Hey there Guys,
Currently within Australia HIV and AIDS has been again thrust into the limelight with an out of the blue announcement by the Queensland State Government’s plan to withdraw $2.6 million of funding for the prevention of HIV infection.
Queensland Healthy Communities (QAHC), the recipients of the $2.6 million have been contracted by the state health department. As noted in QAHC’s guide to the funding cuts:
Healthy Communities receives $2.5 million annually from Queensland Health for statewide HIV, Hepatitis C and STIs prevention for gay and other men who have sex with men. Gay/MSM contribute around 65% of HIV infections in Queensland.
Our gay men’s HIV prevention funding is 75% of the funding for the organisation.
In his ministerial press release Health Minister Lawrence Springborg states:
The LNP [Liberal National Party] government has moved quickly to address an alarming rise in HIV diagnosis rates across Queensland with the announcement it will create a Ministerial Advisory Committee on HIV/AIDS to review and redirect awareness and prevention campaigns.
Health Minister Lawrence Springborg said annual HIV diagnosis rates had doubled in the last decade: from 2.7 per 100,000 population in 2000, to 5.4 in 2010.
The Queensland President of the Australian Medical Association Dr Richard Kidd stated in The Courier Mail his belief that the reason for this jump in Queensland HIV infections was due to an increase in heterosexual sex tourism to Thailand and PNG:
“Young men, isolated from their families, earning lots of money – and whether they are going to Thailand and having sex with prostitutes or whether prostitutes are coming in from other countries, the data doesn’t quite tell us.
“But they are both legitimate concerns.”
“I would want to get that message out again about safe sex – I don’t know how much young men are aware that Thailand is the HIV capital of the world,”
If the increase of HIV infections is in heterosexual men, why is the funding for a body whose primary goal is to address HIV in the gay and “men who have sex with men” (MSM) market having their funding withdrawn?
Why isn’t additional funding being directed towards educating heterosexual sex tourists?
Having traveled within Thailand, I know that the gay community is very aware of HIV and I was able to see and access condoms easily within all night clubs I found.
As part of my role as an educator and doctor, I advise all of my patients to be sure to pack condoms when they are traveling to areas of 1) likely sexual encounters, and 2) potentially higher rates of HIV in groups of people whose government is not funding effective HIV treatment.
This form of education is not difficult but it takes a brave stance to be able to do it. Not everyone likes to hear it.
Offering this education does not effect my ability to also offer safe and sound sexual education to my gay and MSM clients. Believe it or not I am actually able to do both!
If I, one single GP, am able to offer education for both heterosexuals and homosexuals why can’t the Queensland government? Why is the baby being thrown out with the bath water?
Minister Springborg, absolutely it’s tragic to see an increase in HIV infections in your state, however the current funding was never designed to target heterosexual sex tourists. QAHC’s primary goals have always been focused on the GLBTI communities. As the demographic changes, so too should your education strategies.
What hasn’t changed is that HIV is still most prevalent in gay males and MSM. Removal of funding to these groups is not going to reduce the rate of HIV infections.
Ahh, but of course it always going to be about the dollars. Here’s a suggestion; if you are worried about who is going to pay for the additional funds to teach heterosexual sex tourists to use condoms perhaps Minister Springborg should talk to his colleage Minister for Agriculture, Food and Regional Economies Tim Mulherin who recently announced a $110 million plan “to deliver new and improved racing facilities across the state”.
$110 million dollars for horses, dogs and who else knows what running around in circles.
Seems there is plenty of money splashing around, just not if you are gay, a MSM or someone wanting to help them stay healthy.
Yours in good health.
Dr George
The trouble with just reading abstracts from documents is that people miss the figures. If we take a look at page 10 of the Annual Surveillance Report, we can see that the rate of diagnosis of NEWLY ACQUIRED HIV infection was actually STABLE from 2007-2010 in QLD at around 1.2 per 100,000 as opposed to the diagnosis of NEWLY DIAGNOSED HIV infection which was up at around 5.4 per 100,000. There is a distinction between newly acquired HIV and newly diagnosed HIV in the notifications. Perhaps more QLD people who were previously without a diagnosis were being encouraged to test or more people from interstate or overseas without a diagnosis were moving to QLD and then testing positive. I haven’t seen these distinctions made clear in other articles yet. But the distinction is critical. Not only does suggest that the QLD government’s decision to withdraw funding to QAHC was motivated by politics, not epidemiology, it tells us that both the state premier and health minister have deliberately mislead the public.
I think one also needs to be careful in accepting Dr Kidd’s statement without any statistical evidence to back it up. As far as I can see, his statement is speculation, albeit based on anecdotes perhaps, but speculation nonetheless. Some have criticised QAHC even without statistical evidence to back up their claims. Unfortunately, HIV education and health promotion is not as simple as just bumping out the same poster with a heterosexual couple, or throwing condoms at travellors. It is quite a sophisticated practice guided by research such as has been conducted by the National Centre for HIV Social Research. Community based HIV organisations are guided by this research and work with academics and focus groups in creating their campaigns. Everyone has their opinion but when exposed to the machinery behind HIV and health promotion these opinions would probably be somewhat modified.
Now we are seeing the Newman government make all sorts of drastic cuts in other areas of services. Perhaps eventually those who favoured the removal of QAHCs funding will see it for what it really was: a politically motivation retaliation.
Indeed I think we need to acknowledge that when QAHC says that STI testing rates have been stable for 5 years what they are really saying is that they have been static at around 70%. This is a significant problem and needs to be dealt with at the service provision level which has to mean working through the DGPs.
There needs to be a total re evaluation of education strategies.
A re examination of the effectiveness of the peer model and a move away from the employment of non health professionals
Also Dr Kidd does not say “heterosexual” sex tourism, in fact he does not mention sexual orientation at all. The reporter makes a reference to increased heterosexual transmission but does not in this article nor in the Fairfax Brisbane Times. Dr Kidd has also gone on the record supporting gay issues prior to this.
http://m.brisbanetimes.com.au/queensland/health-warnings-over-civil-union-rollback-20120522-1z2wn.html
The issue that needs to be addressed is that Qld needs an effective body to develop public health measures to reduce the increasing rate of notifications. The current proposal is for a ministerial advisory committee which is a bad move. The best thing to do is to forget about QAHC and focus attention on getting a body staffed by suitably qualified health professionals that are focused on a scientifically based public health campaign. If people just focus on the politics and not the public health outcomes then the government will ignore them and the worst outcome will be a reality.
Derek. I suppose the hardest part for many people was the lack of consultation. If the contract included criteria that was able to be followed, and I have no idea what the contract entailed, there would be objective evidence of failure.
The spread of disease is not a linear progression and the way Minister Springborg presented the data was very superficial with little evidence of a depth of understanding of how epidemics spread or in what sectors there was change.
Good data that was properly understood and shared would have saved a knee jerk backdoor press release issued on a Sunday.
I haven’t really been paying attention to anything that Springborg is saying, I have been basing my opinions on the Health Department Data issued before the change of government.
Well given he holds the purse don’t you think we should?
Anything that Springborg says is going to be tainted by politics and he is not going to be swayed by any political pressure that the gay community musters. the only way to deal with the issue is to look at the science and if we do that we will have the medical etc establishment onside. Trying to engage the politics is just a distraction. the problem is that the gay community seems more focused on holding on to QAHC then it is in examining how we can best reduce the rate of new transmissions.
What bothers me as a health professional with regards to health issue is that it is all about the gay politics and not the science. As a gay man I am more interested in examining the evidence and the gay community has not been doing that, the focus has been on Springborg’s homophobia and no discussion has been forthcoming as to whether the data actually supports QAHCs business model and record.
Also you have to remember that Springborg left school at 14 and is probably the least educated man in Australian politics.
That’s cool so do you have your thoughts on a solution?
Indeed I think we need to acknowledge that when QAHC says that STI testing rates have been stable for 5 years what they are really saying is that they have been static at around 70%. This is a significant problem and needs to be dealt with at the service provision level which has to mean working through the DGPs.
There needs to be a total re evaluation of education strategies.
A re examination of the effectiveness of the peer model and a move away from the employment of non health professionals.
The epidemiology indicates that QHAC has been ineffective with a steadily increasing trajectory of increasing notifications per 100 000 that has lead to a doubling of the rate . whilst the moves by Sprinborg are undoubtedly political and homophobic, the failure of the community to do anything about QHACs poor performance in public healthy terms for over a decade, despite ample evidence it direction and strategies were wrong has created the perfect storm. There is no legitimate argument based on public health or epidemiology that can be used in defense because of the failure to operate within a paradigm where public health goals were paramount.
http://www.health.qld.gov.au/sexhealth/documents/hivaidsannualreport.pdf