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Journal of the Australian Health Promotion Association
RESEARCH FRONT

Mobilisation, politics, investment and constant adaptation: lessons from the Australian health-promotion response to HIV

Graham Brown A B C H , Daryl O’Donnell D E , Levinia Crooks A F and Rob Lake G
+ Author Affiliations
- Author Affiliations

A Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, Vic. 3000, Australia.

B Western Australian Centre for Health Promotion Research, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.

C Centre for Social Research in Health, The University of New South Wales, Sydney, NSW 2052, Australia.

D Mental Health Commission of NSW, Locked Bag 5013, Gladesville, NSW 1675, Australia.

E Formerly of: Centre for Population Health, NSW Ministry of Health, Locked Mail Bag 961, North Sydney, NSW 2059, Australia.

F Australian Society for HIV Medicine, Locked Mail Bag 5057, Darlinghurst, NSW 1300, Australia.

G Australian Federation of AIDS Organisations, Level 1, 222 King Street, Newtown, NSW 2042, Australia.

H Corresponding author. Email: graham.brown@latrobe.edu.au

Health Promotion Journal of Australia 25(1) 35-41 https://doi.org/10.1071/HE13078
Submitted: 20 September 2013  Accepted: 13 December 2013   Published: 16 April 2014

Abstract

Issue addressed: The Australian response to HIV oversaw one of the most rapid and sustained changes in community behaviour in Australia’s health-promotion history. The combined action of communities of gay men, sex workers, people who inject drugs, people living with HIV and clinicians working in partnership with government, public health and research has been recognised for many years as highly successful in minimising the HIV epidemic.

Methods: This article will show how the Australian HIV partnership response moved from a crisis response to a constant and continuously adapting response, with challenges in sustaining the partnership. Drawing on key themes, lessons for broader health promotion are identified.

Results: The Australian HIV response has shown that a partnership that is engaged, politically active, adaptive and resourced to work across multiple social, structural, behavioural and health-service levels can reduce the transmission and impact of HIV.

Conclusions: The experience of the response to HIV, including its successes and failures, has lessons applicable across health promotion. This includes the need to harness community mobilisation and action; sustain participation, investment and leadership across the partnership; commit to social, political and structural approaches; and build and use evidence from multiple sources to continuously adapt and evolve.

So what?: The Australian HIV response was one of the first health issues to have the Ottawa Charter embedded from the beginning, and has many lessons to offer broader health promotion and common challenges. As a profession and a movement, health promotion needs to engage with the interactions and synergies across the promotion of health, learn from our evidence, and resist the siloing of our responses.


References

[1]  Plummer D, Irwin L (2006) Grassroots activities, national initiatives, and HIV prevention: clues to explain Australia’s dramatic early success in controlling the HIV epidemic. Int J STD AIDS 17, 787–93.
Grassroots activities, national initiatives, and HIV prevention: clues to explain Australia’s dramatic early success in controlling the HIV epidemic.Crossref | GoogleScholarGoogle Scholar | 17212850PubMed |

[2]  Bowtell B. Australia’s response to HIV/AIDS 1982–2005. Sydney: Lowy Institute for International Policy; 2005.

[3]  Sendziuk P. Learning to trust: Australian responses to AIDS. Sydney: University of New South Wales Press Ltd; 2003.

[4]  Kippax S, Race K (2003) Sustaining safe practice: twenty years on. Soc Sci Med 57, 1–12.
Sustaining safe practice: twenty years on.Crossref | GoogleScholarGoogle Scholar | 12753812PubMed |

[5]  Hurley ME. Then and now: gay men and HIV. Melbourne: Australian Research Centre in Sex, Health and Society; 2003. Monograph no 46.

[6]  Moodie R, Edwards A, Payne M. Review of the national HIV/AIDS strategy 1999–2000 to 2003–04: getting back on track...revitalising Australia’s response to HIV/AIDS. In Wilson A, Partridge N, Calzavara L, editors. 2002 reviews of the national HIV/AIDS and hepatitis C strategies and strategic research (pp. 39–80). Canberra: Commonwealth of Australia; 2003.

[7]  Kippax S, Crawford J, Davis M, Rodden P, Dowsett G (1993) Sustaining safe sex: a longitudinal study of a sample of homosexual men. AIDS 7, 257–64.
Sustaining safe sex: a longitudinal study of a sample of homosexual men.Crossref | GoogleScholarGoogle Scholar | 8466689PubMed |

[8]  Van de Ven P, Campbell D, Kippax S, Prestage G, Crawford J, Baxter D (1997) Factors associated with unprotected anal intercourse in gay men’s casual partnerships in Sydney, Australia. AIDS Care 9, 637–50.
Factors associated with unprotected anal intercourse in gay men’s casual partnerships in Sydney, Australia.Crossref | GoogleScholarGoogle Scholar |

[9]  Dowsett G, McInnes D, eds. Post-AIDS: assessing the long term social impact of HIV/AIDS in gay communities. X1 International Conference on AIDS, 7–12 July 1996; Vancouver, Canada; 2006.

[10]  Sydney Star Observer. No HIV obituaries. Sydney: Sydney Star Observer; 1998 November 1998.

[11]  Van de Ven P, Kippax S, Knox S, Prestage G, Crawford J (1999) HIV treatments optimism and sexual behaviour among gay men in Sydney and Melbourne. AIDS 13, 2289–94.
HIV treatments optimism and sexual behaviour among gay men in Sydney and Melbourne.Crossref | GoogleScholarGoogle Scholar | 10563714PubMed |

[12]  Rosengarten M, Race K, Kippax S. Touchwood, everything will be OK: gay men’s understandings of clinical markers in sexual practice. Sydney: National Centre in HIV Social Research; 2000.

[13]  Van de Ven P, Kippax S, Crawford J, Rawstorne P (2002) In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex. AIDS Care 14, 471
In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex.Crossref | GoogleScholarGoogle Scholar | 12204150PubMed |

[14]  Brown G, Maycock B (2005) Different spaces, same faces: Perth gay mens experiences of sexuality, risk and HIV. Cult Health Sex 7, 59–72.
Different spaces, same faces: Perth gay mens experiences of sexuality, risk and HIV.Crossref | GoogleScholarGoogle Scholar | 16864188PubMed |

[15]  Brown G, Maycock B, Burns S (2005) Your picture is your bait: use and meaning of Cyberspace among gay men. J Sex Res 42, 63–73.
Your picture is your bait: use and meaning of Cyberspace among gay men.Crossref | GoogleScholarGoogle Scholar | 15795806PubMed |

[16]  Dowsett GW, Bollen J, McInnes D, Couch M, Edwards B (2001) HIV/AIDS and constructs of gay community: researching educational practice within community-based health promotion for gay men. Int J Soc Res Methodol 4, 205–23.

[17]  Baxter D. Jeopardising rigour and vigour – is the evidence-base under-pinning Australia’s HIV response about to be de-constructed – inadvertently! Rigour and vigour: directions in HIV prevention. Perth: WA Centre for Health Promotion Research, Curtin University; 2004.

[18]  Grulich A, Kaldor J (2008) Trends in HIV incidence in homosexual men in developed countries. Sex Health 5, 113–8.
Trends in HIV incidence in homosexual men in developed countries.Crossref | GoogleScholarGoogle Scholar | 18588775PubMed |

[19]  Guy R, McDonald A, Bartlett M, Murray J, Giele C, Davey T (2008) Characteristics of HIV diagnoses in Australia, 1993–2006. Sex Health 5, 91–6.
Characteristics of HIV diagnoses in Australia, 1993–2006.Crossref | GoogleScholarGoogle Scholar | 18588771PubMed |

[20]  Fairley C, Grulich A, Imrie J, Pitts M (2008) Introductory editorial: the analysis of a natural experiment in HIV control. Sex Health 5, 89
Introductory editorial: the analysis of a natural experiment in HIV control.Crossref | GoogleScholarGoogle Scholar | 18686332PubMed |

[21]  NSW Department of Health. Consensus statement – a think tank: why are HIV notifications flat in NSW 1998–2006? Sydney: NSW Government; 2007. Available from: http://www.health.nsw.gov.au/sexualhealth/Documents/HIV-consensus-statement.pdf [Verified 25 September 2013].

[22]  Bernard D, Kippax S, Baxter D (2008) Effective partnership and adequate investment underpin a successful response: key factors in dealing with HIV increases. Sex Health 5, 193–201.
Effective partnership and adequate investment underpin a successful response: key factors in dealing with HIV increases.Crossref | GoogleScholarGoogle Scholar | 18686337PubMed |

[23]  The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia. Annual Surveillance Report. Sydney: The Kirby Institute, the University of New South Wales; 2013. Available from: http://www.kirby.unsw.edu.au/surveillace/Annual-Surveilance-Reports [Verified 10 November 2013].

[24]  Cohen M, Chen Y, McCauley M, et al (2011) Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 365, 493–505.
Prevention of HIV-1 infection with early antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 21767103PubMed |

[25]  Coates TJ, Richter L, Caceres C (2008) Behavioural strategies to reduce HIV transmission: how to make them work better. Lancet 372, 669–84.
Behavioural strategies to reduce HIV transmission: how to make them work better.Crossref | GoogleScholarGoogle Scholar | 18687459PubMed |

[26]  Gupta GR, Parkhurst JO, Ogden JA, Aggleton P, Mahal A (2008) Structural approaches to HIV prevention. Lancet 372, 764–75.
Structural approaches to HIV prevention.Crossref | GoogleScholarGoogle Scholar | 18687460PubMed |

[27]  Brown G, Johnston K, Ellard J, Carman M. Evidence synthesis and application for policy and practice project full report. Melbourne: Australian Research Centre in Sex, Health and Society, La Trobe University; 2013.

[28]  Rotheram-Borus M, Swendeman D, Chovnick G (2009) The past, present, and future of HIV prevention: integrating behavioural, biomedical and structural intervention strategies for the next generation of HIV prevention. Annu Rev Clin Psychol 5, 143–67.
The past, present, and future of HIV prevention: integrating behavioural, biomedical and structural intervention strategies for the next generation of HIV prevention.Crossref | GoogleScholarGoogle Scholar | 19327028PubMed |

[29]  Kippax S, Stephenson N (2012) Beyond the distinction between biomedical and social dimensions of HIV. Am J Public Health 102, 789–99.
Beyond the distinction between biomedical and social dimensions of HIV.Crossref | GoogleScholarGoogle Scholar | 22493997PubMed |

[30]  Adam B (2011) Epistemic fault lines in biomedical and social approaches to HIV prevention. J Int AIDS Soc 14, S2
Epistemic fault lines in biomedical and social approaches to HIV prevention.Crossref | GoogleScholarGoogle Scholar | 21968038PubMed |

[31]  Ogden J, Gupta GR, Warner A, Fisher WF (2011) Revolutionising the AIDS response. Global Pub Health 6, 383–95.
Revolutionising the AIDS response.Crossref | GoogleScholarGoogle Scholar |

[32]  AFAO. Implementing the United Nations Political Declaration on HIV/AIDS in Australia’s domestic HIV response: turning political will into action. Sydney: Australian Federation of AIDS Organisations; 2012.

[33]  Government NSW. NSW HIV Strategy 2012–2015 – A New Era. Sydney: NSW Goverment; 2012.

[34]  Legal and Discrimination Working Party of MACBBVS. A series of 7 papers on the impacts of discrimination and criminalisation on public health approaches to blood borne viruses and sexually transmissible infections. Prepared for the Commonwealth Ministerial Advisory Committee on BBV and STIs (MACBBVS). Canberra: MACBBVS; 2013. Available from: http://www.hrc.act.gov.au/humanrights/content.php/category.view/id/215 [Verified 25 September 2013].

[35]  McInnes D, Bollen J, Couch M, Dowsett G. Considering Australian gay communities in HIV health promotion. Sydney: Institute for Cultural Research, University of Western Sydney; 2000.

[36]  Rittel HWJ, Webber MM (1973) Dilemmas in a general theory of planning. Policy Sci 4, 155–69.
Dilemmas in a general theory of planning.Crossref | GoogleScholarGoogle Scholar |

[37]  Australian Government. Tackling wicked problems – a public policy perspective. Canberra: Commonwealth of Australia; 2007.