HIV Prevention in Australian Society - Case Study Example

HIV PREVENTION IN AUSTRALIAN SOCIETY Insert student’s name October 26, 2013. HIV PREVENTION IN AUSTRALIAN SOCIETY Abstract The review is on the response and preventive measures that have Australia have put in place since the first case was reported in 1983. It highlights the characteristics of HIV infections in Australia. It examines some of the approaches that Australia had in place, and their success in containing the spread of HIV. Some of the laws considered are drug laws, and laws prohibiting homosexual acts. Keywords HIV prevention, sexual risk behavior, use of condoms, HIV prevalence, homosexuality and sex, HIV awareness. Introduction In Australia, in 12 months the rate of people newly diagnosed with HIV increased by 10%. This was the largest that was reported in 20 years. In 2012, 1,253 HIV cases were as a result of unprotected sex in men. This is the most common means of transmission. From 1999, the number of new cases have greatly increased for the past 14 years. After the onset of HIV/AIDS in 1980, STIs rates decreased not only among gay but also homosexually active men. This was attributed to widespread decrease in unsafe sexual behavior, greater HIV awareness, and increased testing. From mid 1990s, there have been increased unprotected anal intercourse with casual partners homosexually active and gay men. It also highlights the current epidemiology of HIV in Australia (Bourne, Edwards, Shaw, et al. 2008, p. 189). Objective To determine both the acceptability and epidemiological effects of increase in HIV testing in homosexuals, and heterosexual men in Australia. Australia for years has considered treatment as a prevention measure. This article will further review, the status of HIV in Australia, and the preventive measures that have been undertaken. The purpose of the review is to examine the prevalence of HIV in Australia, and measures that have been taken prevent new infections. Setting The survey was conducted in a clinical setting. About 300 individuals were tested for HIV. Men who were diagnosed with HIV were asked whether they have constantly used condoms, and have tried serosort i.e only had sex with only men who they were sure of their HIV status. The rate of the HIV diagnosis among men who had attempted to use condoms was 1.5%. However, among persons who tried to have unprotected sex with only those they knew their HIV status was 2.6%. However, among men who had unprotected sex regardless of the status stood at 4.1%. Consistent use of condoms among heterosexual and homosexual men prevented HIV infections by 76%. The selected group were tested for HIV in order to determine the prevalence of HIV. This was compared with available literature. Bowtell (2005, p. 13), one of the key solutions to the spread of HIV in Australia is through voluntary testing and counselling. Among the gay community, the rate of HIV testing is high compared to other high risk groups. On the voluntary testing and counselling, it was evident that about 70% of young gay men frequently visit the testing centers (Dickson and Davidson, 2006, p. 45). This is because they engage in short term relationship which prove more risk. The current epidemiology of HIV in Australia Recent data indicate that new HIV diagnoses are increasing in Australia. For the past five years, the number of new HIV diagnoses have increased. In 2002, new HIV diagnoses reduced from 831 in 2002, and 782 in 2003. However, the mentioned is in contrast with 20% increase in 2002, where by 692 cases were reported in 2001. Additionally, within 12 months, the newly acquired HIV infection increased in six from about 151 cases in 1998 to 277 in 2003. It is necessary to note that in every Australian state, there were differing trends. For example in Victoria, new infection in 2002-2003 was recorded to be 190 compared to 130 in 1998-1999. In New South Wales, in 1999-2000, new HIV infections increased from 330 to about 380 in 2003. The increase in the new infection has predominantly occurred among homosexually active men (Dowsett, 2003, p. 121). Additionally, in the indigenous population, the rate of HIV infections has been the same to that of non-indigenous population. Since 1994, the rate of HIV infections among indigenous people remained low at 184, but increased in the recent years. The pattern of HIV exposure between the non-indigenous and the indigenous Australians has remained different. In 1999-2003, among non-indigenous Australians, the main source of exposure was male homosexual contact. However, among the indigenous population heterosexual contact and homosexual contact were reported equally. The indigenous cases were attributed to injecting drug use. However, people from linguistically and culturally diverse backgrounds account for high percentage of new HIV infections. In 2002-2003, individuals on non-English speaking countries accounted for 20% of the new HIV infections. The pattern of exposure among culturally and linguistically diverse backgrounds is distinct from priority groups (Down, Bradley, Ellard, et al. 2010, p. 15). The Australians at risk of HIV/AIDS According to NACAIDS survey conducted in 1987, 14% of Australians are in the very high risk while 21% are at high category. However, in today survey, some of the risk that were used to define risk in 1987 cannot be applied, for example prostitution. Mair (2008, p. 53), Australians who were mostly at risk were bisexual and homosexual men and youth, and not linked with homosexuality. Additionally, men who were not free to talk about their bisexual or homosexual activities were at risk. This is because they got involved in unsafe sexual practices. The highest risk behavior is male-to male sex followed drug injections whereby syringes, and needles are shared. However, the reasons for new diagnosis of HIV are complex and multiple. However, there is limited evidence to explain the increases. It is evident that some of the prevention initiatives, and health promotion programs are not reaching those who are at risk of HIV. The current increase in HIV infections indicates that innovative, and renewed efforts are required in promoting and reinforcing drug injecting as well as safe sexual practices. HIV prevalence among gays, and homosexually active men can be attributed to traditional risk factors such as injection drug use, having multiple partners and unprotected sex. Nonetheless, there are biological reasons for increased risks. The risk of contracting HIV virus is18 times greater in anal sex that through vaginal sex. This explains why the virus is prevalent in gay men despite receiving HIV awareness messages. There have been a number of strategies in Australia aimed at reducing HIV prevalence. The earlier strategies broke new ground in clinical medicine, public health, law, and research. This led to development of partnership between the researchers, service providers, the government, and the affected community. The mentioned has allowed high level of collaboration, and consultation between the groups in their efforts to manage, prevent, and treat HIV/AIDS in the Australian society. Australian success in HIV prevention Australian has exhibited strong record in their attempt to prevent HIV. In 1984, the rate of HIV infections stood at 1700 annually. In 2012, the new infections were recorded to be around 200-800 yearly. Between 1994 and 1999, the rate of HIV infections in Australia decreased by 30%. Drawing from the mentioned statistics, HIV prevalence in Australia is one third of France and Canada, one sixth of the United States. According to Guy, McDonald, Bartlett, et al (2008,p. 91), the fall in the diagnosis of the new infections was due to declining numbers of new diagnoses among homosexually active men, and gays in Australia. The mobilization as well as action of affected communities, particularly gay community has also contributed to decrease in number of new infections. Prevention and education is associated with non-discriminatory HIV care, testing and treatment. Australian success in reducing HIV prevalence is attributed to NSPs keeping HIV low among injecting drug users. In Canada, and the United States, approximately 25% of new HIV infections were associated to injecting drug use, while in Australia it was less than 5%. Jin (2002, p. 272), by 2000 about 25,000 HIV injections have been prevented among Australian injecting drug users. Globally, Australian has reported low HIV infections among sexual workers. This is because of the community based sex worker projects, and organizations carried out in partnership with Australian government, state and territory. Preventive HIV measures In Australia, harm reduction is one of the strategies that have been seriously taken to prevent HIV. Through this program, federal funding has contributed to wide range of outlets- including health centers, vending machines, drug treatment centers and chemists. In this outlets millions of syringes are distributed annually. Since 1980s, harm reduction, and other services have proven effective in preventing HIV in Australia. The harm minimization which was adopted in 1985. It enjoyed bipartisan support in federal and state parliaments. This strategy enabled the creation of syringe, and needle exchange programs. Studies reveal that the introduction of syringe and needle have played critical role to the containment, and prevention not only among drug users and between them but also the wider community. According to Mair (2008, p. 53), the needle and exchange programme have saved about 10,000 lives in Australia. Australia have successfully responded to HIV prevalence. This is because is because civil society organization, Australians, researchers, clinicians, national and provincial governments, fashioned practical, timely and imaginative response to complex presented HIV epidemic. In preventing HIV, Australia has built its HIV prevention responses from grassroots up and not from top down. Public concern as well as mobilization, and action taken by communities affected by HIV, obliged provincial and national Australian governments to respond quickly to new HIV infections. According to Mair (2008, p. 52), surveys undertaken in New South Wales and Victoria indicated increase in unprotected anal intercourse among homosexuals. In the mentioned states, in 2002, the likelihood of gay men having unprotected sex was twice compared to a decade ago. In regard to this, it can be pointed out that gay men are using other strategies to reduce infection rate during unprotected intercourse. Some of the strategies include use on insertive position, withdrawal before ejaculation, avoiding partners with visible symptoms, and negotiating sex with partners whose HIV status is known. None of the mentioned strategies are equivalent to proper use of condoms. Community response When the first case of HIV was reported in 1982, Australian society was permissive. There was minimal enforcement of laws mainly aimed at politically-organized, and active homosexual community as well as individuals. In 1983, community action groups created New South Wales, and Victorian AIDS action communities. The mentioned become states AIDS councils. The state AIDS councils started peer education, and community education. They used funding from the ad hoc government. In 1984, the Australian federal government started dedicated funding for HIV (Mair, 2008, p. 51). Key policy and law reforms A number of legal reforms has been enacted as from 1983 in order to manage new HIV infections. For example tighter controls on blood donation were introduced. In April 1985, mandatory screening began. Furthermore, there was introduction of legislation. The legislation facilitated the reforms that were introduced by federal government and the state. Since, 1983, reforms in federal and state legislation aimed at removing all obstacles to public health policy with regard to HIV. The reforms paved way for new provisions that facilitated positive response to HIV. The federal approach had a number of characteristics in preventing HIV prevalence. The federal approach pursued link with community groups. Community reach and knowledge was used to not only formulate but also implement education campaigns which were directed at affected, and at risk individuals. Significant amount of federal funding were directed to sociological, and medical research on HIV/AIDS (Lynn, Lee and McKenna, 2007, p. 164).The government established organizations for this purpose, and creating institutional mechanisms and linkages that enabled research. The National Advisory Committee which acted as key government advisory committee on HIV was formed. The committee negotiated with the state and territory, civil society organizations, government, and department of health on needs and priorities. Additionally, the AIDS Task Force was created in order to bring together social research, clinical expertise and scientific research. The AIDS Task Force worked together with two specialized clinical/scientific research units for HIV/AIDS research (Kaldor, Williamson, Guinan, Imrie, Gold, 1993, p. 334). The units were dedicated in social, and behavioral research. An enabling political environment was created. This encouraged typically marginalized social groups such as sex workers, IUDs and homosexuals in the national response. The nature of reforms Australia has successfully controlled the spread of HIV, and maintained low rate of new infections. Initially HIV affected three main community groups: injecting drug users, hemophiliacs, gay men. The relative success in preventing HIV can be attributed to containing the spread in the mentioned groups. The mentioned strategy had key characteristics. It mobilized faster as a result of first reported case of HIV in Australia. It was a grassroots response that involved mobilization of groups particularly those affected. Laws regulating sex work Federal laws deal trafficking of sex workers into Australia, and between Australian states. Territory and state governments determines sex industry laws. Prostitution is partially licensed and de-criminalized in most territories and states. In response to HIV threat in 1980s, sex workers advocacy groups came up with a number of strategies. The sex workers promoted the use of condoms with their clients, and education campaigns among them. As a result of the aforementioned, no state advocates for mandatory HIV testing among sex workers. States and federal governments no longer need evidentiary use of condoms among sex workers. According to National Centre in HIV Epidemiology and Clinical Research (2006), no records of sex workers client being infected by sex workers. The ACT prostitution Act 1992 limits sex workers to particular locations. It contains provisions that prohibit escort agency or brothel from hiring a person who is HIV positive and his/her status is known. In summary, Australia adapted peer outreach programmes for homosexual men, and sex workers. Consequently, Australian Federal Government in collaboration with the ministry of health established a common national response to HIV prevalence. They worked closely with clinicians, groups, researchers, and the government with an aim of preventing HIV. The measures included: explicit, direct, and peer based preventive education campaigns. Furthermore, there have been provision of access to anonymous, free and universal HIV testing. The Federal government in collaboration with health care providers have advocated for the need to adopt safer sexual practices particularly the use of condoms. Additionally, they have advocated for removal of legislative, and political barriers. This is to enable effective preventive action and education. For example, passage of legislation so as to prevent discrimination on the basis of HIV status (Schwartlander, Ghys, Pisani et al, 2001, p. 54). Recommendations Consequently, there have been increase in the HIV infection since 1990. The most affected groups are still gays, and other homosexually active men. Additionally, new HIV diagnoses have increased among Aboriginal, and Torres Strait Islander population. The above findings inform future HIV prevention efforts that need to be adapted. Behavioral change alone cannot be effective measure. There is need for combination prevention, which incorporates social, biomedical, behavioral and structural interventions. Biomedical interventions entail behavioral components such as information, community mobilization, information and adherence to recommended risk reduction. Conclusion It is evident that there is need to come up with new prevention measures to curb HIV prevalence not only among the gay men but the country as a whole. Education about HIV/AIDS should be encouraged. Additionally, the act on legalization of homosexuality need to be reviewed in order to reduce HIV infections. There is need to identify effective HIV interventions, to prevent new infections, and prevalence among gay men and Australian population as whole. Risk reduction strategies can be effective in reducing new infections, despite their efficacy being questionable. References Bourne C, Edwards B, Shaw M, et al. (2008). Sexually transmissible infection testing guidelines for men who have sex with men. Sex Health. 5:189–191. Bowtell, W. (2005). Australia’s Response to HIV/AIDS 1982-2005, Lowy Institute for International Policy, Sydney, Australia, Dickson, N. and Davidson, O.J. (2006). HIV prevention in New Zealand still room for improvement. N Z Med J. 119: U2250 Dowsett, G.W. (2003). 'HIV/AIDS and homophobia: subtle hatreds, severe consequences and the question of origins', Culture Health & Sexuality, vol. 5, pp. 121-136, retrieved from Cinahl database. On October 26, 2013. Down I, Bradley J, Ellard J, et al. (2010). Experiences of HIV: The Seroconversion Study Annual Report . Sydney, Australia: The Kirby Institute, The University of New South Wales. Guy, R.J, McDonald, A.M, Bartlett MJ, et al (2008). Characteristics of HIV diagnoses in Australia, 1993–2006. Sexual Health. 5:91–96. Jin, F. (2002). 'Predictors of Recent HIV testing in Homosexual men in Australia, HIV Medicine, vol. 3, pp. 271-276, retrieved from Cinahl database on October 26, 2013. National Centre in HIV Epidemiology and Clinical Research (2006). HIV/AIDS, viral hepatitis, and sexually transmissible infections in Australia Annual Surveillance Report 2006. Available online at: http://www.nchecr.unsw.edu.au/NCHECRweb.nsf/resources/ SurvReports_4/$file/06_ansurvrp_rev.pdf [October 26, 2013]. Kaldor J, Williamson P, Guinan JJ, Imrie A, and Gold J. (1993). Falling incidence of HIV infection in a cohort of clinic attenders. Aust J Public Health. 17: 334-8. Lynn, M.K, Lee, L.M, and McKenna, M.T (2007). The status of national HIV case surveillance, United States 2006. Public Health Rep 122:63-71. Mair, J. (2008) 'Duty of confidentiality and HIV/AIDS', Health Information Management Journal, vol. 37, pp. 50-53, viewed 7 March 2010, retrieved from Cinahl database. On October 26, 2013. Schwartlander, B, Ghys, P.D, Pisani E, et al. (2001). HIV surveillance in hard-to-reach populations. AIDS. 15(suppl 3):S1–S3. Read More