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Thursday, 2 April 1987
Page: 1929


Dr BLEWETT (Minister for Health) —by leave-Two years ago I warned the House that acquired immune deficiency syndrome `is potentially one of the most serious and expensive public health problems to face Australia since Federation'. Events in the two years since have merely confirmed that warning. Around the world as of 13 February there have been over 40,600 reported cases of full acquired immune deficiency syndrome. I seek leave to incorporate in Hansard a table showing an international analysis of AIDS cases.

Leave granted.

The table read as follows-

ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)

Global data

Table 1.

AIDS cases reported to WHO, by country, as of

11 February 1987

Country/Area

Date of

report

Number

of cases

Anguilla...

30.06.86

. .

Antigua and Barbuda...

31.12.85

. .

Argentina...

31.01.87

69

Australia...

22.01.87

382

Austria...

31.12.86

54

Bahamas...

30.06.86

68

Bangladesh...

31.12.86

. .

Barbados...

30.06.86

4

Belgium...

31.12.86

207

Belize...

31.12.85

. .

Benin...

13.11.86

2

Bermuda...

30.06.86

42

Bhutan...

31.12.86

. .

Bolivia...

30.06.86

1

Botswana...

26.09.86

6

British Virgin Islands...

31.12.85

. .

Brazil...

31.12.86

1 012

Bulgaria...

30.06.86

. .

Burkina Faso...

13.11.86

. .

Burma...

31.12.86

. .

Cameroon...

13.11.86

21

Canada...

31.01.87

809

Cayman Islands...

30.06.86

. .

Central African Republic...

13.11.86

202

Chad...

13.11.86

1

Chile...

30.06.86

12

China...

03.11.86

1

China (Province of Taiwan)...

26.01.86

1

Colombia...

31.12.85

5

Comoros...

13.11.86

. .

Congo...

13.11.86

250

Costa Rica...

30.06.86

12

Cote d'Ivoire...

13.11.86

118

Cuba...

30.06.86

1

Cyprus...

08.10.86

1

Czechoslovakia...

31.12.86

6

Denmark...

01.01.87

131

Dominica...

31.12.85

. .

Dominican Republic...

08.12.86

127

Eastern Mediterranean Region...

31.10.86

16

Ecuador...

30.06.86

7

El Salvador...

30.06.86

2

Ethiopia...

13.11.86

. .

Finland...

30.09.86

14

France...

31.12.86

1 253

French Guiana...

31.12.85

31

Gabon...

13.11.86

. .

Gambia...

13.11.86

. .

Germany, Federal Republic of...

31.01.87

875

German Democratic Republic...

31.12.86

1

Ghana...

13.11.86

73

Greece...

31.12.86

35

Grenada...

31.12.85

2

Guadeloupe...

31.12.85

16

Guatemala...

30.09.86

10

Guinea...

13.11.86

. .

Guinea Bissau...

13.11.86

. .

Guyana...

31.12.85

. .

Haiti...

30.11.86

785

Honduras...

30.06.86

6

Hong Kong...

03.11.86

3

Hungary...

31.12.86

1

Iceland...

31.12.86

4

India...

31.12.86

5

Indonesia...

31.12.86

. .

Ireland...

31.12.86

14

Israel...

31.12.86

34

Italy...

31.12.86

460

Jamaica...

30.06.86

5

Japan...

19.12.86

25

Kenya...

13.11.86

109

Lesotho...

13.11.86

1

Liberia...

13.11.86

. .

Luxembourg...

31.12.86

6

Madagascar...

13.11.86

. .

Malawi...

13.11.86

13

Maldives...

31.12.86

. .

Malta...

31.12.86

5

Martinique...

31.12.85

6

Mauritania...

13.11.86

. .

Mauritius...

13.11.86

. .

Mexico...

08.12.86

249

Montserrat...

31.12.85

. .

Mozambique...

31.12.86

1

Nepal...

31.12.86

. .

Netherlands...

31.12.86

218

New Zealand...

03.11.86

22

Nicaragua...

31.12.85

. .

Nigeria...

13.11.86

. .

Norway...

31.12.86

35

Panama...

30.06.86

9

Paraguay...

31.12.85

. .

Peru...

30.06.86

9

Poland...

31.12.86

1

Portugal...

31.12.86

46

Republic of Korea...

05.06.86

. .

Romania...

31.12.86

2

Saint Christopher and Nevis...

31.12.85

1

Saint Lucia...

30.06.86

10

Saint Vincent and the Grenadines...

30.06.86

3

Senegal...

13.11.86

. .

Seychelles...

13.11.86

. .

Singapore...

04.10.86

1

South Africa...

24.10.86

41

Spain...

19.11.86

242

Sri Lanka...

31.12.86

1

Surinam...

30.06.86

2

Swaziland...

13.11.86

. .

Sweden...

24.01.87

93

Switzerland...

31.12.86

192

Thailand...

31.12.86

6

Togo...

13.11.86

. .

Trinidad and Tobago...

30.06.86

108

Tunisia...

14.05.86

2

Turkey...

25.04.86

2

Turks and Caicos Islands...

30.06.86

. .

Uganda...

13.11.86

766

USSR...

31.12.86

1

United Kingdom...

31.12.86

638

United States of America...

19.01.87

29 536

United Republic of Tanzania...

13.11.86

699

Uruguay...

30.06.86

7

Vanuatu...

30.09.86

. .

Venezuela...

08.12.86

69

Yugoslavia...

31.12.86

8

Zambia...

13.11.86

250

Zimbabwe...

13.11.86

6

Total...

40 638


Dr BLEWETT —Globally some five million people are estimated to be infected with the AIDS virus. In the United States of America there has now been a total of 32,825 cases, with 19,021 deaths. In the United States experts predict that by 1991, only four years hence, there will be a cumulative total of 290,000 cases of AIDS, with approximately 179,000 people dead from the disease.

While in much of North America and Europe cases remain concentrated among high risk groups-homosexuals, intravenous drug users, and haemophiliacs-heterosexual spread seems a major mode of transmission in Africa. Moreover, the number of cases of heterosexual transmission is rising in the United States-from one per cent four years ago to 4 per cent today. The figure is distinctly higher in New York, where the disease is widespread among IV drug users. This confirms the fear that the use of contaminated needles by IV drug users would provide a major pathway by which the disease would spread to the heterosexual community.

In Australia, as of last week, there had been a total of 442 cases of full AIDS, of whom 238 had died. On the best scientific advice available to me in May 1985, I predicted a total of 600 cases by the end of 1986. While this figure has not yet been reached, and there are some encouraging statistics on the decline of venereal diseases in homosexual men in this country, there is no room for complacency. Indeed since the previous statistics on AIDS cases were released in February, there has been an increase of more than one additional case in Australia each day.

Moreover, it is estimated that up to 50,000 Australians, most of them walking around in apparently good health, are in fact carriers of one of the most lethal viruses ever known. Because of the long incubation period this will mean a high level of deaths from AIDS into the 1990s. Not only is the disease spreading at an alarming rate, but also the prognosis for those diagnosed as antibody positive has grown bleaker. A few years ago it was believed that only 5 to 10 per cent of those diagnosed as antibody positive would go on to develop full AIDS.

Last Christmas the World Health Organisation revised this upwards, suggesting a rate of about 25 per cent. A recent American study has put the rate at 36 per cent. Some reports from Europe have put the rate as high as 70 per cent. This constant revision upwards of the rate of conversion from seropositivity to full AIDS strongly suggests our present division of cases into those with antibody positivity (no symptoms) and those with AIDS (symptoms), may be overly artificial. We may well need to adopt the conservative assumption that almost all of those infected by the virus will eventually show clinical symptoms of the disease.

I would remind the House that it is only six short years since the disease was first described in the United States. In that short period it has brought grief and tragedy to many thousands, and struck fear into many millions of people around the world. This is a disease which can reveal itself within six months, or lie dormant in the body for anywhere from six months to at least six years, and maybe more. Unlike measles, or smallpox or cholera, or mumps, there is no way of telling outwardly whether you or anyone else has AIDS.

Unlike these traditional diseases, AIDS is not infectious. It is communicable, through the transmission of body fluids, particularly blood and semen, from one person to another. And the person communicating the infection may well show no sign of the disease.

Not that the efforts of medical science have been in vain. More has been learnt about the virus in a brief half-dozen years than about practically any virus known to man. We know AIDS is caused by a special virus which attacks and disables the body's immune system, rendering it prey to particular opportunistic infections. We know many of the mechanisms whereby the virus disables the immune system. We know that, fortunately, the virus is fragile and outside the body does not survive well. We know it cannot be transmitted through any casual contact, even quite close contact such as social kissing. We know that blood, semen and vaginal secretions are the main agents of transmission. That being so. It is now clear that there are four main ways to get AIDS. Through sexual intercourse; through intravenous drug users sharing needles; through transmission from seropositive mothers to babies; and through contaminated blood and blood products.

Significant advances are being made in treating the disease. There has been considerable progress in the treating of opportunistic infections resulting from AIDS. Many scientists are optimistic that new drugs, like Azidothymidine-AZT-which are now in various stages of trial and development would offer some hope that those already infected by the disease might improve and extend their lives. As yet, however, hopes for a cure or for a vaccine are remote.

In the past three and a half years a major co-operative effort has been mounted by all Australian governments against AIDS. In that time, despite economic stringency, some $50m has been spent by Australian governments on the provision of services, the protection of the blood banks, the provision of information, education and counselling support, particularly for high risk groups, and for AIDS research. I would point out that this $50m is AIDS specific money and does not include the more general costs to hospitals, private insurance and Medicare resulting from AIDS. Much of the expenditure has been cost-shared with the States, although it was the Commonwealth that took the original initiatives. Inevitably, as with all cost-sharing arrangements there have been some differences over priorities and emphases between the Commonwealth and the States. States understandably have a tendency to give priority to services, the Commonwealth gives priority to preventive education as the only effective weapon to contain the disease in the absence of a vaccine or a cure. The scientific community, while emphasising the role of prevention, is often torn in its advice between prevention and the immediate provision of treatment and research facilities. I will be taking proposals to the Health Ministers Conference this month to address these issues.

At the Commonwealth level, the integrity of the blood banks was a first consideration. Donor declarations were introduced to exclude high risk donors as soon as the danger of this transmission route was recognised. The National AIDS Reference Laboratory, which is based at Fairfield Hospital in Melbourne and which is funded by the Federal Government, co-ordinated the evaluation of AIDS antibody screening kits. By May 1985, the Government had arranged purchase and distribution of testing kits to all Red Cross blood transfusion centres and to authorised State and Territory laboratories. This made Australia the first nation in the world to put in place comprehensive blood screening tests. This has virtually eliminated the risk of infection through blood transfusion.

So successful have these actions been, and so high has been the compliance of the at-risk groups, that no blood or blood products used since May 1985 have been associated with the AIDS virus. Unhappily, because of the long incubation period, I expect that there will continue to be a small number of transfusion related cases, dating back to transfusions received prior to the introduction of universal screening. In addition, the Commonwealth Serum Laboratory became one of the first agencies in the world to apply heat treatment to factor VIII to eliminate AIDS contamination.

The availability of a testing kit for antibodies to AIDS, while an enormous advance, has generated controversy all round the world. The Government favours encouraging high risk groups to seek testing, provided such encouragement is done in a rational low key way, preferably in one to one consultations. It is also essential that strict confidentiality is maintained to prevent discrimination in employment, housing and the like and provided there is adequate pre-test and post-test counselling, because of the repercussions for individuals of a positive result. Public pressures for such testing, often accompanied by threats, lead too often to polarisation and may indeed inhibit the participation of high risk groups in such testing. It has been a basic tenet of Commonwealth policy, based on the best available evidence from overseas, that a spirit of co-operation between the Government and the high risk groups is the best way of achieving public health objectives. Most of the States have accepted such a philosophy. The testing results would indicate considerable success for such an approach. For example, it is anticipated that 356,000 tests will be administered outside blood banks this year.

In addition, funds have been provided to the National Reference Laboratory at the Fairfield Hospital, which has now been recognised as the World Health Organisation collaborating centre for this region; to the Commonwealth Scientific and Industrial Research Organisation, on the recommendation of the AIDS Taskforce to develop the manufacture of a possibly useful drug, dideoxycytidine; and to the Commonwealth Serum Laboratories for preliminary development of an Australian test kit.

The drug AZT, which is no cure for AIDS but does appear to have the capacity to prolong life in certain cases, is now undergoing clinical trials in Australia with some 40 patients at the expense of the manufacturer. An offer has now been made by the manufacturer to supply sufficient quantities of AZT to Australia to treat another 200 patients at the cost of $10,000 per patient per year. I have no doubt that AZT will be the first of many such drugs available to treat those with the virus, and it is my concern that governments act responsibly and equitably in relation to this and succeeding generations of drugs. Accordingly, I will suggest an approach to this issue at the Australian Health Ministers Conference this month.

In the States, which have the prime responsibility for providing health services, funding has enabled the establishment and development of a wide range of programs, including educational strategies, laboratory diagnostic services, out- patient services, blood bank screening, coun- selling and nursing. Health, welfare, and education personnel have received special training on the provision of information, counselling and care services in relation to AIDS, while educational material, including videos, booklets and leaflets, along with special tutoring, has been provided for an array of people and organisations which could come into contact with AIDS. This includes doctors, nurses, dentists, health care workers, pharmacists, teachers, drug and alcohol workers and union members.

AIDS information lines have been established, and programs have either begun or are being organised for specific groups within the community, such as homosexuals and bisexuals, youth, Aborigines, members of the ethnic communities, prostitutes, intravenous drug users, and people in isolated areas. AIDS is as serious a health threat to the Aboriginal community as it is to the Australian community at large. I am pleased to note that officers of my own Department, State and Territory health authorities and Aboriginal medical services, working in close consultation with the Department of Aboriginal Affairs, have produced a range of educational and medical services designed to establish effective preventive programs on the ground in local Aboriginal communities.

There has been international appreciation and admiration for the leadership and common sense Australia has shown in its response to AIDS. Because of the work already undertaken, Dr Jonathon Mann, the World Health Organisation Controller of AIDS, has asked Australia to share its expertise in our own geographic region. Accordingly, in July this year, Australia will be hosting a conference of member nations of the World Health Organisation in our region. Twenty-three countries will be invited, including China, Japan, New Zealand and other Pacific and Asian nations, and the aim will be to share knowledge we have gained and produce a common plan of action to combat the spread of AIDS in the region.

From the outset of this scourge the philosophy of this Government has been that recently enunciated by the American Surgeon-General, C. Everett Koop:

We are fighting a disease, not people. . . We must prevent the spread of Aids while at the same time preserving our humanity and intimacy.

High risk groups were our first and immediate concern. Efforts to reach those initially thought as most at risk have yielded results. A good example is female prostitutes. So far, there do not appear to have been any known cases of full AIDS among prostitutes in Australia. The low incidence of antibody positivity in members of this group tested may be partly attributable to an AIDS education program run by the Prostitutes Collective. Over the last two years the Federal and New South Wales governments have jointly funded an education program which is aimed to reach prostitutes both in brothels and on the streets.

The Commonwealth and all States except Queensland are cost-sharing grants to State voluntary AIDS organisations for preventive education and support programs. The AIDS organisations' chief task is to reach specific at-risk groups, particularly homosexual men, and to implement programs aimed at modifying behaviours and practices which transmit the disease. The Australian Federation of AIDS Organisations, which co-ordinates the activities of the State and Territory AIDS organisations, also receives funds for special national preventive education projects. The Haemophilia Foundation of Australia receives funding for support and counselling of haemophiliacs and their families. This group has encountered special problems because of their dependence on blood products used to alleviate their condition.

However, we cannot simply direct our efforts towards a limited number of groups tagged at risk. Experts from around the world are increasingly concluding that today `at risk' is a much wider concept, and that heterosexual AIDS is developing at an increasing rate. It is not what you are, or what group you belong to that matters-it is what you do. You do not need to be a homosexual, haemophiliac, or a drug user to get AIDS. You do not even need to be a heterosexual with many partners. All you need to do is have unprotected intercourse with one person who has the virus.

As yet there have been very few cases of heterosexual transmission in Australia. While anal intercourse may be the surest means of transmitting the disease, there is no doubt that it can be transmitted by vaginal intercourse, and possibly also by oral sex. Moreover, given the incidence of needle sharing by intravenous drug users in Australian society, this provides a further path for spread into the heterosexual population. Some recent magazine articles question whether, in the absence of significant numbers of heterosexually acquired AIDS cases-where there has been no concomitant sharing of needles-there is any real need for a general education program, and argue that we should concentrate simply on programs directed at the high risk groups.

It is true that there are very few cases of heterosexually acquired AIDS in Australia. But that should be a challenge, not an inhibition. I am not aware of any public health official or medical scientist who takes in any way seriously the proposition that the virus will not spread among the heterosexual population. On the public health side it would be bordering on the irresponsible to ignore objective facts and not undertake a full and frank public education program.

Actions have already been taken to alert the wider community to the hazards of AIDS; for example the insert in the Readers Digest, by the National Advisory Committee on AIDS, which was estimated to have had 1.7 million readers, and 700,000 reprints have been distributed. AIDS material for students in the recently published `Your Body-Just the Facts' has also been highly praised. From 5 April there will be a more broadly-based public education campaign to encourage awareness of AIDS and the steps that can be taken to contain its spread. Planning for this campaign has been under way for the past five months.

In preparation for the campaign a comprehensive program of research has been conducted to assess the knowledge level and risk patterns of the Australian population. In all States and Territories, in rural and urban environments, 1,703 Australians were surveyed, and in addition smaller surveys were conducted among adolescents, IV drug users, homosexual and bisexual men. Overwhelmingly, most Australians thought that AIDS was someone else's problem, that it did not affect them or their friends.

First, the knowledge level; the survey asked respondents simple questions-on methods of catching the virus, the spread of the virus outside high risk groups and methods of risk reduction. Only 17 per cent of those surveyed were able to answer all questions correctly. Of the 16-60 age group, 91 per cent considered AIDS was transmitted by homosexual activity and 42 per cent correctly identified IV drug use as a high risk activity. There was a general tendency to see AIDS as a threat simply to homosexuals and drug users. Moreover, 36 per cent of those surveyed were misinformed in thinking that AIDS could be transmitted by casual contact including handshaking, hugging and sharing food. In each of the knowledge questions, there was, worryingly, a large number of `don't knows'.

Second, an examination of risk patterns; `Risk behaviour' was defined in the survey as any one of the following behaviours. Has anal sex; has used a prostitute; has used IV drugs; has multiple sex partners and has not, on each occasion, used a condom.

Of men and women aged 16-24 years, 36 per cent were found to have engaged in high risk behaviour, and for those aged 25-34 years, the figure was 33 per cent. Of the total population, 21 per cent were involved in high risk behaviour, and nearly half of that 21 per cent were either in married or in de facto relationship. These findings underlie our public education campaign.

It is clear that the level of knowledge in this nation about the AIDS virus and its implications is still low, and a national campaign needs to urgently redress this situation. The public awareness component of the campaign, which will be seen on Sunday and thereafter, will not please all Australians-that is not the purpose. The purpose of the campaign is to alert Australians to the risk posed by the virus to each of them.

The market research material runs to nine volumes. I have identified just a few highlights for honourable members. The national information campaign is based on market research identifying the level of Australian knowledge and risk practices, and on evidence available to us around the world on the increasing level of heterosexual spread. The campaign is designed to reach every member of the Australian community, and to alert us all to the relevance of AIDS to ourselves, our families and our friends.

The Government has allocated $2m to this media phase of the campaign so that messages will reach people through television, radio, newspapers and magazines. In addition, we will distribute a pamphlet which answers in more detail many of the most common messages asked about AIDS. The pamphlet will be widely available through pharmacies, doctors, surgeries, Medicare offices and other Federal Government agencies. In addition, the National Advisory Committee on AIDS has produced a pamphlet specifically for young people which will be distributed to all Education Departments this week. A further pamphlet, in sixteen community languages, will be distributed through relevant community organisations and government agencies. As well, State governments, community organisations and AIDS councils have produced written and audio-visual material which will supplement and assist the national campaign. The 60-second television commercial is designed to alert all Australians, and to encourage them to seek the information which will be available in national newspapers and the pamphlets. The radio advertisements are primarily directed towards adolescents, and the magazine advertisements are framed to reach a specific readership.

There is no doubt, and indeed it is my expectation, that the campaign will increase the demand for knowledge about AIDS. Accordingly, I have set aside over $500,000 for expected increases in requests for counselling and testing. The Commonwealth has set up phone information lines in States and Territories, and has negotiated with the States to upgrade and train counsellors, and extend their testing facilities. Doctors and pharmacists have received a letter providing information about AIDS and the campaign from the president of their respective professional associations, jointly signed by Miss Ita Buttrose. In addition there have been special briefings of religious leaders, editors of newspapers, appropriate people in the electronic media, the Australian Council of Trade Unions and leaders of Federal political parties on the necessity for the campaign.

My first duty, as Commonwealth Health Minister, is to alert the people of Australia to the disease that is among us. There is no cure and no vaccine. The best, though not a perfect preventive measure after abstinence or a single safe sex partner, is the use of a condom. We have an inescapable duty to provide this advice. The prime purpose of the campaign has been to promote safe sex among those who are sexually active-not to promote condoms for their own sake. There is absolutely no point in telling people about possible defences against the virus when they still believe that the virus only attacks homosexuals and intravenous drug users. Rather the aim is to increase the understanding of all Australians of the hazards of AIDS. The Government will also make every effort to ensure that whatever new information comes to hand on medical or scientific advances is disseminated as quickly and as widely as possible. The hope of a vaccine or a cure is uppermost in everyone's mind. In the meantime, as the American Surgeon General summed it up: ``Information is the only vaccine we have''. That is why the Government asks every Australian to take the greatest heed of the messages of the national education campaign. In what they do, they are not only taking responsibility for their own life and health, but are involving themselves in the life and health of the entire community.

All Australians have the responsibility to improve their knowledge about AIDS. Community leaders, members of parliament, the medical profession, the clergy and the media have a particular responsibility to seek and dispense information which will contain the disease.

Finally, AIDS is not just a health problem. Its impact ranges far beyond the confines of health. The facts are that up to $50,000 per patient from diagnosis to death means approximately a further $150m to hospital costs for 1990. It will impose other costs on our social security, community services, and housing portfolios spreading the economic effects wider. There are further social costs in that AIDS kills mainly young people at the outset of their productive lives and this further extends the economic costs. Relations with other countries will be affected by reaction to AIDS as will tourist, immigration and aid programs. It will have profound effects on social values, lifestyles and societal cohesion. It is a challenge not just for health portfolios, not just for governments, but for the whole Australian community.

I wish to publicly express my support and appreciation for the work of Miss Ita Buttrose, the Chairwoman of the National Advisory Committee on AIDS. She has had the responsibility for advising the Government on the national AIDS program, itself an enormous and very demanding task. In addition Miss Buttrose and her committees have provided advice on the complex and sensitive social, legal and service aspects of AIDS.

Professor David Penington has advised me that he has been appointed Vice-Chancellor of the University of Melbourne, and therefore will relinquish the chairmanship of the AIDS Taskforce. I congratulate him on his appointment and thank him for his dedication and advice on AIDS over the years. I take this opportunity to thank all those on the taskforce and NACAIDS, and indeed all those Australians who have joined in the fight against AIDS and in the support of those afflicted with the disease. Their dedication reminds us that the victims of AIDS are our fellow men and women, our fellow Australians, whatever their sexual preference. It is the duty of governments and the community to make all efforts to eradicate this disease, and as a community to succour and support its victims.