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Thursday, 2 April 1987
Page: 1705

Senator PUPLICK(11.35) —The ministerial statement on AIDS presented today tells us that some 442 Australians have been diagnosed as having so-called AIDS and that some 238 of those AIDS patients have died. I have said in the Senate in the past that a couple of those people were personally known to me. I have had the experience on a number of occasions of going to St Vincent's Hospital to see a friend dying of AIDS who, indeed, eventually did die of AIDS. Like any terminal disease, it is a sad, terrible thing not just for the person who is dying but for those who have any degree of affection for that person-those who are friends, those who are carers, those who are family and those who are relatives.

Every day in Australia somebody now either dies of AIDS or receives the news from the doctor which that person regards as, to all intents and purposes, a potential death sentence. Such people are told that they are antibody positive, and we know that the percentage of those who are diagnosed as antibody positive and then go on to develop full-blown AIDS appears to increase every time we read new scientific details. There is an article in the 5 March issue of the New Scientist entitled: `AIDS and the experts', which simply serves to draw our attention to the fact that in the early days we were told quite different things about AIDS from what we are now being told as a result of the increasing research. For instance, in March 1985, the New Scientist carried articles saying that only 10 per cent of those were likely to get AIDS. The article goes on to say that:

More recently estimates as high as 100 per cent have been proposed and supported by many virologists.

Despite the fact that among the high risk groups in the community there is indeed a greater awareness of the problems and difficulties associated with unsafe sexual practice, anybody who comes to Sydney should avail himself of the opportunity to undertake a most sobering experience; that is, to go up to St Vincent's Hospital on a Friday or Saturday night. There, within the shadows of the wards of the hospital in which a large number of people are dying, they will see a part of the city of Sydney known as the Wall. They will see the young male prostitutes along the Wall offering their services primarily to support their drug habits. I have had the opportunity to spend a couple of evenings with the mobile clinic bus which the Albion Street clinic operates there. Young men and women are encouraged to come to that facility to have blood taken, which is subsequently tested and they are given the results. People come there to receive free condoms, which have been supplied by the New South Wales health authorities, and to receive information in pamphlets about AIDS-about its spread, about its deadliness-and about the use of dirty needles in support of the habit which, by and large, has driven them to the wall.

Let me tell you, Mr Deputy President, of probably the most frightening single experience that I have ever had, when talking to one of the young men there. He was 15 or 16 years of age and working as a male prostitute. He was an intravenous drug user. He had a younger brother aged 14 who was also an IV drug user. The elder brother was working under those circumstances in order to raise the money to keep his brother's habit going long enough for his brother to reach the age of 15, when he would be able to get him into a New South Wales methadone program which is not available to those under the age of 15-that is, if the elder brother lives so long.

Until one starts to look at the human dimension of this issue, one fails to appreciate that this is not just a public health problem, although it is primarily a public health problem; it is a problem about which individuals and individual members of parliament need to be concerned. Unless we display the degree of compassion which is necessary to address this subject and if we address it in an entirely clinical, in an entirely moralistic, or in an entirely public health dimension, we will miss an important part of what the debate should be about.

I have some concerns about the efficacy of public education campaigns per se-no matter what message it is that they are trying to get across. We have been running public health campaigns against smoking for 15 or 20 years and have hardly seen any evidence of the effectiveness of those campaigns in preventing, particularly, young girls from starting to smoke.

Senator Peter Baume —They have never been funded as well as this campaign.

Senator PUPLICK —Senator Peter Baume is entirely correct. They have never been as well funded as this campaign. The reasons relate entirely to the attempts to protect the financial position of the tobacco industry in Australia. If one wants to deal with the question of subsidisation, it probably constitutes the greatest subsidisation of an attack upon public health that has ever occurred in this country.

What I want to do, however, is to indicate one or two things which I think we now need to look beyond. As I said, I believe the public education campaign needs to be as broadly based as possible. I had the opportunity only a few months ago to spend some time with the Department of Health and Social Security in the United Kingdom. I looked at its anti-AIDS campaign and the advertisements which it has been placing in the newspapers and which can now be seen in the underground railway stations and on billboards throughout London and the United Kingdom. The central message of them, which is an interesting and important one, is the slogan: `Don't die of ignorance'. I think it is very important to realise that it is a question of understanding what is the cause of the spread of the AIDS disease. To that extent may I say that Senator Harradine is perfectly correct that the primary cause of the spread of the disease is promiscuous sexual behaviour.

The fundamental question to be addressed is: Can public education campaigns prevent people from being promiscuous? To a certain, although I suspect only limited, extent they can, but they can only do that by frightening people. They can only do that by making it clear, as one of the British advertisements states: `Your next sexual partner could be that very special person. The one that gives you AIDS'. One of the other British advertisements states: `You know what's in his mind. But how can you tell what's in his blood?'. One can only address the issue of promiscuity by frightening people. If, however, one believes that those campaigns will not be effective in preventing promiscuous behaviour, one has to deal with the question of those who will not abstain from such sexual behaviour and one has to focus on the campaign for the use of condoms which, as has been indicated, is the third element of the Government's campaign.

I want to mention, therefore, the other matters which I think we will need to address as time goes on. The first and most important of them is: Will we find the money to provide the hospice and domiciliary care which will be necessary to allow people who are dying of AIDS to die with some human dignity? Will we be prepared to look at the very substantial sums of money which will be necessary to fund hostel, hospice and domestic accommodation for people who need to be looked after once they are suffering the end stage of the AIDS disease? That will be enormously expensive and will need to be addressed and the money found. Secondly, will we look at the social security system? Will we say, quite clearly, that a person who cares for an AIDS patient is entitled to the support of a carer's benefit, regardless of the nature of his or her relationship with that affected individual, and not make the judgment that the carer's pension will be paid to the AIDS carer if that happens to be the patient's mother, brother, sister or wife, but it will be denied if the person happens to be his or her gay lover? It would be an outrage of the most monumental kind to make that sort of judgment when the only threshold test legitimately to be applied is whether the person is in a genuine caring relationship with the person who is suffering. An article by Stephen Kirby in the latest issue of the gay newspaper Outrage makes this point very clearly. He stated:

The Carer's Pension issue represents a rare case where it is possible to make a decision that will at once benefit people in need, help them conduct their lives with dignity and save the government money.

I believe that it will be possible for that to be done. The next point is: How will we avoid making any contribution to some sort of political, social or legal backlash against gay men and women in the community as a result of trying to indicate to them that there is some degree of enormous social disapproval based upon the issue of their sexuality? Professor Penington is reported to have said, in a Westpac symposium address, that Australia could `no longer afford the luxury of permitting the defence of homosexual rights or the ``moral right wing'' to frustrate more stringent controls to help stop the spread of the AIDS virus'.

I say with respect to my friend Senator Sheil that I have also read the reports about `revenge' spreading of the disease. I have not seen one single piece of evidence. Recent articles in journals such as Time magazine have referred to the enormous tragedy of the upsurge of bashings of gay men in London. In Sydney there has been an increased degree of violence against gay men in Oxford Street and elsewhere. People have been murdered and recently a young gay man doing no-one any harm was viciously kicked to death in Oxford Street. He died simply because a gang of disgusting yobboes said `He's a poofter; therefore there's nothing really wrong with beating him up'-or, in this instance, kicking him to death. We cannot afford to allow the balance to get out of kilter between protecting people's rights to be homosexual, overtly so if they choose, and their responsibilities to behave in a way that does not constitute a physical threat to other people in society. We have been through this in New South Wales with the appalling attempts of the New South Wales Labor Government to compel the disclosure of names of people by the health authorities in a way the net effect of which was to prevent people going for testing to find out whether they were antibody positive. Again that is a matter of balance.

I agree with Senator Sheil and Senator Harradine about the increasing availability of testing facilities, particularly for pregnant women and for those who might be innocently at risk of at some stage needing blood transfusions, or whatever it happens to be. We cannot then also turn a blind eye to what has happened in the private blood bank arrangements in New South Wales. We cannot turn a blind eye to the way in which people are attempting to make enormous amounts of money out of the current AIDS crisis. There is in the 20 March issue of the journal Science an article headed `Imminent marketing of AZT raises problems'. We know that AZT, the new drug azidothymidine which Burroughs Wellcome has developed and is marketing and which has now been approved for use in the United Kingdom, France and Norway, will provide some real problems for the public health authorities as to its cost and the way in which clinical trials have been done. We have been through this with the use of isoprinosine and it will be a question of what the Government and the community are prepared to do to provide the necessary funds for both adequate research and development. There are some encouraging signs about the potential slowdown in the rate of AIDS although I read them sceptically. In `Research News' in the journal Science of 20 March a couple of authors published a paper entitled `Mathematical model predicts AIDS spread', which perhaps put into some perspective the fact that the nature of the pandemic may not get to the stage predicted. The report says:

Among their conclusions are that it is by no means clear that the AIDS epidemic will be the Black Death of our age. AIDS may die out naturally.

It may or it may not. Who is in a position to tell? I do not think any of us know at this stage. We must battle on as best we can in the circumstances. The Minister for Health, Dr Blewett, is to be congratulated on having faced up to what politically is an extremely sensitive and delicate-almost a no-win situation.

Senator Durack made it clear that the Opposition has given its total, full and complete support to Dr Blewett in this campaign. Senator Grimes, who is in the chamber at the moment, was actively and very positively involved when he was Minister for Community Services in attempting to grapple with the hospitalisation, hospice and medical services costs involved. On this side of the political spectrum, the shadow Minister for Health, Mr Porter, Senator Peter Baume, when he was a shadow Minister, and the other members, such as Senator Sheil and myself, who are members of the Parliamentary Liaison Committee on AIDS have attempted to play our part in bringing forward some advice and assistance for the Government in developing its campaign. I believe that we have been treated well by the Minister in involvement in discussions, the provision of information and the input to the national campaign on AIDS.

Acquired immune deficiency syndrome has a psychological dimension in the mind of Australians that needs to be addressed. Adam Carr, the President of the Victorian AIDS Council, in a recent article entitled `AIDS in the mind of Australians' makes that quite clear. Although there has to be a judgmental section of this campaign-on the question of promiscuity per se-there also needs to be an element in the campaign which focuses clearly upon its public health dimension for gay people and others alike. I regret that not all my Queensland parliamentary colleagues are here in the chamber today because one of the things I would say to them is this. If there is anything that they can usefully achieve, it would be to turn around the mind of the Queensland Government about its non-participation and non-co-operation in some of the campaigns which are under way. It is not a matter of the Queensland Government saying that it will not participate because it will not do anything to give approval to homosexuality. It is a matter of whether the Queensland Government is prepared to allow people to die quite unnecessarily by the Government not participating in those campaigns.

I believe that most people who have been associated with this campaign have attempted to do everything possible to ameliorate the terrible effects of AIDS. The Archbishop of Canterbury in the United Kingdom has lent his considerable prestige and weight to the campaign in that country. I was in the United Kingdom at the time when he gave an address to health workers in the British hospital system, imploring them to regard this as a public health matter and to respond as true Christians. I pay tribute to the South Australian Government for having taken some independent activity of its own to launch an education campaign.

I conclude with one brief comment about education. In the 22 January issue of the journal Nature there are some criticisms made of the American approach by a representative of the Education Secretary, William Bennett, who criticised the United States Public Health Service for having what he called a `morally empty' approach to educational programs on AIDS. I agree with that. There is a considerable moral dimension to this and I hope that in the campaign the moral issue-the moral issue of promiscuity not the moral issue of homosexuality-is properly addressed. We shall have to look at the expenditure of large sums of money especially for local research. We shall have to be courageous enough to agree to a needle exchange program nationally. When one sees the Royal Australian College of General Practitioners and the Royal Australasian College of Physicians, two of the most conservative medical groups in the country, clearly indicating that they will support a Government-backed campaign for the greater availability of clean needles and syringes, as do the professional pharmacy bodies, I find that a very encouraging and positive response on their part.

We shall have to deal with the question of hospice accommodation and with the question of the carer's pension. We shall have to deal with the genuine protection of the civil liberties of gay men and women throughout Australia who behave responsibly. We shall have to deal with the political pressures on government to use the legal system in a way that will have the effect of reducing people's willingness to be tested and to co-operate with the public health authorities. We shall have to deal with education systems. We shall have to realise that it is no longer possible to argue that sex education will be a matter entirely divorced from the formal education system and from the school system and from public debate. We shall have to make sure that all the governments of Australia, all the political forces, are for once prepared to make something of a national effort, stressing abstinence, monogamous relationships and the use of condoms, when those first two options are no longer being taken by people in the way in which they should. So far I think it has set an excellent example. The Minister's statement was excellent; Senator Durack's response was excellent.

Some of us have been through the process of watching friends die of AIDS-this statement comes too late for them. We must make sure that it does not come too late for any other Australian.

Question resolved in the affirmative.