Don Baxter has retired as executive director of the Australian Federation of AIDS Organisations (AFAO) but will be keeping a lot on his plate.

He spoke to the Star Observer about his plans after nearly a decade with Australia’s peak HIV body, its achievements, and what the future might hold for the fight against HIV.

Baxter, a former CEO of ACON, said he’d joined AFAO after a five-year break from the HIV sector, having been involved in the Australian response to the virus from virtually day one.

“I became head of the arts funding program for the Australia Council for the Arts between 1996 and 2001,” Baxter said. “It had been the decade of death but by ’95 or ’96 we’d started to have quite effective combination therapies and instead of dying, my friends and my community were beginning to survive again.

“It was a good time to leave ACON. But frankly, I was completely exhausted and needed to get out.”

The break allowed Baxter to realise it was where he needed to be.

“That was where my passion was and given the experience I’d had since ’83 it was where I wanted to contribute in society,” he said.

Baxter said one of the achievements of AFAO and its partners during his time at the helm was maintaining the response to HIV in Australia throughout the decade.

“For most comparable countries, there was a severe decline in terms of government leadership and in rates of investment, so I leave AFAO thinking about that as one of the real achievements,” he said.

Baxter was also instrumental in setting up the Global Forum on Men Who Have Sex with Men (MSM) and HIV, which he continues to co-chair.

The idea had been a response to the issues of gay men disappearing from the agendas of international AIDS conferences around that time.

“We were coming up to the Bangkok International AIDS Conference in 2004, so I thought we should organise a full one-day pre-conference satellite so we could have a consistent coherent extended discussion about gay men and HIV,” Baxter said.

“That worked extremely well — 150 people attended, and there was tremendous energy from some very good people from all over the world. From that the Global Forum was established at the Toronto International AIDS Conference two years later.

“It got to its real strength in 2008 just as the global financial crisis hit. So while we’re having a big impact on policy frameworks and leadership, it’s not translating into what’s needed in terms of funding and, because the investment has been very slow, a number of the Asian mega-cities have passed the take-off point for an epidemic of acute infection among MSM.”

Looking at the decade ahead, Baxter saw both causes for hope and concern in the fight against HIV.

“We are now becoming aware in clinical terms that for some people who have been infected for a long time, having the virus for that long leads to, in effect, accelerated ageing,” he said.

“That manifests in different ways — osteoporosis, cardiovascular disease, heart attacks, dementia — things you wouldn’t normally see in people until they’re about 70 but are now beginning to appear among people who are 55 but have been infected for 30 years. The science is fairly early but there is a lot of research about that going on and we should know more next year.”

Other potential challenges included injecting drug use among young Indigenous Australians and meeting the needs of workers imported by the mining sector from countries with high rates of HIV like South Africa and Zimbabwe which had the potential to be dragged into the immigration debate.

But with the first man in the world declared free of HIV this month, there were reasons to feel hopeful.

“We thought about a cure in the very early days but rapidly worked out that we just didn’t understand the virus and really we’ve been in that situation for 25 years,” Baxter said.

“But we can now think about the possibility of a cure — although it’s at least a decade away.”

Efforts to create vaccine had been less promising than expected. But new research indicated that positive people who took their medications religiously could reduce the risk of passing the virus to a negative partner by 96 percent — though the picture there was less clear for gay men.

Pre-Exposure Prophylaxis, where negative guys were given HIV meds prior to exposure to HIV, was also promising, and for Australia, the introduction of rapid testing that could deliver results in 20 minutes had the potential to revolutionise testing rates.

While officially retired, Baxter remains on the board of the International Council of AIDS Service Organisations and is regional coordinator for the Asia Pacific Council of AIDS Service Organisations. He has been appointed to the Australian delegation to the five-yearly global AIDS review in New York next month.

“I’m a mad, driven workaholic,” he explained.

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