1. These Guidelines have been developed to inform, support and harmonise approaches by Australia’s States and Territories to the management of people with HIV who place others at risk of HIV infection.
  2. The Guidelines are informed by the findings of the 2007 National Review of Policies for the Management of People with HIV who Risk Infecting Others undertaken by Associate Professor Robert Griew, and by the 2003 National Public Health Partnership paper, Principles to be considered when developing best practice legislation for the management of infected persons who knowingly place others at risk.
  3. The 2007 National Review made a number of recommendations in relation for legislative, policy and administrative change in the jurisdictional management of people with HIV who place others at risk. The implementation of those recommendations is being overseen by the inter-governmental Blood-Borne Virus and Sexually Transmissible Infections Sub-Committee of the Australian Population Health Development Principal Committee. The development of these Guidelines is one of those recommendations.
  4. The National Review found that the number of individuals whose behaviours require intervention utilising coercive public health management strategies is small and that these individuals do not drive Australia’s HIV infection rate. The Review noted that the continued effective management of HIV/AIDS in Australia is reliant on sustained investment in prevention education efforts based on the latest surveillance data and targeting high-risk populations as the highest priority.
  5. The Guidelines provide direction on the management of the sub-set of people with HIV who place others at risk in circumstances where it may be necessary to take steps that infringe upon the liberty of an individual in order to protect the health of the public.
  6. The Guidelines are based on the following principles and assumptions:
  • except in special circumstances, testing for HIV should be conducted on a voluntary basis;
  • people with HIV should not be quarantined, or excluded from social or sexual activities;
  • every individual has a responsibility to prevent themselves and others from becoming infected and preventing further transmission of the virus;
  • most people with HIV are motivated to avoid infecting others and the risk of transmission by most people with HIV is best managed through access to information, education, resources for the prevention of transmission and HIV treatment services;
  • counselling and support services, including post-diagnosis counselling, should be provided to encourage behaviours that minimise the risk of infecting others;
  • for people with HIV who place others at risk, a variety of increasingly interventionist strategies may be needed, with preference being given to strategies that are least restrictive, as these will generally be the most sustainable and effective in the long term;
  • the right to equitable, non-discriminatory and transparent dealing, including the right of review and appeal, should be preserved; and
  • the roles of clinicians and local service providers with clients and of public health officials in surveillance and enforcement should be kept distinct.
  1. The management of people with HIV who place others at risk requires a variety of strategies including access to the range of services generally available to people with HIV; information and education about HIV transmission and prevention; access to HIV treatment and clinical care; and access to goods, such as condoms and needles and syringes. It may also require more intensive, individualised case management, a variety of responses to other health and social service needs and an escalating series of behavioural management techniques including counselling, behavioural supervision, formal warnings and public health orders, including, if necessary, detention or referral to Police.
  1. HIV is a lifetime infection. There is, as yet, no cure. HIV treatments are understood to reduce infectivity but that is not by itself a safeguard. HIV transmission does not occur via casual contact. Specific behaviours are linked to infection. Managing individuals with HIV who place others at risk therefore requires techniques that will be effective over a life course at modifying behaviours. Escalation to more directive strategies will generally not be preferred because these will be the most difficult to sustain.
  1. In general, therefore, pre-emptive escalation to the more interventionist of these strategies will not be considered until less restrictive alternatives have been tried and have not been successful. However, there are cases where a step-by-step escalation through the full list of possible techniques will be considered too slow to respond to the behaviour of a particular individual. The best mix and order of strategies will be determined on a case-by-case basis.