Kay Hull (Riverina, National Party) Share this | Link to this | Hansard source

I have put this motion on the agenda simply to raise awareness of the issues that are confronting us with the HIV-AIDS populace and strategy. I just attended the UN National Assembly on HIV-AIDS in New York. It is my view that most countries are showing a lack of political leadership. At times, when we listened to the interventions and the presentations that were made at the assembly, it seemed that if the rhetoric counted for anything we would not have a problem. Sadly, the reality does not yield a positive picture. Whilst we have come a long way, we have a long way to go. In particular there are issues of treatment—more specifically, the lack of trained practitioners to deliver treatment—that we must deal with. There must be investment in workforce availability across the world to enable the delivery of antiretroviral therapies to those who are affected. It is a fact that many developed countries are poaching trained professionals from developing countries, and we are sadly leaving these areas with no ability to treat this HIV-AIDS epidemic.

Prevention is still by far the best solution. When we are faced with figures that indicate that for every one infected person we treat there are 2.5 people who become newly infected, it is obvious to me that we need to have serious preventative measures and serious strategies that are concerned with the cheapest solution of all—prevention. That for every one person we treat 2.5 people become newly infected obviously puts significant pressure on maintaining and enhancing our funding. There has been a ridiculous notion that there is too much money going into responding to HIV-AIDS globally when in fact this is not correct. Treatment and intervention, particularly that which has a strong impact, is indeed very expensive and fewer than half of the people affected with HIV currently have access to treatment. Frankly, prevention is far less expensive and attention must be given to delivering prevention campaigns designed to target those most at risk.

A serious rethink of Australia’s strategy should be undertaken. We must openly evaluate the success of the delivery of HIV care in all areas, including rural and regional areas. We must seriously re-evaluate our prevention message to determine if we have been effectively targeting our most at risk. Our first strategy was formulated in 1988 and it had bipartisan support that over the years successfully prevented many Australians from becoming infected. It began the process of eliminating discrimination. Indeed, it determined that all affected people would be provided with compassionate care.

We have now seen four national strategies. My belief is that we are now heavy on rhetoric and the principles but that we are most definitely lacking leadership and drive in the delivery on the ground of a real HIV strategy. It is a fact that the strategy ends in only seven days time. Justifiable concerns have been raised that key programs could have their funding jeopardised. I urge the Minister for Health and Ageing to announce that the funding for programs under the old strategy will continue until the new strategy is in place.

We cannot afford to take our eye off the ball. We must continue our practice of bipartisan responses to ensure that the sensitive issues are put on the table and discussed. This has been the platform—the key to the success—of the Australian control of HIV since the inception of strategies. It has been the desire of members of parliament on both sides of the House to discuss the sensitive issues of males having sex with males, intravenous drug use, sex workers and many other issues involved in HIV-AIDS and hepatitis C strategies.

Every member in this House has an obligation to be a part of a candid response to HIV-AIDS, and it requires some significant thinking. We need to incorporate the UN declarations and the commitments from the UN into our strategies. We endorsed the declaration back in 2001, but we have never included the measures of that statement and the declaration into our own strategy. It is imperative that we look at ways to continue to show great leadership in the international areas. We have undertaken many reviews in respect of HIV and hepatitis C. There has been research into the epidemic and the disease, yet over the years we have seen few of these recommendations effectively implemented or even adopted. The states and the territories have been particularly lax and directionless in their response to HIV-AIDS. The Commonwealth must demand a better response from all parties. We can do better, and we must do better. There are many, many things that we need to apply in order to ensure that people have equity in treatment and services.

We have an option to lead the world and to suggest greater implementation of new and emerging programs. The one thing that I was most interested in was to ensure that, in our strategy for HIV-AIDS—in the national strategy and the international strategy—we include a positive and proactive plan of action for those people who are survivors of rape and incest. If they were to get a postexposure prophylaxis for HIV, it would stem from some of the many problems that are now emanating from quite brutal actions in many Asia-Pacific countries. Indeed, Australia is not free from that either. We as a nation have always acted in a bipartisan way. It is time that we took the strategy, reviewed it precisely and determined its effectiveness on the ground in respect of controlling new infections, as we have over 1,000 new infections per year. Obviously, we have a problem that we need to address.

I am concerned that the strategy has not yet been endorsed or implemented. Whilst I recognise that it is out there for consultation, many of the program operators are waiting for some sort of recognition or lead as to whether or not to continue their programs. Following my visit just recently to New York—and having now been appointed to the IPU HIV-AIDS task force—I feel quite confident that Australia still has so very much to offer. However, in order that we continue to be world leaders and provide direction for the rest of the world—and that in our international aid programs we can provide key advice and directions in those areas—it is very important that our strategy addresses the UN declaration, and that which is contained within the UN declaration, so that we continue to lead the way.

This motion is before the House because we have only seven days before our strategy expires. I urge the minister—and I know that she is very aware of and significantly concerned about this issue—to ensure that our programs continue and that we take the opportunity to have a full and no-nonsense review of whether or not our strategy is being successfully delivered on the ground and what changes need to take place in order for us to provide whole-of-life and whole-of-health care for all of those HIV-AIDS sufferers and their families in communities in rural Australia and city areas alike. I applaud the House for allowing me to bring forward this private member’s motion.

Yvette D'Ath (Petrie, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the motion moved by the member for Riverina. I am sure that I speak for all members of this parliament when I say that we should continue to invest in the areas of research, health services and education for the benefit of those suffering with the HIV-AIDS infection and the Australian community as a whole.

While Australia continues to have one of the lowest rates of new HIV diagnoses among similarly developed countries, in recent years there have been worrying trends in infection rates for HIV-AIDS and other sexually transmitted infections—trends which the previous government did little to address. Up to 2006 there were five successive increases in the annual number of diagnoses of HIV, to around five diagnoses per 100,000 population. In 2006 there were 998, almost 1,000, new notifications of HIV infection.

The statistics are similarly disturbing for other sexually transmitted infections. From 2005 to 2006 the rate of chlamydia increased by 12 per cent, continuing increases seen over the past 10 years. Gonorrhoea rates in 2006 increased by 29 per cent. Infectious syphilis increased from 3.1 per 100,000 people in 2004 to four per 100,000 in 2006. Respected data shows that, between 2000 and 2006, the number of new HIV diagnoses in Australia increased by 31 per cent. In Queensland the rate of diagnosed HIV infection in 2006 was four per 100,000 population.

HIV continues to be transmitted primarily through sexual contact between men, although particularly concerning are recent media reports that there has been a significant increase in the rates of sexually transmissible infections in Queensland, particularly in young children—although an unknown proportion of the cases in children could result from a related chlamydia strain that causes an infectious eye disease called trachoma rather than having been acquired through sexual contact. The data also shows that, although there was a similar rate of HIV diagnosis per capita in the Aboriginal and Torres Strait Islander and non-Indigenous populations, a higher proportion of cases were attributed to heterosexual contact and injecting drug use in the Aboriginal and Torres Strait Islander population.

Although HIV-AIDS is one of the more commonly known of the blood-borne virus infections, in recent years chlamydia has been the most frequently notified sexually transmissible infection in Australia. Queensland has the highest number, at over 12,200 cases, and the second highest rate, at around 890 cases per 100,000 Queenslanders. Young, sexually active people are overwhelmingly the most at risk. Because untreated chlamydia can also lead to infertility in infected women, the high prevalence rates in Australia in women aged between 15 and 29 are of serious concern. Currently there is a testing program aimed at increasing the awareness of chlamydia and improving screening processes and surveillance. The results of this program will inform improvements in chlamydia testing nationally.

The data on HIV-AIDS and other sexually transmissible infections in Australia emphasises the importance of federal and state governments taking an active role in dealing with all sexually transmissible infections. Obviously, it has been some years since we saw the grim reaper on our televisions, educating the Australian community about the risk of HIV-AIDS infection. At the time that campaign was very successful in bringing this issue to the forefront of people’s minds. This was especially the case for our young people. Of course, many of our youth and young adults today have never seen that advertising campaign. It is important that we keep a high awareness of the risk of HIV-AIDS and other sexually transmissible infections.

Since 2005, prevention activities have been guided by a national strategy aimed at reducing the transmission of not only chlamydia but also other sexually transmissible infections, in addition to providing leadership through the four national strategies that underpin the national prevention and education activities. The government provides considerable funding to support targeted prevention and management of such infections. However, the statistics show that these strategies have not resulted in a reduction in diagnosed infections. It is not only the statistics that are disturbing in relation to chlamydia, gonorrhoea and infectious syphilis diseases; as these diseases share many risk factors, they paint a very worrying picture for HIV infection rates in the future.

Clearly, the previous government fell asleep at the wheel. While Australia had a world-leading role in HIV-AIDS policy under the previous Labor government, this position was allowed to erode under the Howard government. In 2008 there are significant opportunities to redress this concerning trend. Reducing the transmission of HIV, other blood-borne viruses and sexually transmissible infections is a key area of the government’s preventative health agenda. The Australian government is committed to working in partnership with government and non-government organisations to refocus programs that help address rising rates of HIV-AIDS and minimise the personal and social impacts on those living with HIV-AIDS.

There are opportunities in a number of areas to strengthen the health system’s focus on preventative health, as one of the key priorities of the government. Consistent with this, the government will look at how existing resources can be refocused and used more effectively to help reduce the transmission of HIV and other sexually transmissible and blood-borne viral infections. The government acknowledges that effective partnerships between government, researchers, clinicians and affected communities have played a critical role in preventing and managing the spread of HIV to date and has committed in 2008 to reinvigorating this partnership approach.

The previous government allocated $9.8 million in the 2007-08 budget for a four-year national prevention program to raise awareness of sexually transmissible infections, including HIV, and encourage behavioural changes to reduce their prevalence and spread. However, it did nothing to implement this program. The Rudd government will move ahead to ensure this program is implemented as quickly as possible.

With regard to our leadership role in the Asia-Pacific region, the Australian Agency for International Development is undertaking a review of Australia’s international HIV strategy. It is greatly concerning that the epidemic is still expanding in many Asia-Pacific countries, including Papua New Guinea, Indonesia, Fiji, Vietnam and China. Papua New Guinea has been confirmed as experiencing a generalised epidemic affecting more than one per cent of adults. On the other hand, with comprehensive responses now in place and a history of leadership on the issue, the epidemics in Cambodia and Thailand are considered to be declining.

The Australian government provides $13.4 million per year to community based and research organisations that contribute to the development of prevention, education and research policies and programs. The government will ensure that it works closely with all key stakeholder groups and non-government organisations in refocusing our approach to HIV. Approximately $8.3 million of this funding is allocated annually to four national research centres to provide epidemiological data and undertake HIV clinical and social research, HIV and hepatitis virology research and research focusing on sex, health and society. Funding arrangements for community based and research organisations were reviewed in 2007. Future funding arrangements are presently being determined.

An amount of $814.7 million over the period 2004-05 to 2008-09 is being provided to states and territories through public health outcome funding arrangements. The states and territories are required to meet a range of performance measures including the development of local HIV strategies and health promotion activities. The government is looking to reform and improve performance and accountability for funding provided to states and territories through its reforms to Commonwealth-state financial relations.

In addition, stakeholder organisations have raised a number of complex issues about the ongoing effectiveness of Australia’s national response to HIV-AIDS. That is why officers from the Department of Health and Ageing have met with one of the key organisations to gain a better understanding of the issues from the sector’s perspective. This advice is informing consideration of the issues raised.

The Rudd Labor government is committed to reinvigorating the partnerships between governments, researchers, clinicians and affected communities. To this end, the government will be undertaking a review of the four strategies before they expire at the end of 2008 and will respond to other issues raised by the sector in coming months. Importantly, the review will help establish more explicit links between the strategies and state and territory implementation plans. The government is confident that a reinvigoration of the preventative health agenda in partnership with the states and territories and other relevant stakeholders will assist in tackling the rising rates of blood-borne virus and sexually transmissible infections. The Rudd Labor government looks forward to working in partnership with all of these groups to tackle these important issues in our community.

Luke Hartsuyker (Cowper, National Party, Deputy Leader of Opposition Business in the House) Share this | Link to this | Hansard source

I welcome the opportunity presented by the member for Riverina to speak on this important motion. After about a decade of decline, the rate of HIV-AIDS infection in Australia has been rising since the late 1990s. There are now more people in Australia with HIV-AIDS than ever before. Unfortunately, this trend seems set to continue. According to the research released in March by the University of New South Wales, Australia could actually be facing a huge surge in HIV infection rates over the next seven years. Lead researcher Dr David Wilson says that, although the numbers are lower than they were at the peak of the 1988 HIV-AIDS crisis, the trend is worrying.

On a positive note, new treatments have seen a marked increase in the life expectancy of people infected with HIV and AIDS. If you were diagnosed with AIDS in 1996, the median survival time was only 19 months. By 2003, that had increased to 34 months. For Australians with HIV, the virus is no longer a death warrant, and many people diagnosed with HIV will go on to live long lives and have HIV-free children.

The challenge before us is that people infected with HIV in developing nations have little or no chance of accessing the same treatment and medicines as Australians. Research by AusAID has found that 64,000 people, or two per cent of the population, in New Guinea are HIV positive. The research concluded that, unless interventions to address the spread and impact of HIV-AIDS are scaled up, by 2025 over 500,000 New Guineans will be living with HIV or AIDS. The effects of such an increase would be devastating: 117,000 children would lose mothers to HIV-AIDS, the workforce would decline by 12.5 per cent and 70 per cent of all hospital beds would be needed for AIDS sufferers.

These statistics show that HIV and AIDS are not just a health challenge; they are an economic challenge, they are a social challenge and they are a national challenge. The diseases affect families physically, emotionally and financially. It is estimated that by 2015 HIV will have caused six million Asian families to slip below the poverty line. International experience has shown that, with strong leadership and comprehensive responses in place, the epidemics of HIV-AIDS can be brought under control, as evidenced in Cambodia and in Thailand. The problems are large and challenging. In Asia in 2008, only 26 per cent of HIV sufferers have access to the necessary drugs and treatment. Although this is up from just nine per cent in 2004, we would all agree that there is still a long, long way to go.

Australia has been and has the opportunity to continue as a leader in the fight against HIV-AIDS. Internationally, we are recognised for our leadership on HIV policy and for technical strength in the prevention, treatment and research of the disease. Australia’s international AIDS strategy is due to conclude shortly—in fact, within seven days—and AusAID has released a consultation paper in preparation for the release of a new strategy later this year. This presents the Rudd government with an opportunity to continue Australia’s leading role in the field of HIV-AIDS treatment and prevention.

Research into HIV-AIDS must continue in Australia, for the benefit of Australian sufferers as well as the international community. Unfortunately, many governments in our region have been unwilling or unable to develop comprehensive AIDS strategies. As a result, Australia’s position as a leader in this region is vital and must be maintained and expanded. On the domestic front, access to HIV-AIDS services for people living in rural and regional Australia must be improved. Counselling and support is often very difficult to obtain, and treatment may require travel and considerable inconvenience. HIV and AIDS are terrible conditions that affect thousands of Australian families. Today, I call on the government to ensure that HIV-AIDS sufferers and their families are given the best possible options for the management of their condition.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

I would like to commence my contribution to this debate by congratulating the member for Riverina for bringing this motion before the House tonight. In addition, I would like to put on the parliamentary record that she is renowned worldwide for the contributions she has made in this area. Recently, she was invited to participate in an IPU briefing held in conjunction with the 2008 high-level meeting of the UN General Assembly on AIDS. I would like to congratulate her for the work that she has done in this field and the recognition that she has brought to this parliament.

I believe that the only way that we can have the best outcome in relation to HIV and AIDS is by adopting a bipartisan approach and having all levels of government involved in the fight against this deadly illness. We need a whole-of-community approach. As rightly mentioned by the previous speaker, people in developing African countries are some of the worst affected by AIDS and HIV. When you look at those countries, you can see just what happens if you do not adopt an approach where you attack the disease and try to resolve the issues that surround it. You can see that there is absolutely no benefit at all to putting your head in the sand and pretending it does not exist. Now, 25 years post the epidemic, we need to think about what it means to be HIV-positive and ageing. People with HIV are now living longer than previously as a result of antiretroviral medications. Those are the medications that need to be made available in Third World countries. Also, we need to look at alternative treatments.

Something I have never before shared in this parliament is this: a member of my extended family was bisexual, and he had HIV-AIDS; his wife contracted the disease as well, and they both died. They had four children, and their deaths caused great anxiety and great upheaval in the lives of those children. When I look back to that era, there was much secrecy surrounding the illness and little treatment available. Moreover, there was not much of a mindset to actually attack the disease.

It really does worry me that we are in an age where the number of HIV infections is increasing and we have developed a complacency about the disease. I would like to strongly support what the member for Riverina has said. We need to have more research. We need to have a very wide community campaign where we embrace the fact that this disease is out in the community and that it is actually increasing in prevalence. We need to look at the issues that are causing this increase. I do not want to see other families go through what the members of my family went through, with four young children having to be brought up without a mother or father. We need to have proper policies in place, and we need to have proper recognition of this disease and to ensure that the knowledge that we as a nation have is shared with other countries. Mr Deputy Speaker, I am mindful of the fact that I have jumped up the list of speakers so I will end my comments there.

Stuart Robert (Fadden, Liberal Party) Share this | Link to this | Hansard source

I rise to support the motion. There are approximately 12½ thousand Australians living with HIV, 2½ thousand of whom live with AIDS. From 1993 to 1999 the number of cases declined by 32 per cent, but it increased by 31 per cent from 1999 to 2006. Between 1993 and 2006, 12,313 new diagnoses of HIV infection were reported in Australia. The conclusion is that the number of HIV cases has risen across the country in the past seven years—although, incidentally, not in New South Wales. It is thought that the early drop in the number of cases and the new treatments available have perhaps reduced the fear of infection in the community and have caused the resumption of dangerous sexual practices. According to recent research at www.news-medical.net, if current trends continue, infection rates could rise by a staggering 70 per cent in Victoria and 20 per cent in Queensland. This research is based on men who have sex with men, because it is in this population that the increase in HIV has primarily been seen. It seems that almost one in five transmissions amongst gay men are from men who have been recently infected. It also appears that almost one in every three infections are estimated to be transmitted by approximately 13 per cent of men who are themselves undiagnosed and are unaware that they have the disease.

The new spectre is the emergence of the drug resistant strains of HIV. In England right now, 27 per cent of HIV cases do not respond to treatment. Transmission in Australia continues to be predominantly through male homosexual contact, with 25 per cent attributed to injecting drug use and heterosexual transmission, but the pattern is changing. In the UK heterosexual contact has recently overtaken homosexual contact as the most common means of acquiring HIV. I therefore call on the government to do everything they possibly can about this. I note with interest that Meeting the Challenge, Australia’s international HIV strategy, finishes in seven days and there is nothing immediately available that I can see that the government are doing to follow it up. I call on the government to do everything they can to follow up on this strategy and to meet the challenge head on.

Outside of Australia the AIDS epidemic is far from under control. The World Health Organisation estimates that more than 58 million people have been infected with HIV and 23 million have already died from the disease. More than two-thirds of these cases are in sub-Saharan Africa, where infection statistics are staggering. In 2000, one in three adults in Botswana between the ages of 15 and 59 were infected with HIV. In South Africa, Zambia and Namibia one in four are infected, and the rate is one in five in Zimbabwe and Swaziland. HIV in Africa is primarily a heterosexual disease. This means that AIDS strikes down the most productive generation. The World Bank estimates that the central African republic of Malawi will lose a quarter of its workforce to AIDS in the next 10 years, with one in six adults infected. In Malawi 700,000 children will be orphaned by 2010.

Uganda has been seen as the HIV model for the world. There, more than in any other country, the message seems to be working. There is community education at every level, predominantly the ‘ABC’ initiative, started by the churches. A is for abstinence, B is for being faithful and C is for being Christ like—that is, having a moral value in your life—although that is now changing, with C standing for condoms. This has been led by the churches. I acknowledge leadership of the Ugandan churches and especially KPC, under the leadership of Gary and Marilyn Skinner, who decided to fight this fight very early on. In 1990, 15 per cent of the population of Uganda was diagnosed with AIDS, including 30 per cent of all pregnant women in the country. At the end of 2006 the rate was only six per cent. Yet Uganda has a population of 25 million, and 50 per cent are under 15. It has the highest rate of AIDS orphans of any country in the world—upwards of two million.

There is a tsunami every month in Africa. The deadly tide of disease and hunger steals silently and secretly across the continent. It is not dramatic and it rarely makes the television news. Its victims die quietly, out of sight, hidden in their pitiful homes, but they perish in the same numbers. The eyes of the world may be diverted from their routine suffering but the eyes of history are upon us. In years to come, future generations will look back and wonder how our world could have known what was happening—how our world could have known that, by 2010, there would be 50 million AIDS orphans around the world—and failed to act. The government needs to act. It needs to follow on from this successful strategy. We look to the government for guidance and leadership.

Shayne Neumann (Blair, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the motion of the member for Riverina. It is well framed and well put, and I congratulate her. As the former Secretary-General of the United Nations Kofi Annan famously proclaimed in 1999, AIDS is everybody’s business. It has been nine years since that declaration was made, and HIV-AIDS still is everybody’s business. The disease respects no national boundaries, spares no race or religion and devastates both men and women, rich and poor, black and white.

Since the first Australian case of AIDS was reported in Sydney in October 1982, Australia has not been inoculated from the threat of an HIV-AIDS pandemic. By September 2006, there were 23,065 Australians who had been infected with HIV and 6,658 Australians who had died from AIDS. In the 1980s, while other developed nations pursued policies which wrongly demonised HIV-AIDS as some sort of divine punishment for alleged sins, Australia subscribed, correctly, to the idiom that prevention is better than a cure. Australia’s approach, which focused on prevention and encouraged people to make simple changes to risky behaviour, was eminently more successful than the approaches overseas—particularly in America, which had adopted a head in the sand approach.

Over 25 years on, Australia’s rate of HIV prevalence is 75 people per 100,000 compared with 402 people per 100,000 in the United States. Australia’s incidence of AIDS is 1.3 per 100,000 compared with 14.3 per 100,000 in the United States. Looking at the stark comparison, it is not too much to say that tens of thousands of lives have been saved thanks to Australia’s pragmatic and inclusive approach to HIV-AIDS. It was the policies initially pioneered by the Hawke Labor government that kept Australia’s rates of HIV-AIDS amongst the lowest in the developed world. As those in the chamber will be aware, it has been more than two decades since our last national prevention and education campaign. A generation of students have graduated without ever having heard the grim reaper’s warning. Twenty-five years on, it is starting to look as though complacency has set in. Alarmingly, rates of new HIV infection are climbing. It is a very worrying trend, even if it comes from a comparatively low base.

Under the stewardship of the previous government, the incidence of HIV-AIDS and other sexually transmitted diseases rose sharply. The world-leading approach to HIV-AIDS pioneered by the former Labor government unfortunately, sadly and regrettably eroded under the Howard government. Despite allocating $9.8 million in the 2007-08 budget for a four-year sexual health campaign, little action was taken. I am pleased to say that, while the former Howard government did almost nothing to implement this program, the Rudd government will move ahead to ensure this program is implemented as quickly as possible. The neglect of this health issue by the previous government has been acknowledged by a number of different sources.

HIV-AIDS remains a disease for which there is no cure at the moment, and I look forward to the day when there is a cure. It is vitally important we as a nation do everything we can to promote prevention. Simply saying no and having zero tolerance of drug use will not solve the problem. Those things alone cannot do it. The Rudd government understands the steps that need to be taken to protect Australians from the spread of the disease. Reducing the transmission of HIV, other blood-borne viruses and other sexually transmitted diseases is a key component of the Rudd government’s preventative health agenda. The Rudd government is committed to working in partnership with government and non-government organisations to refocus programs that will address rising rates of notification of HIV and AIDS. This will be done by strengthening the health system’s focus on preventative health, partnering with governments, researchers, clinicians and other community groups and undertaking an evaluation and review of the national HIV-AIDS strategy by the end of this year.

The Rudd government will respond to this review. The Rudd government understands that more emphasis needs to be placed on prevention. There is no silver bullet to cure HIV-AIDS—I wish there were—but health promotion which supports people in changing their behaviour is one of the most effective tools. I commend the member for Riverina for her contribution. She is a champion of this cause and I thank her very much for representing Australia so well. I look forward to her future contribution internationally on behalf of our country.

Kevin Andrews (Menzies, Liberal Party) Share this | Link to this | Hansard source

Order! The time allotted for this debate has expired. The debate is adjourned and the resumption of the debate will be made an order of the day for the next sitting.