Reversing The Trend

FEATURE Melbourne Star – MAR 30 2006

Last issue of Melbourne Star we reported a significant spike in new HIV infection rates. Dr Jonathon Anderson from Carlton Clinic wants reform of the Victorian AIDS Council (VAC) but that’s just the tip of the iceberg.

HIV infections have been rising slowly but steadily since at least 2000, and the latest statistics show a big jump. Dr Jonathan Anderson has called for many of Victorian AIDS Council’s functions to go to Vic Health instead (see front page). But not everyone - and especially not Mike Kennedy, CEO of the VAC – agrees. Greg Iverson, President of People Living with HIV/AIDS Victoria (PLWHA), says a lack of funding is the problem. On the other hand, Sean Slavin, researcher with the Australian Research Centre in Sex Health and Society (ARCSHS), says the kind of big budget campaigns seen in Sydney wouldn’t work in Melbourne.

Mike Kennedy, CEO of the VAC disagreed with both analyses.

“Jonathan’s contribution is starting at the wrong end,” he said. “The discussion Jonathan has started is about who should be doing it. The discussion about funding is, we need more money to do it. We need to agree what this it is before we start talking about who is going to do it, or whether we need more money for it.”

Sean Slavin, of the Australian Research Centre in Sex Health and Society (ARCSHS), doubted that big public campaigns like those run by AIDS Council of New South Wales (ACON) could work.

“The Melbourne gay community is quite dispersed geographically and culturally. It isn’t anywhere near as coherent as the Sydney gay scene, and that does present some particular challenges for health education in Melbourne. There’s much more of a sense of identification around gay identity and institutions in Sydney.”

Slavin, who is normally based in Sydney, identified another difference campaigns would need to address. He said that positive men in Melbourne had a much harder time disclosing their HIV status to potential partners.

“From what I’ve seen, rejection would be the mildest outcome,” he said. “They also run the risk of some fairly strident stigma being thrown at them.”

So if the leading organisations and individuals involved in fighting HIV/AIDS can’t agree, who will sort out the mess? Mike Kennedy reckons Health Minister Bronwyn Pike needs to step in and take a leadership role, get everyone together to sort through the options and make the decisions.

Kennedy said the funding would be there if the community could make a case for it.

“I’m not suggesting we do another inquiry, it doesn’t need months and months of work. But ....you’ve got to get the policy stuff right first,” he said. “You’ve got to mount the business case, and... when we’ve been able to do that effectively, government has found the money..”

Greg Iverson of PLWHA said that while he didn’t always agree with the VAC – in particular there were strong objections to the Staying Negative campaign – in this case they were right. Funding was the major problem. But he also thought that over the longer term the need for dedicated AIDS groups would fade away.

“This... trend is already happening,” he said. “Linkages have been established between AIDS councils and Hepatitis C councils. We’ve already got a gay and lesbian section in our health department – the only one in the country that does. Where does that leave the VAC? They need to ponder that.”

Dangerous Liaisons

While organisations, bureaucrats and activists wrangle, new infections continue to occur, because some dangerous myths are leading men to make high-risk decisions that increase their risk of getting HIV.

Unprotected sex – sex without a condom – also referred to as raw or bareback sex – is on the rise. That doesn’t mean that gay men are recklessly deciding the risk of HIV is worth the feel of skin-on-skin. Instead they are experimenting with a range of strategies to try and have unprotected sex safely.

Drugs, Drink and Sex-on-Site

A study of 15 newly infected HIV positive men in Melbourne, by the Australian Research Centre in Sex Health and Society, found that most of the men became infected while bottoming unprotected – half of them at a sex-on-site venue or beat. And “drugs and/or alcohol featured in the risk incidents” for most of the men in the sample.

Don’t Assume

Researcher Sean Slavin said the study also showed that positive men often assume that when a prospective partner offers unprotected sex, he is positive too. Negative men, on the other hand, assume he’s negative. Either way the false assumption leads to risky sex.

This is what’s known as sero-sorting – trying to reduce your risk by only having unprotected sex with partners of the same HIV status as yourself. The problem is, it’s not possible to have unprotected sex safely with a casual partner in any circumstances.

Sero-Sorting – Positive Guys

If you’re both positive, there is still the danger of other sexually transmitted infections, such as chlamydia, and syphilis, which are fast rising in the gay community. These are a major problem for people whose immune systems are already challenged. Mike Kennedy of the Victorian AIDS Council, says, “Particularly gruesome complications can arise from being HIV positive and having syphilis.”

Sero-Sorting – Negative Guys

In a casual context, you can never be sure that you’re both negative. Greg Iverson of People Living with HIV AIDS says you can never call yourself negative unless you’ve had an HIV test, “and what’s more, unless you had the test yesterday.” Otherwise your status is not negative, it’s unknown. In other words, sero-sorting is not going to protect you.

The Joys Of Monogamy

The only time when it’s safer – not safe – to have unprotected sex with a partner is within a monogamous committed relationship. But even that’s not simple. The VAC publishes guidelines on the web called Talk-Test-Test-Trust - Details: www.vicaids.asn.au

In short, while community organisations try to decide what they should do next, we as individuals need to look at some the assumptions we’ve made that have resulted in some of us becoming infected.

In the meantime, as the party season gets under way, remember to play safe.