Effective partnership and adequate investment underpina successful response: key factors in dealing with HIV increases
Diana Bernard A C , Susan Kippax A and Don Baxter BA National Centre in HIV Social Research, University of New South Wales, Sydney, NSW 2052, Australia.
B Australian Federation of AIDS Organisations, PO Box 51, Newtown, NSW 2042, Australia.
C Corresponding author. Email: d.bernard@unsw.edu.au
Sexual Health 5(2) 193-201 https://doi.org/10.1071/SH07078
Submitted: 10 October 2007 Accepted: 14 February 2008 Published: 2 June 2008
Abstract
Background: Australia has mounted an effective response to HIV and AIDS by investing in evidence-informed policy. Recently, in response to increases in HIV in some states in Australia, the New South Wales Department of Health set up a ‘think tank’ to examine differences in epidemiological and behavioural data, policies, strategies and community responses in order to account for state-based differences and ensure an effective ongoing response to HIV. Methods: The National Centre in HIV Social Research undertook key informant interviews with major stakeholders to help understand differences in responses by the three states most affected by HIV in Australia – Queensland, New South Wales and Victoria. In parallel, the Australian Federation of AIDS Organisations completed an analysis of the investments in HIV-prevention activities targeting gay men in all jurisdictions in Australia. The Australian Federation of AIDS Organisations also analysed the strategic contexts and government responses to HIV in the three states. Results: There were significant differences between New South Wales, Queensland and Victoria in the way the HIV partnership functions. Type of prevention strategy and level of financial investment in prevention activities appear to be related to the effectiveness of the ongoing response to HIV. Conclusions: An active commitment to and adequate resourcing of HIV prevention by all stakeholders in the HIV partnership – government and non-government departments, researchers and gay community organisations – is crucial if Australia is to respond effectively to HIV among gay and other men who have sex with men.
Additional keywords: evidence-based policy, HIV transmission.
Acknowledgements
The authors acknowledge and thank all respondents for their willingness to participate in open and frank discussions of sensitive issues. The authors are funded by state (NCHSR) and Commonwealth (AFAO) health departments.
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Appendix 1. National Centre in HIV Social Research questions for stakeholders
1.How do you explain increases in HIV transmission? What do you think is going on? Can you throw light on what is happening in your state?
2.How do you think your state has responded?
3.How would you characterise the nature of the partnership – state government departments, NGO, researchers, health practitioners?
4.How would you characterise sexual subcultures and the role/place of positive men in these?
5.What capacity/resources does your state have to respond with and how well have these been utilised?
Appendix 2. Australian Federation of AIDS Organisations mapping instrument
Mapping HIV and sexually transmissible infection prevention programs and activities targeting gay and other homosexually active men
Activites from July 2005 to June 2006
Interview questionnaire
(1) Name of organisation. Please include contact name, email and phone number.
(2) Please list dedicated positions for 2005–06:
(a) List the positions (full-time to half-time only), including the position title and a brief description of key activities that are specifically dedicated to HIV and STIs prevention work targeting gay and other homosexually active men.
(b) List the funding for each of these positions.
(3) Were the following programs carried out by your organisation during 2005–06:
(a) A systematic program of regular liaison with venues (e.g. bars, nightclubs) frequented by gay and other homosexually active men, for the purpose of having these venues display and promote up-to-date HIV and STI prevention awareness information targeting gay and other homosexually active men (safe sex, injecting drug use).
Yes/No? Frequency? Comments?
(b) A systematic program of regular liaison with sex on premises venues (e.g. gay saunas, sex clubs) and/or businesses where sex occurs (e.g. sex video and sex aid shops), frequented by gay and other homosexually active men, with the aim of having these venues promote up-to-date HIV prevention and STI awareness information targeting gay and other homosexually active men (display safe sex messages, ensure availability of condoms and lube, display safe injecting drug-use messages).
Yes/No? Frequency? Comments?
(c) A systematic program of regular visits to gay ‘beats’ (e.g. parks, toilets) on a regular basis with the aim of locating in these venues up-to-date safe sex messages targeting gay and other homosexually active men.
Yes/No? Frequency? Comments?
(d) A systematic program of activities (e.g. peer education type group sessions, one-on-one counselling, group workshops) specifically aimed to promote and sustain safe sex and safe injecting practices among gay and other homosexually active men, and information regarding recreational drug use (including alcohol) and links with sexual practice. (Note: please list each activity and provide information about availability.)
Yes/No? Frequency? Target audience? Objectives? Brief description?
(e) A systematic program of activities that use community development approaches and community based events/activities (e.g. supporting gay and lesbian community organisations, community arts projects) as way of empowering the gay community to address their health needs in relation to HIV and STI.
Yes/No? Frequency? Target audience? Objectives? Brief description?
(f) Any other systematic program of activities (not already identified above) and/or dedicated positions promoting HIV and STI prevention to specific subpopulations of gay and other homosexually active men:
Yes/No? Frequency? Target audience? Objectives? Brief description?
(4) Were gay and homosexually active men HIV and STI prevention activities targeting sex-on-premises venues conducted by your organisation during 2005–06, and if so:
(i) are they based on a protocol or code of conduct;
(ii) which organisation/s approved or developed the protocol or code of conduct;
(iii) how frequently is conformity with this protocol or code monitored; and
(iv) is conformity with this protocol or code advertised in these venues and in associated publicity?
(5) Did your organisation conduct regular campaigns or other activities to advocate HIV and STI testing as part of sexual health monitoring by gay and other homosexually active men during 2005–06?
Yes/No? Frequency? Brief description?
(6) Did your organisation provide regular training/update courses on trends in HIV and STI transmission during 2005–06, prevention and social impact for:
(i) general practitioners and other physicians with significant gay and other homosexually active men clientele;
(ii) sexual health clinic personnel; or
(iii) counsellors and other health professionals working with gay and other homosexually active men.
Yes/No? Frequency? Brief description?
(7) Did your organisation utilise the internet to provide HIV and STI prevention and health promotion information to gay and other homosexually active men?
URL address? Brief description?
(8) What is the geographic reach of each of the above activities/programs? (e.g. state- territory-wide, limited to specific cities, geographic regions, limited to area health service boundaries, etc.)
(9) Please give details of funding provided for the production of specific campaign materials, brochures and advertising to promote HIV and STI prevention among gay and other homosexually active men.
(Note: Please provide brief details of development protocols, approval requirements and targeted distribution strategies.)
(10) Other activities, not previously outlined, that you believe are relevant. Include activities or programs that:
(a) Are HIV and STI prevention programs or activities not specifically targeted at gay and other homosexually active men, but where they are identified as one of the key target populations.
(b) Are programs or activities targeted primarily at gay and other homosexually active men but that have a focus broader than just prevention.
(c) Are broader health promotion programs or activities targeted at a more general audience, but where gay and other homosexually active men are identified as one of the key target populations.
Frequency? Target audience? Objectives? Brief description? Number of gay and other homosexually active men reached?Geographic reach?
For the purposes of this mapping project, it is not necessary to provide descriptions of diffuse or indirect activities that may reach some gay and other homosexually active men from time to time.
