By Ken Davis
People with HIV, community AIDS organisations and international health bodies are agreed that human rights and public health go hand in hand in fighting AIDS. Countries with widely accessible health systems as well as greater degrees of social and political freedom are responding better to the epidemic than those countries which lack primary health care services and where women or minorities are more repressed.
Australia is regarded in many countries as having responded pragmatically and effectively to the epidemic, carrying out widespread preventive education, outlawing discrimination, reforming relevant laws, and guaranteeing a relatively good level of care, treatment and support for people with HIV and AIDS.
This effective response is not without its inadequacies, nor is it simply the product of the "ideologically correct" liberalism of the state or national governments. AIDS in Australia is characterised by an unprecedented level of community organising and mobilisation, challenging traditional repressive public health models as well as dominance by the medical experts and drug companies.
In political advocacy, in preventive education and in volunteer support programs, the communities of people with HIV, gay men, drug injectors and sex workers have shown leadership. Australia's successes are as much due to their efforts as to those of health professionals or governments.
State intervention and policing are notoriously ineffective in altering sexual or drug taking behaviour. Since HIV is not contagious, but transmitted by private and usually voluntary interpersonal practices, only ourselves, as individuals, HIV positive and negative, our peers and communities can take responsibility for preventing transmission.
HIV is not the same as TB, (though increasingly the two epidemics are interacting on a world scale), which is easily transmitted in ordinary life, and which requires isolation during early treatment. HIV is transmitted only via blood, sex or birth, but is potentially infective over many years. Even in traditional public health terms, HIV necessitates different approaches.
The 1993-96 National HIV Strategy launched recently by health minister Graham Richardson aims to decrease new infections to fewer than 300 per year. There are 300-600 new HIV infections in Australia each year. In the 12 months to June 30, 1993, 986 people tested positive for the first time, but many of these people were infected long before and only tested recently. In the last 12 months the incidence of HIV appears to be slightly lower than in previous years.
It is possible that there are higher rates of new infections occurring now, but not showing up in current testing. On the other hand, Australia has an extraordinarily high rate of voluntary HIV testing. In fact, almost a million HIV antibody tests are performed in Australia each year, in addition to the testing of blood donated for transfusion.
The relatively low rates of new infection make sense in relation to the data available about behaviour change. Surveys over several years show that around 87% of gay men changed their sexual practices in the mid-1980s, and have maintained those changes. In the sex industry, surveys show 97% of workers insist on condoms every time. Australia has one of the most comprehensive and successful needle exchange programs in the world.
Despite these successes, no one in the front-line communities is complacent. Every new infection is a tragedy. For gay men, who make up the majority of new infections, the issues of sustaining safe sex after a decade of loss and grief are complex. It can be hard to use condoms every time, regardless of the significance of anal sex in sexual expression and identity, of the intensity of a relationship or attraction, of depression at multiple grief, of intoxication, of inexperience and so on.
Most nations and most Australian states have laws which can penalise or isolate anyone considered to be spreading HIV. In most cases, the laws are unused because they are unviable and can play no real role in limiting the spread of an infection transmitted by private and voluntary activities. Safe behaviours are the responsibility of all, not only those known to be HIV-positive.
The manifesto of the "new public health", the Ottawa Charter adopted by the World Health Organisation in 1986, calls for popular control over the social determinants of health, through community, personal, environmental and public policy action, as well as reorientation of health services towards primary care and prevention.
AIDS necessitates a radical agenda of expanding human rights, abolishing legal and policy restraints that stand in the way of marginalised and oppressed communities responding in their own terms to the epidemic. In Australia we need to:
- decriminalise drug use;
- end legal and police harassment of sex workers;
- ensure universal, explicit and non-moralistic sex education in schools;
- end travel and immigration restrictions;
- guarantee people with HIV protection from discrimination and breaches of confidentiality;
- remove remaining anti-homosexual laws;
- end censorship of sexually explicit discussion in the media;
- close the prisons;
- secularise health, education and welfare services;
- ensure adequate resources to Aboriginal-controlled health services;
- remove legal restrictions on assisted suicide/euthanasia;
- abandon the punitive provisions of the public health laws.
Socialists do not oppose liberalism because it lacks repressive measures, but because liberalism thrives on the inequalities that deny the majority of the world's population opportunities to exercise real personal freedom. Socialists do not seek to maximise control by the state, but strive to maximise the power of ordinary people over all issues of life: the economy, the environment, health, media, education and sexuality.
[Ken Davis works with the AIDS Council of NSW.]