Decades after Grim Reaper, HIV/AIDS diagnosis is grim

AIDS Day is an initiative to remember the dead, to keep sunshine on the risk of infection and to support people living with HIV.

It sounds like a nice message of unity and collaboration. But it belies the reality.

An Australian coalition of AIDS organisations and others conceded in a July 2012 report that things are grim:

“The HIV partnership has been undermined by lack of certainty, limited investment, ineffective communication mechanisms and poor leadership.” It is uncertain.

Two years ago, high profile gay rights campaigner Gary Burns attacked the AIDS Council Of New South Wales (ACON).

He wanted it “demolished” for failing the community and wasting millions on wages and administration costs.

Premier Newman did his best to demolish the Queensland equivalent, gutting the Healthy Communities program of funding in his first 100 days and bringing HIV/AIDS prevention to the desk of his health minister.

In the late ‘80s journalist Randy Shilts penned a book And the Band Played On, chronicling the infighting, ego and politics during the initial discovery and spread of HIV. It’s 30 years on and his book is still hauntingly relevant here in Australia.

Take the polar opposite approaches of the campaigns of Queensland and New South Wales.

The northerners have a government run campaign, which in a paternalistic and preachy kind of way says “we shouldn’t be making this ad”.

Words like “shouldn’t” have been chosen to scold the players in HIV prevention for not doing enough. This is despite Queensland outperforming other states with over 8 per cent reduction in HIV infection for nearly two full years.

The ad also reprised the Grim Reaper, which was seen as being out of touch with today’s reality. The print advertisements that accompanied this campaign featured pretty coloured condoms but steered clear of any controversial messaging. The sexual health page on the Queensland government website only has heterosexual images.

Conversely in recent months ACON has gone down the path of a “Know Your Risk” approach which gets into the nitty gritty of who puts what, where. It isvery graphic.

This campaign is designed to help at risk people to make informed decisions. It also has its critics for straying from a strict prevention message of wearing a condom.

What is agreed is that ad campaigns are only a minor part of the total solution.

There is a hidden statistic too. According to the July 2012 comprehensive report by a coalition of AIDS Councils, sex workers and others, over 25 per cent of people infected with HIV do so from heterosexual contact. So this isn’t just a gay thing, but a community thing.

This is where things get rocky. The World Health Organisation promotes community led solutions to health problems. While not insisting, the WHO endorses impacted stakeholders take charge to manage the problem, as they are closest to it. This is known as being peer led.

The Queensland government’s intervention into HIV/AIDS prevention is not peer led. It has sent a shudder through other AIDS councils and community health groups.

Community health messaging needs to talk candidly to the people affected in a variety of ways, and it goes way deeper than advertising alone.

Once a government gets involved, they are at the hands of their constituents and their lobbyists. The super sanitised messaging out of the Queensland health minister’s office seems to play to that fear.

Conversely some AIDS councils are considered fat and wealthy. They get a bucket of cash from the taxpayer and then spend it on initiatives that can embarrass a government by their graphic content or by going off message into new areas.

HIV/AIDS is not likely to be an avenue for corporate sponsorship. It is hard to imagine a re-badged bottle of water like the pink breast cancer campaigns have executed so effectively.

One director of an AIDS council described it by saying “We are icky people. Who’s going to sponsor us?”.

This leaves the support of these groups in the hands of the government. If they don’t throw adequate resources to it, they will pay the price in increased health costs and social welfare.

Alternatively by following the WHO advice and outsourcing the response to peer led community groups, the government are no longer in control of the message.

If the peer led group goes off the reservation or embarrass the government, they are opening themselves up for flack from its constituents – making it a political problem.

This lack of cohesion is both understandable and unacceptable as people’s lives and quality of life are on the line.

AIDS Councils need to be able to show why their methods are successful and that they are spending your money wisely.

Governments need to avoid the temptation of making HIV/AIDS a political plaything. 30 years on and the band still plays on.

Follow Miles on Twitter: @mileshef

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