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Monday, 26 May 2003
Page: 14924


Dr SOUTHCOTT (6:18 PM) —I rise to speak in this grievance debate of a national health campaign that has been fairly successful but, in its success, I fear that there is now a sense of complacency emerging within our community about the risk to the health of many Australians. I speak of the issue of HIV-AIDS and also the National HIV-AIDS Strategy, which I think has been one of the most successful public health initiatives in Australia in recent times. I did not agree with a lot of the actions of former Minister for Health Dr Blewett, but the National HIV-AIDS Strategy, which was bipartisan, has been a very successful public health initiative which was also seen around the world as a very coordinated and strong response to the issue of HIV-AIDS.

Looking at AIDS in Australia at the moment, we see that the number of full-blown AIDS diagnoses each year has fallen from about 950 in 1984 to 178 in 2001, while the number of HIV diagnoses has remained the same—at about 700 per year for the last five years. The introduction of the newer generation of antiretroviral drugs has led to a substantial fall in AIDS diagnoses and an increase in survival rates. In 1994 the survival rate for people with AIDS was 19½ months. For people who were diagnosed with HIV in 1997, survival had increased to 46.6 months. By the end of 2001 there were 18,854 Australians with HIV and 12,730 of these with HIV-AIDS.

However, despite the success of this strategy, new cases are still occurring. In the year 2000 there were 655 additional cases of HIV diagnosed, and in 2001, 697. In the year 2000 we saw a dramatic increase in the number of new diagnoses in Victoria, and transmission still remains predominantly—about 78 per cent—through homosexual contact between men. However, over 10 per cent of new cases were through heterosexual contact, another 4.5 per cent were intravenous drug users and another four per cent had both homosexual contact and IV drug use. Comparing Indigenous and non-Indigenous Australians, the rate of infection is similar but, significantly, while infection rates have been falling in the general population, they have remained steady in the Indigenous population. HIV diagnosis remains highest in New South Wales. Figures for the last five years show that New South Wales recorded 6.1 new cases per 100,000 people, with Victoria, the Northern Territory and Queensland about half that and the ACT, Western Australia and South Australia about a third of the New South Wales rate.

As I said, the National HIV-AIDS Strategy was a bipartisan strategy. It was first released in 1989. Its two main goals were to eliminate the transmission of HIV and to minimise the personal and social effects of HIV infection. It aimed to do this through proven population interventions targeted to priority areas and at-risk groups. It has been the result of coordination between federal and state governments, researchers, educators and the community. The strategy has been promoted through development of and access to new treatments; providing at-risk groups with prevention information, means of prevention and health promotion programs; making sure that the skills of health care workers are up to scratch in dealing with people with HIV-AIDS; increasing the awareness of HIV-AIDS amongst the general population; the development of sound research; and also appropriate health care for those with HIV-AIDS.

The challenges now are to ensure that we continue to have a national coordinated response to HIV-AIDS and also to maintain the safe sex culture amongst homosexual men. There are certainly indications that there is a degree of complacency there. We also need to improve the sexual health of Indigenous Australians, as well as their more general health, and we need to ensure that those who do have AIDS are able to receive appropriate care and a continuum of care.

For the last five years in education, there has been a move away from general education to focusing specifically on target groups: groups which are seen as being high at-risk groups. While much has been done to reduce the incidence of HIV-AIDS in Australia, we now face a new risk, which is complacency. A report by the National Centre in HIV Social Research has highlighted this risk. It states that there is a whole generation of younger gay, homosexually active men who were not part of, or directly affected by, the HIV-AIDS crisis of the 1980s and early 1990s. Another risk is what is known as treatment optimism. The increase in knowledge about the newer generation of antiretroviral drugs is also leading to dangerous practices in these groups. This is creating new challenges for HIV educators. The challenge is to make education more effective in the face of increasing evidence of unsafe sex amongst the high-risk groups. Broadly, in Australia we can say that the rates when we compare Australia with most other countries of the region are remarkably low. The rates in Australia are also very low compared with most other developed countries. But internationally we see that there are 42 million people with HIV-AIDS; 95 per cent of the infections in the world are occurring in developing countries and 7.2 million in the Asia-Pacific region. Last year alone there were five million new infections. I am indebted to the AusAID web site for some of these figures.

There is an issue with antiretroviral drugs, which has come to prominence in recent years. The issue, more broadly, is that if you have these drugs, which increase life expectancy, perhaps reduce transmission and so on, why not use them? The cost is coming down. The government's response has been quite sensible, which is to say that the government is happy to help developing countries gain access to these drugs as long as they ensure appropriate intellectual property rights. They could be quite useful in areas such as preventing transmission from a mother to a baby and infection after exposure, and also in establishing protocols for antiretroviral therapies and treatment of opportunistic infections. The problem is that in some countries there is not the infrastructure to make sure that these drugs are widely available and used appropriately without resistance occurring. However, in middle-income countries such as Brazil and Thailand, the new antiretroviral drugs have been used quite effectively.

Internationally, we often get criticised by ACFOA and other groups about how much of our economy we contribute to overseas aid but our overseas aid in the area of health is directed appropriately very much towards primary health care. We have a focus on the Asia-Pacific region and the countries of southern and eastern Africa. Australia supports the work of UNAIDS. In November 2000, I was lucky enough to visit India and see the work of UNAIDS in New Delhi and Chennai. HIV-AIDS in India is a major public health issue. In contrast to the experience we have had in Australia, the epidemic has spread rapidly and unpredictably. In a similar way to Thailand, HIV-AIDS has spread from high-risk groups such as sex workers and IV drug users to their clients or partners and then to the general population. In 2000, there were more than 3½ million people infected with HIV in India. The number is now estimated to be over four million. HIV was once concentrated in certain provinces but has now spread much more widely across India. In a similar way to Africa, the spread has been facilitated by long-distance truck drivers.

It was clear, on visiting India three years ago, that the country was losing the battle against the spread of the virus. In 2000, India spent just $60 million to contain HIV-AIDS—in a country of over one billion people. At that time, we also visited Chennai, where Dr Suniti Solomon diagnosed the first case in India. Chennai has one of the few tertiary care centres in India. It was built with the assistance of the Australian Community Assistance Scheme administered by the Australian High Commissioner in India.

Two years ago, I was fortunate to visit the Indonesian HIV-AIDS and STD prevention and care project, which was funded by the Indonesian government and AusAID. The project's focus was to support research on the incidence of HIV-AIDS and STDs in selected regions such as Bali, West Timor and South Sulawesi, and also to educate, support and care for those most at risk. I want to commend the architects of the National HIV-AIDS Strategy and also the work of AusAID in relation to HIV-AIDS. (Time expired)