AS Australia takes centre stage on Sunday for the HIV prevention and AIDS awareness messages, the Star Observer spoke to those on the frontline who explained the challenges of reaching young men and the risks and rewards of de-emphasising the condom-only message.
According to Pacific Friends of the Global Fund to Fight AIDS executive director Bill Bowtell, NSW was leading the charge by having evidence-based targets to reduce HIV transference. He credited the close collaborative way in which ACON worked with the NSW health department and ministry as “best practice”. Its Ending HIV initiative has also been licensed by other HIV organisations nationally.
“It is also being used by NSW Health to educate health care providers about what needs to be done to significantly reduce HIV transmission – and that’s getting people to test more, treat early and stay safe,” ACON chief Nic Parkhill said.
“Here in NSW, we’re currently encouraging safe sex and condom use through the “I’m On” component of the Ending HIV campaign,” he added, insisting the message had to reach other audiences too.
“This includes sexually adventurous men or SAMs – men who practice group sex, have multiple partners, use drugs when they’re having sex and/or engage in various esoteric sexual activities.
“HIV behavioural research findings indicate that SAM account for up to one- third of all HIV diagnoses in Australia, so ACON has a program that works specifically with SAM.”
Outgoing VAC president Michael Williams has also been on the frontline addressing some of the challenges and associated backlash his organisation has received by having multiple messages.
“If you’re de-emphasising condom- based messages, people get very nervous about that, because they say that’s the only thing that works, but actually as an organisation we need to be honest with our community that actually, other things work,” he said.
“And if there is a section of our own community that, for whatever reason, without judgement, chooses not to use condoms, we have a responsibility to them to say, well actually, this will reduce your chance of infection.
“HIV treatments do that. It’s not replacing a condom-based message — condom-based messages are still going to be central to our health promotion work, but we need to be honest with people about the science of that so they can protect themselves.”
Mr Bowtell acknowledged that sometimes prevention organisations had to traverse a tough message but this was part of their job and it was the job of funders to hold firm and back their message.
“Through decades of hard work, Australia is fortunate that we have an HIV challenge, and no longer an AIDS epidemic. As each new group of young men come through they need to be taught about prevention, testing and medical options,” he said. “It is most unpalatable to see HIV infections in grown men increase as they are weighing up risk and discarding some of the safer sex messages.”
Mr Bowtell said there were economic realities to his message as well: “I am not in favour of reckless spending, but having regular testing and cost effective treatment saves lives and inevitably saves costs to the Commonwealth and states as less transmissions occur.”
The Victorian Government has echoed Mr Bowtell’s sentiments towards accessible medicines, adding pre-exposure prophylaxis into the mix, with the Victorian health minister’s spokesperson saying the state response to HIV prevention and support was built on a partnership between government, affected communities, clinicians and research agencies.
“A major focus is on increasing HIV testing frequency and treatment as prevention. This focus will help reduce HIV transmission and improve the lives of people living with HIV,” the spokesperson added.
“New initiatives this year include the establishment of PRONTO, Australia’s first community-based rapid HIV testing service and the funding of a pre-exposure prophylaxis, or PrEP, demonstration project in partnership with Alfred Health and Gilead Sciences.”
Queensland HIV Foundation’s Darren Russell said there was simply no evidence to suggest condom use was on the increase and therefore the message had to be practical in that reality.
“One of the difficulties is that I am unaware of anywhere in the world where condom usage is actually increasing among gay men,” he said.
“My personal feeling is that holding condom rates where they are now will be a big win. In 2012 Queensland had the highest reported rate of unprotected sex among gay men ever recorded, so I don’t think it will be easy to turn that around, much as we may want to.
“Safer sex campaigns are just one of the prevention messages we need to get out to gay men. Obviously, we need more testing, so that men can be diagnosed earlier and then have the opportunity to take treatments that greatly reduce the risk of them passing on HIV.
“In addition, we will have a Pre- Exposure Prophylaxis project up and running on the first half of 2014. All of these things combined will be necessary to bring HIV rates down.” Mr Parkhill and his interstate colleagues have all identified that keeping the prevention message refreshed was one of their key responsibilities, as was early testing and early access to medication.
The long-serving ACON chief also suggested Grim Reaper-style campaigns had run their course and were now dangerous.
“One of the key reasons is that these campaigns spread fear and stigmatise the target audience. What tends to happen is that people don’t want to come forward, get tested for HIV or disclose their status, which is exactly the opposite of what we want people to do,” he said.
“We also know that these types of campaigns can drive risk underground – making people less likely to seek advice or assistance if they require it.”
ACON were also planning to expand a[TEST], its rapid HIV testing service, to other parts of Sydney and regional NSW.
In summing up the seemingly-shared experience of all health promotion organisations, Mr Parkhill said prevention messages were just part of the story.
“ACON has learned a lot about how to implement campaigns – the messages require support and constant reinforcement. That reinforcement needs to be done online, in venues, at community events – wherever our community is and wherever sex happens,” he said.
“For example, ACON has been working with our communities to stay safe for decades, and part of what we do is make condoms and water based lube available in places we know guys need them.”
In another sign that rapid testing is a critical pillar in the overall HIV prevention strategy Queensland’s Health Minister Lawrence Springborg recently announced free HIV testing will be expanded across the state, as part of AIDS Awareness Week.