Filed under virus

The Grim Reaper died in the ’80s

The Bouverie Centre’s Jennifer Power on the Queensland government’s HIV prevention efforts:

The government argues that de-funding QAHC was a response to rising HIV rates — evidence of QAHC’s lack of effectiveness — not an anti-gay agenda. But it would be a concern if HIV prevention in Queensland was to become more conservative, with little acknowledgement of the needs or interests of gay men.

Australia is known as a world leader in HIV prevention largely because the federal government at the time had the foresight to see that community-led organisations such as QAHC were best placed to deliver targeted HIV prevention campaigns to the communities most at risk.

The Grim Reaper died in the 80s – time for a new approach to HIV prevention

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It’s Different Now

As a follow-up from my previous post, take a look at this amazing campaign coming out of Vancouver. Unlike the Queensland campaign, this effort is open and honest about the reality of living with HIV today. It presents HIV testing as a personally and socially worthwhile thing to do, and situates that action within a broader framework of ultimately stopping HIV.

Australian HIV organisations can’t even make up their mind whether or not to accept the evidence about treatments as prevention, while the rest of the world embraces our first real chance to actually end HIV infections with innovative campaigns like this.

With all the talk about how our HIV response will look at the 2014 International AIDS Conference in Melbourne, this video shows just how far behind the curve we are.

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Dude with a scythe

The Grim Reaper TV advertisement has cast a shadow over the HIV response since it was first aired more than a quarter century ago. The original ad, with its foreboding “Always use a condom — always” tagline and grim predictions that AIDS could “kill more Australians than World War Two,” has often been credited with raising awareness of HIV in Australia. It’s also been rightly criticised for having the unintended consequence of increasing stigma around HIV and towards gay men.

Those surreal bowling reapers were supposed to represent death, but too many people read them as representing gay men, hurling a deadly virus at the innocent women and kids at the end of the alley. The ad fed into a climate of fear and hysteria and generated a great deal of hateful commentary towards gay men and those living with HIV, who were seen as the diseased vectors of a plague that at the time seemed certain to sweep through the ‘innocent victims’ of the heterosexual community.

Despite its many failings, we’ve never quite shaken off Mister Grim and his bowling buddies. The ad is so widely believed to have been a smashing success that barely a year has gone by in the last quarter century when some ill-informed government minister or pundit calls for a ‘new grim reaper campaign’ to scare people into behaving more sensibly. Luckily, to date those calls have been largely resisted.

All that changed this last weekend with the launch of We Shouldn’t Be Making This Advert, a new TV advertisement from the Queensland government, the first evidence we’ve seen of its new ‘in-house’ approach to HIV prevention following the shock de-funding of the Queensland Association for Healthy Communities. And there, proud as punch, is our old friend Grimsby, not looking a day older despite the intervening decades, ready to scare us all back into using condoms.

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How to fight an epidemic of bad laws

“The law can seem remote, arcane, the stuff of specialists. But it isn’t, because for those of us who live in democracies, the law begins with us,” says Shereen El-Feki, vice-chair of the Global Commission on HIV and the Law, in this TED talk.

The talk is a very fine summary of the issues around HIV criminalisation and its unintended effects. The comments below the video, alas, show how far we have to go.

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The great leap backwards

Queensland’s LGBT and HIV communities have been hit with a double whammy this morning, showing just how dangerous the new LNP government in that state is.

First came the news that the Queensland government is set to overturn the state’s civil union laws. With a new poll showing that 50% of Australians are in favour of marriage equality, and just 33% opposed, the reported LNP plans represent the opening of a new front in the war on queer civil rights in this country. But given the LNP’s opposition to the legislation when it was passed, it doesn’t come as a complete surprise.

Much more troubling is the announcement this morning that the government has, without warning, pulled all funding from Healthy Communities, the only LGBT health organisation in the state and the front line of Queensland’s HIV prevention effort. Formerly the Queensland AIDS Council, Healthy Communities has been continually funded by Queensland governments of all political stripes since 1988, and currently holds (or rather, held) government contracts valued at $2.6 million for HIV prevention and LGBT health work.

In a press release (PDF link) issued this morning, Healthy Communities has confirmed that 26 of their 35 staff will lose their jobs as a result of the defunding decision.

This is an appalling, short-sighted, ideologically driven decision that will hurt LGBT people in Queensland. Cutbacks in HIV prevention funding in Queensland and Victoria between 1998 and 2006 led to pronounced increases in HIV infections, and this will happen again now.

According to the Queensland health minister, Lawrence Springborg, Healthy Communities is being defunded because it has “lost its way” and that funding is “made available for health campaigns, not advocacy.” This shows just how out of touch the minister is – it displays a complete absence of understanding of the basic principles of health promotion and its smacks of an ideological approach.

Springborg says the LNP government will fund a new AIDS Council – there’s no detail on when that will happen or how, but we can expect it will be a timid, compliant body with no real attachment to the community it is supposed to serve.

Elsewhere: A thoughtful post on the decision on View from the Quarterdeck.

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Farmyard shenanigans

First it was ‘Pig AIDS‘, now Australia’s agricultural industries are under threat from ‘Apple Herpes‘. No matter where you look, increasingly our food has a sexually-transmitted infection.

And the common link? Senator Nick Xenophon, whose involvement in both stories suggests he has some explaining to do.

Or maybe Xenophon and the farmers’ lobby could just lay off the venereal metaphors.

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A positive test

When someone tells you you’re going to die, it’s normal to have a few questions. Depending on the context, these might include “how?” and “why?”, but most importantly, “when?”

On the day that I got my HIV diagnosis, Chris, my doctor never said I was going to die — but that’s what I heard. He said “This was a positive test.” It’s an odd choice of words, a bit clumsy and scientific, but of course medically precise. The diagnosis had to be confirmed with a second test, and backed up by a T-cell count. There was the possibility that the second test would show the first to be false, but he and I both knew that wasn’t really going to happen. “Don’t get your hopes up,” he said.

The test was positive, and so was I.

In my head, “This was a positive test” became “You’re going to die.” I wanted to know what all people given this news want to know: when?

“How long have I got?” The words came out of my mouth like a line from a bad TV movie. Chris looked at me with sad eyes.

“We don’t know. Some people do better than others, but without treatment I think you would have between one and three years before you were very seriously ill. There is a treatment available — it’s called AZT — and with that you would probably double that, but better treatments are being worked on and new ones could come along in the future.

“You shouldn’t worry: you can expect to have another five to ten years with a bit of luck. And in that time, who knows — treatments might improve. Who knows? You could live for another 20 years.”

I knew he was trying to be upbeat, stretching the story as far as possible to make me feel better. But no-one lived that long with HIV, not in those days. I walked out of the surgery with a prescription for AZT and started taking it the same day.

That was twenty years ago, today. The 6th of August, 1991, when I was 27 years old and going to die.

I posted another story about the day of my diagnosis a few years ago: Hiroshima Day.

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How to trick people into getting an HIV test

Watch this extraordinary “training video” which explains how hospital workers in Texas “encourage” patients to undergo routine HIV testing. I particularly like the part where they stress that written consent isn’t required, and there’s no need for pre-test counselling.

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Silence of the Mice

Yesterday I was on TV. Researchers at the Walter and Eliza Hall institute in Melbourne made a significant breakthrough on HIV, and the media needed someone to be the voice of positive people. In my PLWHA Victoria role, this duty falls to me.

It’s not often that the Australian news media take this much interest in HIV issues at all, and when they do it’s typically bad news, so it was refreshing to see this much interest in a ‘good news’ story. The fact that the news release had the words ‘HIV’ and ‘cure’ in it probably helped (the last time the commercial TV news became interested in HIV science, that news release had the ‘C’ word in it too, so I’m seeing a pattern; from now on all my news releases will have ‘HIV cure’ in the headline).

So I scrubbed up, borrowed a clean shirt (thanks Nathan), and choofed off to WEHI to do my bit for the cause. Here’s the resulting ABC TV News item. Read on over the page for the horrifying truth.


(The Channel 10 version is also available, on YouTube, if you’re really keen.)

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HIV infections aren’t going up, they’re going down

The annual HIV surveillance figures are out today and, as usual, there is lots of reporting of apparently bad figures. “Australians newly diagnosed with HIV totalled 1050 during 2009, the highest number in almost two decades,” according to this AAP story.

Indeed, there was a rise in HIV diagnoses last year, and we’ve crossed the seemingly symbolic 1000-cases barrier, and that is of course significant cause for concern. But HIV diagnoses have been up around the 1000 mark for several years now, and deaths from AIDS are at an all-time low – just nine people were reported to have died from AIDS-related causes in 2009, a piece of good news that the media has pretty much ignored. Because of this, the number of people living with HIV in Australia has risen every year, and so the number of new HIV diagnoses should be read in that context.

The chart below shows what happens when you do. The blue and green lines show the number of HIV diagnoses per year since 2000, and the consequent raw incidence rate per 100,000 population. The pink line shows the raw incidence rate per 100 people living with HIV, and shows a clear downward trend since 2005, as HIV infections have not risen in proportion to the number of positive people living in Australia. (Click the image to see a larger version).

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To my mind, this is a significant piece of good news that the media has ignored. But that’s not surprising as NCHECR’s annual surveillance report doesn’t include this measure, making a ‘bad news’ interpretation of the data almost inevitable.

That falling pink line suggests that positive people are succeeding in preventing onward HIV transmission. With a larger HIV-positive population, you’d naturally expect more HIV transmission to occur, yet this isn’t happening.

If this falling incidence rate were acknowledged, we could begin to ask why it is so. What has changed since 2005 to reduce HIV incidence, and how can we extend that success? Reported rates of unprotected sex among gay men have risen during that period, so how do we explain this apparently contradictory effect? These are important, and potentially valuable, questions.

HIV incidence is falling, not rising, when you take into account the growing positive population. This is something we should be celebrating, and for which positive people should be congratulated, instead of focusing on raw numbers that give a skewed perception of the epidemiology of HIV in Australia.

There are several caveats to the data I used for the chart. Most of the data came from the published NCHECR surveillance reports, which can be found here and from ABS population data. The 2010 report isn’t up yet, so I have taken the figures for 2009 from today’s media reports. And as I say, I’m no statistician, so I will accept criticism of my methods with my usual sanguine humour.

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