As so often happens with my posts, the beginning of this one lies in someone else’s comment thread.
A short while ago, Ren posted her thoughts on the recent HIV cases in the porn industry and condom use. She mentioned that, statistically, she’d be a lot safer having sex with anyone in the mainstream porn industry in California than having sex with non porn performers in her area. In the comment thread, I said that I’d frankly be too scared to fuck anyone in the US without barrier protection, because the USA’s HIV infection rates scare the crap out of me.
IamCuriousBlue commented, saying thus:
Is it really that much lower in Australia? Honest question, since I’ve never seen comparative stats like this.
Now, not to pick on IACB for his genuine lack of knowledge in a fairly specific area, but I was a little bit stunned by the question. It had never occurred to me that the USA’s HIV rates would be seen as anything but dramatically high, despite my awareness of just what can be normalised by exposure.
I answered the question briefly on Ren’s post, with a little bit of information about the Australian response to HIV/AIDS. But now… well, I’ve got this big shiny international blogging platform for a couple of weeks, and I figure I might as well use it for good as well as evil share a bit of information about one of the things my country has managed to do really quite well.
As a bit of background for those not familiar with how things run in Australia, we have Federal, State and Local Governments. The Federal Government is responsible for most taxation and for allocation resources and funds to State and Territory Governments, which then run most of the public health services in accordance with policies set on both a State and Federal level. Non-Government Organisations (NGOs) at federal and state levels represent communities and interest groups, and lobby on their behalf for particular policy development and changes.
When HIV/AIDS emerged in the 1980s, Australia was initially hit quite early on. The first case of HIV was diagnosed in Sydney in 1982, with the first death from complications associated with HIV recorded in Melbourne in 1983. By the mid-1980s, several thousand new infections were occurring every year.
The impressive bit happened towards the end of the 1980s, a rather dramatic shift in a few short years. New HIV infection rates took a dive, and continued to steadily decline through to the end of the 1990s.
The cause of this, the Australian response to HIV, took time to develop. This was a clear and deliberate choice on the part of the Australian Government, actively slowing the process of developing policy and including in that process a national consultation to provide an opportunity for, amongst other things, community input. Affected and at-risk communities – gay men, sex workers, and injecting drug users chief amongst them – began to develop HIV focused health promotion initiatives aimed internally, provided by new and existing peer-based organisations. NGOs devoted to HIV/AIDS formed quickly: the AIDS Trust of Australia was established in 1987 by the then Governor-General to raise and distribute funds for research, education, care and support, and the Bobby Goldsmith Foundation (Australia’s longest running HIV/AIDS charity) founded in 1984 after the death of its namesake to provide financial and practical assistance ranging from counseling to housing to people living with HIV.
While peer-based organisations played a significant role in the Australian response to HIV from the beginning, there was a push for a more coercive, paternalist and controlling approach. State and medical organisations worked together to develop a fear-tactic campaign, attempting to “shock” at-risk individuals into changing their behaviours. The most memorable example of this approach was the infamous “Grim Reaper” advertising campaign, which I’ve dug up for you on the YouTube.
Hideous, no?
The campaign emphasised the prevalent fear that the epidemic would “cross over” from the currently at-risk (and, some thought, disposable) communities and begin to infect and threaten the general public. Unsurprisingly, it also contributed heavily to the stigma surrounding HIV/AIDS, both in the general public and within affected and at-risk communities. One of the big barriers to an effective HIV response is the silence brought on by stigma and discrimination (both individual and institutional) and presenting people living with HIV as vectors of disease through which the evil man with the scythe will bowl down women with babies is not an effective way to dispel this fear of persecution.
Still, advocacy groups and peer-based organisations worked to persuade Government that affected and at-risk communities had the capacity to educate themselves from within. Funding was provided for the production and dissemination of safe-sex materials and resources that drew on the real-life experience of members of those communities and which spoke the language of the people involved. State and Federal Governments began to agree on mechanisms to share the cost of funding these programs. An emphasis was placed on providing an enabling environment for prevention and care, rather than enforcing behaviours from above. A legitimate place was created and maintained for the community sector in the dialogue and the response, encouraging health promotion and care and support in affected communities.
It cannot be stressed enough how important it was that these community-based organisations were staffed with peers: gay men advocating for and educating gay men, sex workers advocating for and educating sex workers, and injecting drug users advocating for and educating injecting drug users. These people came from within the affected communities, complete with intimate knowledge of the values and norms of those communities. They could provide a “whole context” approach, working to build and sustain a culture of safety, supporting individuals in making decisions to avoid infection and/or prevent transmission, and speaking with a kind of authority completely absent in “top down” approaches that privilege the knowledge and decision-making of non peer “experts” and medical personnel.
The partnership of Government, medical and community groups banding together in a single unified response was vital, but just as important was the capacity of different affected and at-risk communities to work together. People from the gay community, sex workers and sex worker organisations, injecting drug users and people affected by medical transmission worked together and, despite their different perspectives on the epidemic, continued to present a coherent and consistent face to Government as well as sharing skills and resources amongst themselves. The Australian Federation of AIDS Organisations, the peak national body for the HIV community response, was established early and remains strong and active today. Its current members can be viewed here.
Underpinning the Australian response to HIV is a series of National AIDS Strategies that formalise guiding principles, allocate responsibilities and resources, and define the approach(es) to be taken during the specified time periods. The first was released in 1989, and the latest (the fifth) can be found here (Caution, here be PDF!) The more observant amongst you will note that the sixth is due for release this year.
So. There’s your edu-ma-cation on the Australian response to HIV. The question remains, how are we doing now?
The organisations mentioned here are still running, although others have folded over the years. A worrying spike in new HIV infections has occurred over the last decade, prompting mobilisation to address the newer generation of at-risk individuals. Discrimination on the basis on HIV status is legally prohibited by nation-wide anti-discrimination legislation, yet the Bobby Goldsmith Foundation reports that nearly a third of people living with HIV in NSW, the State with the largest HIV positive population, are still living below the poverty line. Aboriginal Australians and Torres Strait Islanders are still disproportionately affected by HIV/AIDS, with Indigenous women in particular maintaining a far higher HIV infection rate than their non-Indigenous counterparts. Australia directs much of its funding and energy towards other countries in the Asia-Pacific region, many of which have astronomical and still-increasing HIV infection rates, and many affected communities are fighting to keep the organisations that represent them peer-based or mostly peer-based.
The lesson to be learned from the Australian response to HIV is that HIV prevention cannot simply be left up to individuals and their obligation to act responsibly and rationally. The behaviours that increase risk of HIV transmission occur between individuals, and in socially constructed settings. A whole-context and whole-community approach is necessary and effective, and empowering communities to protect themselves (grassroots-up rather than top-down) is vital.
Housekeeping: I’ll leave this one relatively open, although I’ll repeat my observation from the last few threads that have appeared here that deal with HIV/AIDS. No-one has yet responded to a Feministe comment thread about HIV who has been comfortable disclosing that they are in fact HIV positive themselves. Please keep this, and what you know about safe space and how it is made, in mind when commenting.
So…it sounds like the gov and gov’t organizations did a really good job of using peer advocacy for some at risk groups (sex workers, gay men, IV drug users) but not so much for others (Indigenous peoples). Am I reading that correctly?
Does the ignoring of at-risk Indigenous women allude to the fact that they exist outside of the stereotypical HIV/AIDS patient, or is it indicative of the larger narrative with regard to the gov’t's treatment of these populations?
I’m just curious about where you got your statistics about HIV/AIDS prevalence in Australia vs. U.S. The CIA World Factbook lists HIV/AIDS-positive percentages as 0.6 % for the U.S. and 0.2 % for Australia.
RMJ, perhaps both. The treatment of Aboriginals in Australia is something else. Take what we did to the Native Americans, mix in some of the African-American experience and stir until smelly and you’d have an idea. See here and here
Now, am I reading this right? You had about 1,000 diagnosis of HIV/AIDS with a total population of about 20 million people or 1:20,000. We had 44,084 in 2007 with a total population of 300m. Isn’t that 1:68,000? My math sucks so, maybe there’s too many zeroes in there. Please, check my math.
I think one things that impedes it here in the US is the idea that using condoms is just so icky and clinical and awful. Takes all the fun and eroticism out of sex, dontcha know! I also think that condom use is never even portrayed in the popular media as a given or as something that is a natural part of sexual behavior–soe people think of it as awkward and unsexy.
Quite impressive what activists and advocates in Australia have accomplished. And I think you’re spot on–creating an atmosphere where prevention and care are actually encouraged and seen as positive things (as opposed to our current attitudes about it in the US) would do much to increase safer-sex practices.
Okay, this makes more sense. Australia is 89th in prevalence rate, while the US is 69th.
oops. Correction: Australia is 108th.
I think one things that impedes it here in the US is the idea that using condoms is just so icky and clinical and awful.
Sheelzebub, is that really true though? It’s just my own personal experience but I grew up catholic and “condoms condoms condoms” was still drilled into me, even at the catholic schools I went to.
And yeah, I agree with you that most media doesn’t really portray condom use at all, but I do remember one Friends episode from way back where Rachel and Monica were both trying to have sex one night but there was only one condom in the apartment. The roommate who didn’t get the condom, didn’t have sex that night. I’m sure there’s at least a handful more examples in currently running shows, but I don’t watch much TV anymore. Not saying your point is invalid at all, just pointing out that there are at least some shows that are trying to be responsible.
Ali-yeah, but how much of it was “use them even though men won’t like it as much”? That was always the implication that I got-that we women had to insist on it, since we could get pregnant or sick. Though why they didn’t think a man could get a STD either.
[...] Feministe » The Australian Response to HIV It cannot be stressed enough how important it was that these community-based organisations were staffed with peers: gay men advocating for and educating gay men, sex workers advocating for and educating sex workers, and injecting drug users advocating for and educating injecting drug users. These people came from within the affected communities, complete with intimate knowledge of the values and norms of those communities. They could provide a “whole context” approach, working to build and sustain a culture of safety, supporting individuals in making decisions to avoid infection and/or prevent transmission, and speaking with a kind of authority completely absent in “top down” approaches that privilege the knowledge and decision-making of non peer “experts” and medical personnel. (tags: hivaids australia sexwork) [...]
Ali, I do think it’s true. I don’t dispute that schools (without abstinence-only education) teach condom usage, but that’s not what I’m talking about. I’m talking about the general attitude people have towards using condoms, and how it’s reflected in popular portrayals of sex.
I’ve heard people (in general) deride condom usage as clinical and cold and that it kills the mood. Condoms seem to be regarded as something you should use (thanks to safer sex education), but no one wants to use, and so it’s oddly popular to reject them (like salads vs. burgers or biking vs. driving). And a few shows may use them as a punch line or plot line, but they’re not normalized in our popular imagination–not in the way that using them is something everyone automatically does. I almost never see them in a sex scene.
And I do think this comes from our larger cultural ambiguities around sex–it’s something that should just overtake us, because actually taking steps to be responsible is not seen as erotic (and being responsible means that you want sex, which is icky, apparently). And to what KB said, a lot of the onus is placed (in heterosexual relationships at least) on women to insist on condom usage.
The behaviours that increase risk of HIV transmission occur between individuals, and in socially constructed settings. A whole-context and whole-community approach is necessary and effective, and empowering communities to protect themselves (grassroots-up rather than top-down) is vital.
I think this is something the US response to HIV/AIDS lacked. A “whole-context and whole-community approach” is currently absent, and in some ways was always absent. Australia’s response to HIV/AIDS has some flaws (i.e. treatment or lack thereof of Aboriginal people and others who aren’t part of the stereotypical at-risk group) but it can be held up as a general example of the appropriate response to HIV/AIDS, or any STI epidemic/pandemic.
Regarding the USA’s current rates: I think that abstinence-only education, a general social stigma or ignorance surrounding contraceptives (especially toward women who use them), the socially-reinforced silence and shame that surrounds HIV/AIDS and STIs, and far-right conservatives (who are typically anti-reproductive health care) politicians are ALL partially responsible.
Wow, haha, it’s kind of overwhelming when I look wall o’ text. We’re dealing with a lot here.
I work in public health (in the US), so allow me to nerd out for a moment.
I’m not sure that comparing worldwide rates is really realistic. Testing will greatly impact the rates (more testing = higher numbers) and looking at prevalence only gives you a piece of the puzzle since it represents existing cases and allows grows for incurable diseases. Incidence would be interesting to look at.
Also, the CDC revised the prevalence estimate to be closer to 53,000 instead of 44,000ish this past year.
Anyway, I think the gay men’s movement in the US was incredibly grassroots and still maintains a strong activist voice for HIV work. Maybe sometimes unintentionally at the loss to other communities with growing rates.
There’s a lot missing here in terms of the role of meth in transmission and the fact that sheer population size will boost rates. Urban areas in the US (where prevalence is highest) are so populous, you are just more at-risk having sex here than in other places. Even with the exact same behaviors.
Frankly, I’m a fan of universal healthcare as a strong approach. Although not necessarily community-based, it would go a long way for people to get drug treatment (for meth in particular) and get treated for STDs (some of which can increase transmission & acquisition of HIV by 3-5 times) in terms of preventing HIV.
Does the ignoring of at-risk Indigenous women allude to the fact that they exist outside of the stereotypical HIV/AIDS patient, or is it indicative of the larger narrative with regard to the gov’t’s treatment of these populations?
A little of column A and a little of column B. I have no meaningful experience with the experiences of POC in the US, but I know somewhat more about our home situation.
Indigenous women tend to be silenced or made invisible in the greater dialogue, certainly historically, and while they are fighting for recognition now, even recently the situation is fairly dire. For example, mining companies negotiate with Elders regarding the placement and organisation of mines, but these Elders are male. Female Elders are not approached. Recently a number of indigenous women have been speaking up about this, being very left out of the process. I imagine this has a nasty intersection with government initiatives in sexual health.
The Australian situation is dire all by itself, as most of the indigenous population live in extremely remote areas with very little in the way of modern conveniences. Having recently traveled North Western Australia, it is hard to really get across how remote these communities can be – you might drive four hours through the desert seeing not a single other car before reaching one. We have a flying doctor service that is available for various things, but it’s not exactly like living somewhere you can drive to the next town for treatment.
In Controlling HIV in Indigenous Australians” (2005;183(3):116-117), Francis Bowden wrote, “Few indigenous children in remote areas complete high school and, as a result, there are few reliable means of informing young people about health risks.”
Add the tyranny of distance to institutionalised racism, poor health outcomes in general, and poverty and marginalization and you have an extremely high transmission rate. While it is certainly true that the government is attempting to make inroads into the situation, ‘the government’ isn’t really a single body with a single policy – we have our frothing fanatics who screech about the evils of ‘handouts’ as well as our truly good folk.
When there is a situation this bad, communicating AIDs risks also, I suspect, ends up lower down on the list than difficulties like petrol sniffing or suicide rates, depression, police brutality, and so forth.
RMJ:
It’s a bit of both. Non-Indigenous non-injecting drug using women in Australia have an extremely low risk factor when it comes to HIV infections, but Indigenous women are at higher risk through heterosexual intercourse. There are a variety of theories on why this is, including the general poverty and lack of access to health care and sexual health resources and care of Indigenous Australians.
Sheelzebub:
It’s complete anecdata, as I’ve never been to the US myself, but I’m told by friends who have visited that condoms are also more expensive over there. They’re cheap here, widely available, and provided for free in quite a lot of places.
secondlastwish:
Fortunately that wasn’t the point of the post.
A few people have jumped on my use of statistics to lead into the discussion about the Australian HIV response, and on re-read I see I forgot to include a few things I meant to mention. That relatively low number of infections? Once the risk of medical transmission was lowered, they were almost all from those most at risk communities. The vast majority of HIV/AIDS cases occur in men who have non-commercial sex with men and injecting drug users, with heterosexual women specifically experiencing a notably low infection rate. Something I can’t believe I neglected to mention is that in Australia, sex workers actually have a lower HIV infection rate than the general population, due largely to peer education and the early establishment of a culture of condom use. There has actually never been a recorded case of HIV transmission in a sex work context.
The wins of the Australian system certainly aren’t all about the numbers.
… I don’t think there is. I mentioned injecting drug users and their organisations just as frequently as any demographic placed at risk by sexual behaviours, and they have always played and still play an active and involved role in the ongoing HIV response in this country.
As for the population size, you’re quite right. Sydney is the most heavily populated city in this sparsely populated country and the epicentre of the Australian HIV positive population.
Steampunked:
I think it’s worth emphasising that this silencing is largely external, and doesn’t occur everywhere.
That’s a common misconception, but not actually the case. More Indigenous Australians live in NSW and Queensland than in other states, with large numbers based in coastal or regional cities. There are certainly large numbers of Indigenous people living in remote areas compared to the non-Indigenous population, however.
There’s also the fact that most people don’t think of Indigenous Australians when one says “at-risk and affected communities when it comes to HIV”.
Thanks for chiming in :)
I really like this but I disagree on your take on the grim reaper ads. Around my straight peers I wish their was ads like this still running, because many of them don’t get tested, and don’t, or at least didn’t when I was closer too them use condoms because they believed that hiv was something “other people” got, and that to me is the key to the reaper message. You mr & mrs white picket fence, you are at risk, your children are at risk, this isn’t something you can continue to assume is other peoples problems.
The best std awareness I have ever run into in within the poly and gay community, the worst is within the straight serial monogamy community. This message should get though without alienating the at risk community and presenting them as risk.
I absolutely agree that there needs to be a bigger push towards normalising STI testing in the straight community, and awareness raising around actual risk of contracting various STIs. I just disagree that the grim reaper ads or similar scare campaigns low on actual facts are the way to do so.
When I was 14 (this was back in 1983, when the US blood supply was still only receiving spotty and imperfect testing for HIV) I had major surgery, requiring more than 12 transfusions. From age 15 to age 25 I had an HIV test every year at the local heal department. After that I was tested every other year or so, mostly because I could never be sure that my husband wasn’t at risk and he wasn’t ‘comfortable’ using condoms. I really only stopped being tested on a regular basis once I had stopped engaging in unsafe sexual activity. And I’ve tried to get my children to understand that ‘safe sex’ ISN’T just about pregnancy, it’s about STDs and HIV. But they’re teenagers, so I’m still not sure if they’re listening. I will keep harping though, because I feel very strongly about this.
To get back on track; I was tested every year because of insecurities about the blood supply when I was transfused. And each and every one of those tests was absolute torture – not only because of the fear of a positive result, but because of the stigma that was (and still is) attached just to the idea of needing a test. A woman who asks for testing at the local health department (as I had to, not having medical insurance) and tell the nurse you need an HIV test they will automatically make several assumptions about you. That you’re 1) a slut and 2) an IV drug user. And when the nurse asks why you need the test, if you dare to claim it’s because of tainted blood supply s/he will roll hir eyes and give you the ‘sure’ look. I can only imagine how much harder it must be for even more marginalized groups.
I had to start that routine at the ripe old age of 15. And even after having that same test, at the same health department, for almost 10 years not ONCE did I get any education about the prevention of HIV. Not once. I educated myself (and this was long before the internet was a household item), and often had to educate my peers as well.
As stated above, I have teenage children. I have, in the past few years, had to explain that HIV is not ‘only’ for gay men, or for IV drug users; that HIV is not spread through kissing, or sharing a drink from the same cup or bottle; that yes, heterosexual men and women can both be infected with HIV through sex. Of course, I live in the rural, Deep South. The Bible Belt. So there is no kind of comprehensive sex education in the schools, not even to the point of how to avoid STDs and HIV. The only prevention is abstinence after all, so why educate?
And people wonder why the US still has such appalling infection rates?
Thanks for sharing, Pega.
I can’t speak for gay men or IV drug users, but as a sex worker I really get the shits with health professionals who are either unaware of the actual stats surrounding HIV infection in this country or have the knowledge but fail to apply it. We’re treated like walking AIDS vectors despite being, in general, safe sex experts.
Cheshire, on first reading Hexy’s take on the grim reaper ads, I must say I agreed with you. I remembered those ads from my childhood and I have to say it made a huge impact on public awareness within the whole community.
However, we don’t want to stigmatise those who are HIV+. I used to work within a first aid organisation, and heard the story of someone double-gloving to put a band-aid on a HIV+ man’s finger. I shuddered.
Ads like this which are currently up on trams and bus stops around Melbourne do more to help stop the spread of HIV and other STIs without stigmatising people who have them.
0_o
I guess that’s a step up from refusing to share plates/bathrooms/workspace/etc. *sigh*
Your link just comes back here. I have seen a great many positive and effective education campaigns, not all of which are in-community for at-risk groups. I might try and source some for another post…
I have just checked this website and I am very glad to read the post above. HIV/AIDS is certainly the most dangerous disease for which there still isn’t any remedy. It is an old saying that prevention is better than cure. Australia has proved to be a very good example of this. The way australian government and NGOs united themselves to fight against this HIV/AIDS really very impressing. I think other countries must take a lesson from this and try to combat HIV/AIDS like australia have done.
Frustratingly, I can’t see the youtube from here to know if it’s the one I’m thinking of, but I remember one from my early childhood that made a huge impact on me at the time, which involved a couple in bed, and then a couple more beds appearing representing their past partners, and then a few more representing THEIR previous, and then a few more for those people, and a few more, etc, until it’s a sea of beds and people.
I liked that ad. Partially because it was applicable to all STIs, and partially because every attempt during high school to tell me I couldn’t know the past history of my partners felt like “they could be lying!” which, as a sixteen year old who was seeing the same girl for years, didn’t hold much water. And because, from memory, it didn’t feel like sly slut-shaming the way a lot of the education I received about STI’s did.
I realise this is frustratingly vague, but I don’t think I was even 10 at the time, so my memory isn’t clear enough to recall the slogan and google it. :/
Thanks for the post, Hexy!
I find it fascinating the way the bottom-up approach to the HIV epidemic developed, particularly amongst gay men & sex workers in Sydney, in the 80s and 90s. That kind of collaboration really needs to happen more often.
I think a large part of what made HIV/AIDS such a special case, and one of the reasons people have become complacent about it since, is that in the early 80s AIDS was this BIG SCARY DEATH SENTENCE. The Grim Reaper ads were a perfect reflection of community attitudes towards this disease that people didn’t really understand, but which was killing off injecting drug users and gay men at alarming rates (and don’t get me started on the fundamentalist whackjobs who declared it God’s judgement for precisely that reason). Part of the reason the at-risk communities mobilised so rapidly was precisely because there was a suspicion that if they didn’t, they would indeed be treated as disposable.
Another important point as background to Hexy’s post – here in Oz, sex education tends to be delivered earlier and more effectively than in the US, at least from the anecdotes I’ve heard from Americans. I think this was largely a result of the AIDS crisis and may be slipping now, if the dramatic climb in chlamydia infection rates is anything to go by.
Yes, absolutely I have horror stories of trying to get tested and doctors assuming I been to some gay_sex and needle sharing party because why else would someone like me want to be tested, their is no “hi I just like to make sure that I and my partners know my risk” in the medical discourse around STI testing it is so frustating.
I just had this pointed out to me by a friend: http://www.myspace.com/theglamreaper
The Glam Reaper is a “viral” campaign produced by ACON, referencing the original Grim Reaper advertisement and encouraging condom use. It’s cute :)
[...] Bonus July post from Hexy guesting at Feministe: The Australian Response to HIV. [...]