It is recognised that individuals have a responsibility to prevent themselves and others from acquiring HIV infection and to prevent further transmission, and Australia’s targeted HIV prevention and health promotion response should be improved in relation to this. To respond to rises in infections, prevention will be revitalised as the cornerstone of the national response. Targeted prevention is cost effective, and is cost saving to the national economy. Investment in HIV prevention shows higher returns than other comparable health promotion programs, including tobacco control and prevention of heart disease. An economic model measuring the impact of investment in HIV prevention in New South Wales, for example, projected that at least 44 500 infections had been avoided in the state through HIV prevention programs and that for every dollar spent, $13 was saved.4
Prevention will focus on populations experiencing resurgent epidemics. It will also strengthen efforts focused on populations in which the epidemic has largely to date been prevented (particularly sex workers, people who inject drugs and people in custodial settings) and guard against emerging epidemics (particularly in Aboriginal and Torres Strait Islander peoples who inject drugs and people from priority CALD backgrounds). International evidence on concentrated epidemics concludes that effective HIV prevention must be focused on communities and populations most at risk and most affected by HIV rather than be spread evenly throughout the population.5 Targeted resourcing of the prevention response is highly efficient and critical to the success of the national response, but may need increased support to reach highly marginalised populations. Poorly targeted investment and disinvestment in prevention have led to a resurgence of HIV in some jurisdictions.6
With young people, the focus will be on those most at risk of HIV who fall within the priority groups identified earlier in this strategy. Universal programs for youth in the general population will be implemented through the Second National Sexually Transmitted Infections Strategy 2010–2013.
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New complexities also need to be addressed, including changing community perceptions about HIV, the impacts of new therapies, increasingly diverse and diffuse gay communities, a growing and ageing population of people living with HIV and challenges in reaching particular populations where emerging or re-emerging epidemics may be a problem. A continued strong focus on gay men will be coupled with recognition of increasing diversity in the populations most at risk of HIV. It is important to ensure that a comprehensive package for HIV prevention is delivered to those most at risk. This includes:
- providing information and equipment to support safe sex and safe injecting practices
- building individual skills around HIV risk reduction strategies
- ensuring community development, social change and peer-based health promotion tackling STIs that act as a cofactor in HIV transmission
- working with mainstream services to address the health factors that compound HIV vulnerability such as alcohol and other drug use, depression and other mental health issues among people living with HIV and priority populations
- paying attention to the social determinants of health that affect HIV prevention efforts, including social marginalisation, access to health promotion and health services, and law and policy frameworks
- reducing HIV-related stigma and discrimination.
- communication and biomedical technologies relevant to specific prevention and health promotion interventions
- prevention agents such as microbicides and vaccines.
The following populations are priorities for prevention. These populations are not mutually exclusive.
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4 Health Outcomes International, 2007, The Impact of HIV/AIDS in NSW: Mortality, Morbidity and Economic Impact; NSW Health.
5 Coates TJ, Richter L & Caceres C, ‘Behavioural strategies to reduce HIV transmission: how to make them work better’, Lancet, 2008;372(9639): pp. 669–84.
6 Fairley CK, Grulich A, Andrew E, Imrie J & Pitts M, ‘Investment in HIV works: A natural experiment’, Sexual Health 2008;5(2):pp. 207–10.