At this ceremony I was proud to be able to renew our commitment, with the ACT Government and our other partners, to the local response to HIV/AIDS. There is mounting evidence, however, that the Commonwealth Government is failing in its leadership responsibilities and is wavering in Australia’s previous commitment to an effective national response.
This is particularly alarming at this point in time. Victoria experienced a decade of decline in new HIV notifications from 1990 to a low point of 140 in 1999. These figures have increased over the last three years, with 234 new infections reported in 2002. Victorian infections are now at a level not seen since 1994. The Victorian figures could well translate into a national trend. In addition, sexually transmissible infections are increasing. The recent report “Sex in Australia”, released by the Australian Research Centre in Sex, Health and Society, shows that Australians generally have poor knowledge about the transmission and health consequences of sexually transmitted infections.
In 1999, in the current Fourth National HIV/AIDS Strategy, the then Commonwealth Health Minister Michael Wooldridge wrote "Australia's comprehensive national approach to responding to HIV/AIDS has long been regarded as one of the best in the world." He stated that the Strategy was built on an important foundation established under previous HIV/AIDS Strategies - the partnership between and with affected communities, governments at all levels, and medical, scientific and health-care professionals. He described the partnership as an effective, cooperative effort, working together to control the spread of HIV and to minimise the social and personal impacts of the disease, based on a commitment to consultation and joint decision-making in all aspects of the response. He committed the Commonwealth to a strong leadership role.
This Strategy, which expires in June 2004, is strong. It has guided our community based response to HIV/AIDS. However, the structures to monitor its implementation have been ineffective. The Commonwealth has failed to address difficult issues.
Little progress has been made with Commonwealth law reform to support the Strategy. There is little evidence of a ‘whole of government’ approach to HIV/AIDS. Advisory structures, especially the peak advisory body, the Australian National Council on AIDS, Hepatitis and Related Diseases (ANCAHRD), have been dysfunctional, often ignoring advice from expert sub-committees. The Commonwealth refuses to fund a national peak sex worker group, excluding a vital group from the partnership, when a recent Australian study found that one in six Australian men have paid for sex at some time. There is no transparency for HIV/AIDS funding. It is impossible to track where, how, or even if, HIV/AIDS money is spent. The future of continued dedicated Commonwealth funding for the three national HIV research centres in Australia remains uncertain. There have been attacks on harm reduction strategies relating to injecting drug use, particularly needle and syringe programs.
In light of these concerns, the Federal Health Minister, Senator Kay Patterson, agreed to an early and extensive review of the 4th National Strategy. The Review was completed and delivered to her in November 2002, together with recommendations for substantial improvements, including the swift development of a 5th National Strategy.
Some six months later, the Commonwealth has neither released nor responded to the report. In her only action so far, Senator Patterson has twice extended the term of ANCAHRD, despite its ineffectiveness. This protracted silence is disturbing and irresponsible.
To make matters worse, the capacity of the HIV/AIDS section of the Commonwealth Health Department has hit an all time low. Significant staff turnover and downgrading of staff resources has led to loss of continuity, historical knowledge and experience working within the partnership approach.
The shortcomings of the Public Health Outcomes Funding Agreements, through which Commonwealth funds for HIV/AIDS are distributed to the States and Territories, have not been addressed. It remains impossible to track funds targeted to HIV/AIDS prevention initiatives, let alone evaluate their effectiveness. There has been no indication of when the agreed review of this funding mechanism might take place.
The Commonwealth lacks leadership and is withdrawing from the partnership in spirit and practice. A salient example is the failure to actively promote “Return on the Investment”, an Australian study of the cost effectiveness and efficacy of needle and syringe programs. An estimated 25,000 HIV infections had been prevented by 2000. 4 500 deaths will have been averted by 2010. In other words, our HIV epidemic would have been double what it is today without needle and syringe programs. The net savings to the Australian community, through HIV cases avoided thus far, total $6.9 billion.
A responsible government would promote “Return on the Investment” in defence of harm reduction. Sadly, the report has received little active promotion from the Commonwealth. The Howard Government spends increasing resources on the reduction of illicit drug supply and is increasingly less committed to harm reduction policies and initiatives that work. Howard opposes medically supervised injecting facilities and heroin trials. This inhibits our ability to explore new approaches that could ultimately save lives and reduce the impact on individuals and communities.
In the current climate, the continued success of the ‘partnership’ approach is under threat. In addition, the proposed changes to Medicare, the Pharmaceutical Benefits Scheme and the Disability Support Pension, will reduce essential support for men and women living with HIV/AIDS and others with long term chronic illnesses.
The community sector is eager for an effective and meaningful partnership, but the Commonwealth marginalises partnership members and is dismissive of advice from the coalface. Non-government agencies are bold and innovative in pursuing evidence-based strategies, but the Commonwealth is cautious, censorious, and disregards effective approaches. The community is willing to address difficulties within the current national response. The Commonwealth is silent.
The Victorian figures remind us that we cannot afford to be complacent. Senator Patterson has sat on the findings of the Review of the 4th National HIV/AIDS Strategy for too long. She must make it public immediately. The Commonwealth must respond to the Review’s recommendations. It must keep Michael Wooldridge’s promise to take a strong leadership role. It must advance a 5th National HIV/AIDS Strategy as a matter of urgency.
Only then can all players have renewed confidence in the partnership approach which has been internationally recognised as the key factor in Australia’s successful response to HIV/AIDS, until now.
Joey Tabone is President of the AIDS Action Council of the ACT.
To page top