Australia’s HIV response is recognised globally as a success. National prevalence is lower than in most other comparable high-income countries. Australian gay communities, sex workers and people who inject drugs mobilised early and effectively to the emergent crisis, providing care and support and educating each other through peer education and community based organisations about safe sex and injecting practices. Government and healthcare professionals demonstrated strong leadership in their engagement with affected communities and the epidemic in its early days. This leadership produced a level of policy innovation that Australia continues to benefit from, for example, in the implementation of needle and syringe programs (NSPs) that prevented a large-scale HIV epidemic among people who inject drugs.
At the end of 2008 an estimated 17 444 people were living with HIV infection in Australia, of whom 995 were diagnosed during 2008.1 During this period around two-thirds of new infections occurred between men who have sex with men (69% in 2008). While the HIV epidemic in Australia remains concentrated it is now resurgent among gay men with increasing numbers of new infections. There are also clear indications of smaller but significant epidemics emerging among Australians travelling and working in high prevalence countries, among some culturally and linguistically diverse (CALD) communities and among injecting drug users in some Aboriginal and Torres Strait Islander communities. This indicates that the national response has entered a challenging period. Strong leadership on HIV from government at all levels is required, especially as public interest in engagement in the domestic epidemic has waned. The long-standing success of Australia’s HIV response among injecting drug users and sex workers also needs to be maintained.
The national response has been adjusted over the last decade to recognise the dramatic advances in HIV treatment since 1996. However, there remains no cure or effective vaccine for HIV on the horizon. It is important to recognise this reality in focusing on the need to reinvigorate prevention and to reinvest in a long-term, comprehensive response to HIV. This sixth national HIV strategy takes immediate steps to:
- strengthen the HIV partnership
- reinvigorate prevention as a cornerstone of the national response
- emphasise monitoring and accountability
- address key workforce development needs
- provide a renewed focus on law reform to ensure an enabling human rights-based environment for the response.
It is essential that a partnership approach be reflected in all jurisdictional and non-government agency planning, implementation, monitoring and evaluation and that lessons learned are shared.
Australia has endorsed the United Nations (UN) General Assembly Declaration of Commitment on HIV (2001) and the UN Political Declaration on HIV (2006) including commitments to universal access to HIV prevention, care, support and treatment.
Partnership between people living with HIV, affected communities, the healthcare professions, researchers and government at all levels is at the core of the national HIV response. A guiding principle of this strategy is the meaningful participation of people living with HIV and affected communities in development, implementation, monitoring and evaluation of programs and policies. Their participation is essential because it ensures that policies and programs:
- are effective
- are informed by the experiences of those with HIV and affected communities
- are responsive to need
- take into account the full range of personal and community effects of policy directions.
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1 National Centre in HIV Epidemiology and Clinical Research, 2009, ‘HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia’, Annual Surveillance Report, 2009, National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney.