laws, with four convictions recorded between 2004 and 2006.27
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.272829
In February 2008, Hector Smith, aged 41, a male prostitute in the Australian Capital Territory who is HIV-positive, 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.30 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 sexually transmitted infection (STI). In January 2009 Melbourne man Michael Neal was jailed for 18 years (with a minimum term of thirteen years, nine months) for deliberately infecting and trying to infect sexual partners with HIV without their knowledge, despite multiple warnings from the Victorian Department of Human Services.31
Australian governments have made it illegal to discriminate against a person on the grounds of their health status, including having HIV/AIDS;32 for example, see Disability Discrimination Act, 1992 (Cwlth). However HIV positive individuals may still be denied immigration visas on the grounds that their treatment takes up limited resources and is a burden for taxpayers.33
Australia was one of the first countries to screen all blood donors for HIV antibodies,1 with screening in place for all transfused blood since March 1985.34 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 medical condition such as HIV 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.35 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.36
The Sydney Mardi Gras, one of the largest street parades and gay and lesbian events in the world,37 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.38
Australian researchers have been active in HIV/AIDS research since the early 1980s.39 The most prominent research organisation is the Kirby Institute (formerly National Centre in HIV Epidemiology & Clinical Research), based at the University of New South Wales, regarded as a leading research institution internationally, and a recipient of one of the first grants of the Bill & Melinda Gates Foundation outside the United States.40 The Centre focusses on epidemiology, clinical research and clinical trials.41 It also prepares the annual national surveillance reports on the disease. In 2006 the Centre received just under A$4 million in Commonwealth government funding, as well as several million dollars of funding from both public and pharmaceutical industry sources.42 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).
As at December 2005, there had been 22,361 diagnosed HIV infections and 6,668 deaths following AIDS in Australia, and just over 15,000 people were living with HIV/AIDS including a low but growing proportion of women.43 Survival time for people with HIV has improved over time, in part through the introduction of antiretroviral drug treatments.44
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.9 Living with HIV/AIDS is associated with significant changes in employment and accommodation circumstances.4546
After the initial success in limiting the spread of HIV, 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 2005.47 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.4748 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).49
The new trend toward an increase in HIV infections prompted the government to indicate it was considering a return to highly visible advertising.50 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.51
On 19 October 2010, The Sydney Morning Herald reported that 21,171 Australians have HIV, with 1,050 new cases diagnosed in 2009. The Sydney Morning Herald also reported that 63% of Australians living with HIV were men who have sex with men, and 3% were injecting drug users.52
On 17 October 2012, The Daily Telegraph reported that up to 35,000 Australians have HIV, with 1,137 new cases diagnosed in 2011. The Kirby Institute data shows 72% of people diagnosed from 2007-2011 were men who had sex with men, while heterosexual contact accounted for 16% and 2% from injecting drug use.53
- Altman, Dennis (2001). Global Sex. Chicago: University of Chicago Press. p. 216. ISBN 0-226-01606-4.
- Bowtell, William (May 2005). "Australia’s Response to HIV/AIDS 1982–2005" (PDF; requires download). HIV/AIDS Project (Lowy Institute for International Policy).
- "26 years of HIV/AIDS". World AIDS Day Australia. Retrieved September 2007.
- Bowtell. p. 15. Missing or empty
- "Vision & History". Queensland Association for Healthy Communities. Retrieved September 2007.
- "ACSA History". AIDS Council of South Australia. Retrieved September 2007.
- "History". Western Australian AIDS Council. Retrieved September 2007.
- "Welcome to TasCAHRD". Tasmanian Council on AIDS, Hepatitis and Related Diseases. Retrieved September 2007.
- "List of members". Australian Federation of AIDS Organisations. Retrieved September 2007.
- "About the Trust". AIDS Trust of Australia. Retrieved October 2007.
- "Message from the President". Bobby Goldsmith Foundation. Retrieved October 2007.
- "Who was Bobby Goldsmith?". Bobby Goldsmith Foundation. Retrieved October 2007.
- Sendziuk, Paul. "Denying the Grim Reaper: Australian Responses to AIDS". Eureka Street. Retrieved January 2009.
- Bowtell. pp. 18, 21. Missing or empty
- Bowtell. p. 31. Missing or empty
- Plummer, D; Irwin, L (December 2006). "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 17 (12): 787–793.
- Kippax, Susan; Connell, R.W; Dowsett, G.W; Crawford, June (1993). Sustaining safe sex: gay communities respond to AIDS. London: Routledge Falmer (Taylor & Francis). p. 1.
- "Top ads? The creators have their say". The Age. 6 October 2002. Retrieved September 2007.
- Altman, D (1992). "The most political of diseases". In Timewell, E; Minichiello, V; Plummer, D. AIDS in Australia (Prentice Hall).
- "20 years after Grim Reaper ad, AIDS fight continues". ABC News (Australia). Retrieved September 2007.
- "HIV and AIDS discrimination and stigma". AVERT. Retrieved September 2007.
- "Grim Reaper's demonic impact on gay community". B & T. 1 October 2002. Retrieved September 2007.
- Bowtell. p. 27. Missing or empty
- "Needle & Syringe Programs: a Review of the Evidence" (PDF). Australian National Council on AIDS, Hepatitis C and Related Diseases. 2000. Retrieved 29 August 2008.
- "Projecting Australia and its Values". Advancing the National Interest: Australia's Foreign and Trade Policy White Paper. Department of Foreign Affairs and Trade. 2003. Retrieved September 2007.
- Bowtell. p. 10. Missing or empty
- "Our Projects: Hope For Children – Cambodia". The AIDS Trust. Retrieved October 2007.
- "Criminalisation of HIV transmission in Europe". The Global Network of People Living with HIV/AIDS Europe and The Terrence Higgins Trust. 2005. Retrieved September 2007.
- Cameron, Sally (2007). "HIV on Trial". HIV Australia 5 (4). Retrieved September 2007.
- Roberts, Jeremy (1 February 2007). "HIV experts line up to refute denier". The Australian. Retrieved September 2007.
- "NHMRC says link between HIV and AIDS "overwhelming"" (Press release). National Health and Medical Research Council (NHMRC). 4 May 2007. Retrieved September 2007.
- Corbett, Kate (7 February 2008). "An HIV-positive male prostitute has admitted to potentially spreading the deadly virus". News.com.au. Retrieved 10 February 2008.
- "Man jailed for trying to spread HIV". Yahoo! News. 6 January 2009. Retrieved 19 January 2009.
- Bowtell. p. 19. Missing or empty
- Sean Parnell (6 July 2012). "Sponsored workers bumping up HIV bill". The Australian (News Limited). Retrieved 24 February 2013.
- Victorian Department of Human Services, Hospitals, AIDS & you |accessdate=September 2007
- Dwan v. Farquhar, 1 Qd. R. 234, 1988
- "Health Ministers agree to new blood screening test" (Press release). Australian Health Ministers. 4 August 1999. Retrieved 29 August 2008.
- "About us – History". New Mardi Gras. Retrieved September 2007.
- Altman (2001). p. 83. Missing or empty
- See for example the Publications List of participants in the National Centre in HIV Epidemiology & Clinical Research dating back to 1983.
- Lebihan, Rachel (16–17 April 2011). "Top class research fails to get local support". Weekend Australian Financial Review. p. 31.
- "National Centre in HIV Epidemiology & Clinical Research". Retrieved September 2007.
- "Annual Report" (PDF). National Centre in HIV Epidemiology & Clinical Research. 2006. Retrieved September 2007.
- McDonald, Ann (2006). "HIV/AIDS, Viral Hepatitis & Sexually Transmissible Infections in Australia Annual Surveillance Report" (PDF). National Centre in HIV Epidemiology and Clinical Research. p. 9. Retrieved September 2007.
- Li,, Yueming; McDonald, Ann M; Dore, Gregory J; Kaldor, John M. "Improving survival following AIDS in Australia, 1991–1996". AIDS 14 (15): 2349–2354, 2000.
- Ezzy, D; De Visser, R; Grubb, I; McConachy, D (1998). "Employment, accommodation, finances and combination therapy: the social consequences of living with HIV/AIDS in Australia". AIDS Care 10 (2): 189–199.
- Ezzy, D; De Visser, R; Bartos, M (1999). "Poverty, disease progression and employment among people living with HIV/AIDS in Australia". AIDS Care 11 (4): 405–414.
- McDonald, Ann (2006). "HIV/AIDS, Viral Hepatitis & Sexually Transmissible Infections in Australia Annual Surveillance Report" (PDF). National Centre in HIV Epidemiology and Clinical Research. Retrieved September 2007.
- Altman (2001). p. 78. Missing or empty
- McDonald, Ann (2007). "HIV infection attributed to heterosexual contact in Australia, 1996 – 2005". HIV Australia 5 (4). Retrieved September 2007.
- "Govt considering funding AIDS campaign". The Sydney Morning Herald. AAP. 5 April 2007. Retrieved September 2007.
- "The National HIV/AIDS Strategy 2005–2008: Revitalising Australia’s Response". Department of Health and Ageing. Retrieved 29 August 2008.
- Benson, Kate (19 October 2010). "HIV rate rising but other infections less common". The Sydney Morning Herald. Retrieved 19 October 2010.
- Evelyn Yamine (17 October 2012). "HIV cases in Australia is on the rise". The Daily Telegraph. Retrieved 22 October 2012.
Australian government official information source on HIV/AIDS:
The AIDS councils and their peak representative body:
- Australian Federation of AIDS Organisations
- AIDS Action Council of the ACT
- AIDS Council of New South Wales
- Northern Territory AIDS and Hepatitis Council
- Queensland Association for Healthy Communities
- AIDS Council of South Australia
- Tasmanian Council on AIDS, Hepatitis and Related Diseases
- Victorian AIDS Council
- Western Australian AIDS Council
The four Commonwealth government-funded research centres:
- The National Centre in HIV Social Research
- The National Centre in HIV Epidemiology and Clinical Research (NCHECR)
- Australian Centre for HIV and Hepatitis Virology Research
- Australian Research Centre in Sex, Health and Society
Other HIV/AIDS organisations:
- Bobby Goldsmith Foundation
- AIDS Trust of Australia
- 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 Grim Reaper TV advertisement, at YouTube, retrieved September 2007.
- AIDS Australia
- ASHM | Supporting the HIV, Viral Hepatitis and Sexual Health Workforce
HIV/AIDS initiatives in Australia:
- Melbourne Declaration | Action on HIV!
- Implementing the United Nations Political Declaration on HIV/AIDS in Australia's HIV Domestic Response: Turning Political Will into Action